VA Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, PA, USA.
Addict Sci Clin Pract. 2013 Nov 4;8(1):18. doi: 10.1186/1940-0640-8-18.
Increasingly, patients with unhealthy alcohol and other drug use are being seen in primary care and other non-specialty addiction settings. Primary care providers are well positioned to screen, assess, and treat patients with alcohol and other drug use because this use, and substance use disorders, may contribute to a host of medical and mental health harms. We sought to identify and examine important recent advances in addiction medicine in the medical literature that have implications for the care of patients in primary care or other generalist settings. To accomplish this aim, we selected articles in the field of addiction medicine, critically appraised and summarized the manuscripts, and highlighted their implications for generalist practice. During an initial review, we identified articles through an electronic Medline search (limited to human studies and in English) using search terms for alcohol and other drugs of abuse published from January 2010 to January 2012. After this initial review, we searched for other literature in web-based or journal resources for potential articles of interest. From the list of articles identified in these initial reviews, each of the six authors independently selected articles for more intensive review and identified the ones they found to have a potential impact on generalist practice. The identified articles were then ranked by the number of authors who selected each article. Through a consensus process over 4 meetings, the authors reached agreement on the articles with implications for practice for generalist clinicians that warranted inclusion for discussion. The authors then grouped the articles into five categories: 1) screening and brief interventions in outpatient settings, 2) identification and management of substance use among inpatients, 3) medical complications of substance use, 4) use of pharmacotherapy for addiction treatment in primary care and its complications, and 5) integration of addiction treatment and medical care. The authors discuss each selected articles' merits, limitations, conclusions, and implication to advancing addiction screening, assessment, and treatment of addiction in generalist physician practice environments.
越来越多有不健康饮酒和其他药物使用问题的患者出现在初级保健和其他非专业戒毒场所。初级保健提供者处于有利位置，可以对有酒精和其他药物使用问题的患者进行筛查、评估和治疗，因为这些使用问题和物质使用障碍可能导致许多医疗和心理健康伤害。我们试图在医学文献中确定并研究与初级保健或其他通科医生环境中患者护理相关的、成瘾医学领域的一些重要的最新进展。为了实现这一目标，我们选择了成瘾医学领域的文章，对这些文章进行批判性评估并总结，突出它们对通科医生实践的意义。在最初的审查中，我们通过电子 Medline 搜索（仅限于人类研究和英文）使用 2010 年 1 月至 2012 年 1 月期间发表的酒精和其他滥用药物的搜索词来确定文章。在最初的审查之后，我们在网络或期刊资源中搜索其他文献，以确定可能感兴趣的文章。从这些初步审查中确定的文章列表中，每位作者独立选择了一些需要更深入审查的文章，并确定了他们认为对通科医生实践有潜在影响的文章。然后，根据有多少作者选择了每篇文章对这些文章进行了排名。通过 4 次会议上的共识过程，作者就对通科临床医生有实践意义的文章达成了一致意见，这些文章值得讨论。作者随后将文章分为五类：1）门诊环境中的筛查和简短干预，2）住院患者中物质使用的识别和管理，3）物质使用的医疗并发症，4）在初级保健中使用药物治疗来治疗成瘾及其并发症，以及 5）成瘾治疗和医疗保健的整合。作者讨论了每篇选定文章的优点、局限性、结论及其对推进通科医生实践中成瘾筛查、评估和治疗的意义。
