McNeely Jennifer, Halkitis Perry N, Horton Ariana, Khan Rubina, Gourevitch Marc N
a Department of Population Health , New York University School of Medicine , New York , New York , USA.
Subst Abus. 2014;35(1):12-20. doi: 10.1080/08897077.2013.789463.
With rising rates of prescription drug abuse and associated overdose deaths, there is great interest in having accurate and efficient screening tools that identify nonmedical use of prescription drugs in health care settings. The authors sought to gain a better understanding of how patients interpret questions about misuse of prescription drugs, with the goal of improving the accuracy and acceptability of instruments intended for use in primary care.
A total of 27 English-speaking adult patients were recruited from an urban safety net primary care clinic to complete a cognitive interview about a 4-item screening questionnaire for tobacco, alcohol, illicit drugs, and misuse of prescription drugs. Detailed field notes were analyzed for overall comprehension of the screening items on illicit drug use and prescription drug misuse, the accuracy with which participants classified drugs into these categories, and whether the screening response correctly captured the participant's substance use behavior.
Based on initial responses to the screening items, 6 (22%) participants screened positive for past-year prescription drug misuse, and 8 (30%) for illicit drug use. The majority (26/27) of participants correctly interpreted the item on illicit drug use, and appropriately classified drugs in this category. Eleven (41%) participants had errors in their understanding of the prescription drug misuse item. The most common error was classifying use of medications without abuse potential as nonmedical use. All cases of misunderstanding the prescription drug misuse item occurred among participants who screened negative for illicit drug use.
The results suggest that terminology used to describe misuse of prescription medications may be misunderstood by many primary care patients, particularly those who do not use illicit drugs. Failure to improve upon the language used to describe prescription drug misuse in screening questionnaires intended for use in medical settings could potentially lead to high rates of false-positive results.
随着处方药滥用率及相关过量用药死亡人数的上升，人们对在医疗保健环境中拥有准确有效的筛查工具以识别处方药的非医疗用途有着浓厚兴趣。作者试图更好地了解患者如何理解关于处方药滥用的问题，目的是提高用于初级保健的工具的准确性和可接受性。
从一家城市安全网初级保健诊所招募了27名说英语的成年患者，以完成关于一份包含烟草、酒精、非法药物和处方药滥用的4项筛查问卷的认知访谈。对详细的现场记录进行分析，以了解对非法药物使用和处方药滥用筛查项目的总体理解、参与者将药物分类到这些类别的准确性，以及筛查反应是否正确捕捉到参与者的物质使用行为。
根据对筛查项目的初步反应，6名（22%）参与者筛查出过去一年有处方药滥用阳性，8名（30%）有非法药物使用阳性。大多数（26/27）参与者正确理解了非法药物使用项目，并对该类别中的药物进行了适当分类。11名（41%）参与者对处方药滥用项目的理解有误。最常见的错误是将无滥用潜力的药物使用归类为非医疗用途。所有误解处方药滥用项目的情况都发生在非法药物使用筛查为阴性的参与者中。
结果表明，许多初级保健患者，尤其是那些不使用非法药物的患者，可能会误解用于描述处方药滥用的术语。在用于医疗环境的筛查问卷中，若不改进用于描述处方药滥用的语言，可能会导致高比例的假阳性结果。
