a Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University , Waltham , Massachusetts , USA.
b Psychology Service , Bedford Department of Veterans Affairs Medical Center , Bedford , Massachusetts , USA.
Subst Abus. 2018;39(4):410-418. doi: 10.1080/08897077.2018.1449165. Epub 2018 May 23.
Unhealthy drug use is a concern in many settings, including military and veteran populations. In 2013, the Veterans Health Administration (VHA) medical center in Bedford, Massachusetts, started requiring routine screening for unhealthy drug use in outpatient primary care and mental health settings, using a validated single question.
This study used descriptive and multivariable analyses of VHA electronic records for patients eligible for the screening program (N = 16,118). The study assessed first-year rates and predictors of screening and of positive screens, both for drug use and for unhealthy alcohol use, for which screening was already required.
During the first year, 70% of patients were screened for unhealthy drug use and 84% were screened for unhealthy alcohol use. In multivariable analyses, screening for drug use was more likely for patients who had 8 or more days with VHA visits or were aged 40 or over. Patients with a prior drug use disorder diagnosis were much less likely to be screened. Three percent of patients screened for unhealthy drug use had a positive screen, and 14% of those screened for unhealthy alcohol use had a positive screen. Strong predictors of a positive drug use screen included a prior-year diagnosis of drug use disorder, any mental health clinic visits, younger age, or being unmarried.
The drug screening initiative was relatively successful in its first-year implementation, having screened 70% of eligible subjects. However, it failed to screen many of those most likely to screen positive, thereby missing many opportunities to address unhealthy drug use. Future refinements should include better training clinicians in how to ask sensitive questions and how to address positive screens.
在许多环境中，包括军人和退伍军人中，滥用药物都是一个令人担忧的问题。2013 年，马萨诸塞州贝德福德退伍军人健康管理局（VHA）医疗中心开始在门诊初级保健和精神健康环境中使用经过验证的单一问题对不健康的药物使用进行常规筛查。
本研究使用描述性和多变量分析退伍军人健康管理局电子记录，对符合筛查计划的患者（N=16118）进行分析。该研究评估了第一年筛查和阳性筛查的发生率和预测因素，包括药物使用和已经要求进行筛查的不健康酒精使用。
在第一年，70%的患者接受了药物滥用筛查，84%的患者接受了酒精滥用筛查。在多变量分析中，对于接受 VHA 就诊 8 天或以上或年龄在 40 岁或以上的患者，药物使用筛查的可能性更大。有药物使用障碍诊断史的患者不太可能接受筛查。接受药物滥用筛查的患者中有 3%呈阳性，接受酒精滥用筛查的患者中有 14%呈阳性。药物使用筛查阳性的强烈预测因素包括前一年药物使用障碍的诊断、任何心理健康诊所就诊、年龄较小或未婚。
在实施的第一年，药物筛查计划相对成功，对 70%的合格对象进行了筛查。然而，它未能对许多最有可能呈阳性的患者进行筛查，从而错过了许多解决药物滥用问题的机会。未来的改进应包括更好地培训临床医生如何提出敏感问题以及如何处理阳性筛查。
