Health Services Research, The National Center on Addiction and Substance Abuse, New York, New York, USA.
Division of Internal Medicine, Emergency Medicine, and Psychiatry, Northwell Health, Great Neck, New York, USA.
J Eval Clin Pract. 2019 Jun;25(3):441-447. doi: 10.1111/jep.13060. Epub 2018 Nov 13.
RATIONALE, AIMS, AND OBJECTIVES: There are well-documented barriers that have limited widespread, sustained adoption of screening and brief intervention for risky substance use in health care settings. In order to better inform implementation efforts, this study evaluates whether patient characteristics, screening results, and implementation success indicators differed between two clinical setting types: primary care and emergency.
Patients presenting to an emergency or primary care setting were screened for risky substance use (n = 41 567). Patients with a positive screen were further assessed for psychosocial, health, and substance use problems (n = 1604). Differences in patient characteristics between primary care and emergency settings were examined using chi-square and t tests. Multilevel logistic regression was used to examine whether setting type predicted screening results. Site-level indicators of implementation success were calculated (percentage prescreens completed, percentage full screens completed, and percentage refused services) for all patient visits (n = 78 656).
As compared with primary care patients, emergency patients had more severe substance use patterns and screening scores, were more likely to use a variety of illicit drugs, and reported more psychosocial issues. In logistic regression models, setting type did not predict whether patients screened positive; however, it did predict screening into a higher vs lower risk category such that emergency patients were more likely to be in a higher risk category. Emergency settings had lower indicators of implementation success (eg, 14% lower prescreen completion rate) as compared with primary care settings on some implementation measures.
This evaluation found important differences in patient characteristics and screening and implementation results between primary care and emergency settings. Health care organizations and administrators implementing screening and brief intervention should attend to setting differences that could affect implementation and clinical care.
背景、目的和目标：有充分记录的障碍限制了在医疗保健环境中广泛、持续地采用筛查和简短干预措施来治疗危险物质使用。为了更好地为实施工作提供信息，本研究评估了两种临床环境类型（初级保健和急诊）之间的患者特征、筛查结果和实施成功指标是否存在差异。
对就诊于急诊或初级保健环境的患者进行危险物质使用的筛查（n=41567）。对筛查阳性的患者进一步评估心理社会、健康和物质使用问题（n=1604）。使用卡方检验和 t 检验比较初级保健和急诊环境之间患者特征的差异。使用多水平逻辑回归检验环境类型是否预测筛查结果。为所有患者就诊（n=78656）计算了实施成功的地点水平指标（完成预筛查的百分比、完成完整筛查的百分比和拒绝服务的百分比）。
与初级保健患者相比，急诊患者的物质使用模式和筛查评分更为严重，更有可能使用多种非法药物，且报告了更多的心理社会问题。在逻辑回归模型中，环境类型并不能预测患者是否筛查阳性；然而，它确实预测了筛查到更高或更低风险类别，即急诊患者更有可能处于更高风险类别。与初级保健环境相比，急诊环境在某些实施措施上的实施成功指标较低（例如，预筛查完成率低 14%）。
本评估发现了初级保健和急诊环境之间患者特征以及筛查和实施结果的重要差异。实施筛查和简短干预措施的医疗保健组织和管理人员应注意可能影响实施和临床护理的环境差异。
