烟草、酒精、处方药及其他物质使用（TAPS）工具在初级保健患者物质使用筛查中的性能
Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients.
作者信息
McNeely Jennifer, Wu Li-Tzy, Subramaniam Geetha, Sharma Gaurav, Cathers Lauretta A, Svikis Dace, Sleiter Luke, Russell Linnea, Nordeck Courtney, Sharma Anjalee, O'Grady Kevin E, Bouk Leah B, Cushing Carol, King Jacqueline, Wahle Aimee, Schwartz Robert P
机构信息
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
出版信息
Ann Intern Med. 2016 Nov 15;165(10):690-699. doi: 10.7326/M16-0317. Epub 2016 Sep 6.
BACKGROUND
Substance use, a leading cause of illness and death, is underidentified in medical practice.
OBJECTIVE
The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool was developed to address the need for a brief screening and assessment instrument that includes all commonly used substances and fits into clinical workflows. The goal of this study was to assess the performance of the TAPS tool in primary care patients.
DESIGN
Multisite study, conducted within the National Drug Abuse Treatment Clinical Trials Network, comparing the TAPS tool with a reference standard measure. (ClinicalTrials.gov: NCT02110693).
SETTING
5 adult primary care clinics.
PARTICIPANTS
2000 adult patients consecutively recruited from clinic waiting areas.
MEASUREMENTS
Interviewer- and self-administered versions of the TAPS tool were compared with a reference standard, the modified World Mental Health Composite International Diagnostic Interview (CIDI), which measures problem use and substance use disorder (SUD).
RESULTS
Interviewer- and self-administered versions of the TAPS tool had similar diagnostic characteristics. For identifying problem use (at a cutoff of 1+), the TAPS tool had a sensitivity of 0.93 (95% CI, 0.90 to 0.95) and specificity of 0.87 (CI, 0.85 to 0.89) for tobacco and a sensitivity of 0.74 (CI, 0.70 to 0.78) and specificity of 0.79 (CI, 0.76 to 0.81) for alcohol. For problem use of illicit and prescription drugs, sensitivity ranged from 0.82 (CI, 0.76 to 0.87) for marijuana to 0.63 (CI, 0.47 to 0.78) for sedatives; specificity was 0.93 or higher. For identifying any SUD (at a cutoff of 2+), sensitivity was lower.
LIMITATIONS
The low prevalence of some drug classes led to poor precision in some estimates. Research assistants were not blinded to participants' TAPS tool responses when they administered the CIDI.
CONCLUSION
In a diverse population of adult primary care patients, the TAPS tool detected clinically relevant problem substance use. Although it also may detect tobacco, alcohol, and marijuana use disorders, further refinement is needed before it can be recommended broadly for SUD screening.
PRIMARY FUNDING SOURCE
National Institute on Drug Abuse.
背景
物质使用是疾病和死亡的主要原因之一，但在医疗实践中未得到充分识别。
目的
开发烟草、酒精、处方药及其他物质使用（TAPS）工具，以满足对一种简短筛查和评估工具的需求，该工具涵盖所有常用物质且适用于临床工作流程。本研究的目的是评估TAPS工具在初级保健患者中的性能。
设计
在国家药物滥用治疗临床试验网络内进行的多中心研究，将TAPS工具与参考标准测量方法进行比较。（ClinicalTrials.gov：NCT02110693）。
设置
5家成人初级保健诊所。
参与者
从诊所候诊区连续招募的2000名成年患者。
测量
将访谈者管理版和自我管理版的TAPS工具与参考标准——改良的世界心理健康综合国际诊断访谈（CIDI）进行比较，CIDI用于测量问题使用和物质使用障碍（SUD）。
结果
访谈者管理版和自我管理版的TAPS工具具有相似的诊断特征。对于识别问题使用（临界值为1+），TAPS工具对烟草的敏感性为0.93（95%CI，0.90至0.95），特异性为0.87（CI，0.85至0.89）；对酒精的敏感性为0.74（CI，0.70至0.78），特异性为0.79（CI，0.76至0.81）。对于非法药物和处方药的问题使用，敏感性范围从大麻的0.82（CI，0.76至0.87）到镇静剂的0.63（CI，0.47至0.78）；特异性为0.93或更高。对于识别任何物质使用障碍（临界值为2+），敏感性较低。
局限性
某些药物类别的低患病率导致一些估计的精度较差。在进行CIDI评估时，研究助理知晓参与者的TAPS工具回答情况。
结论
在成年初级保健患者的多样化群体中，TAPS工具检测到了临床上相关的问题物质使用。虽然它也可能检测到烟草、酒精和大麻使用障碍，但在广泛推荐用于物质使用障碍筛查之前，还需要进一步完善。
主要资金来源
国家药物滥用研究所。
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