Connors Elizabeth, McKenzie Meghan, Robinson Perrin, Tager Michael, Scardamalia Kris, Oros Marla, Hoover Sharon
National Center for School Mental Health, University of Maryland School of Medicine, 737 West Lombard Street, 4 Floor, Baltimore, MD 21201, USA.
New York-Presbyterian Hospital/Westchester Division, 21 Bloomingdale Rd, White Plains, NY 10605, USA.
Prev Med Rep. 2019 Mar 16;14:100852. doi: 10.1016/j.pmedr.2019.100852. eCollection 2019 Jun.
Although preventive screening, brief intervention and referral to treatment for adolescent substance use is recommended by the American Academy of Pediatrics, primary care providers inconsistently address substance use with their pediatric patients (AAP Committee on Practice and Ambulatory Medicine and AAP Bright Futures Periodicity Schedule Workgroup, 2017). Further research on provider perceptions about addressing adolescent substance use may help identify and address some barriers to screening. However, there are few validated measures of provider perceptions toward patient substance, and none are specific to pediatric patients. This study (conducted in Maryland, 2015-2017) examines the internal consistency and factor structure of an adapted measure to assess perceptions of adolescent substance use. Internal consistency was assessed using responses from a sample of 276 healthcare practitioners (87.7% women, 12.3% men). Their professions included the following: Certified Medical Assistants (10.9%), Registered Nurses (17.8%), Nurse Practitioners (8.3%), Physician Assistants (3.6%), Medical Doctors (13.8%), Clinical Therapists (10.9%) and Other (21.0%). A four-factor solution was identified and initial evidence suggests the adapted measure is appropriate for use with health care providers. A subsample of 181 participants who reported direct interaction with adolescent patients in a provider role was also used to assess convergent validity with self-reported screening practices and effectiveness. Provider-reported frequency of alcohol and drug use assessment for pediatric patients was significantly related to positive perceptions about adolescent substance use on all subscales. The adapted measure could prove useful for assessing provider readiness to receive adolescent substance use screening training and could be further adapted to include items unique to adolescent care, including parental involvement.
尽管美国儿科学会建议对青少年药物使用进行预防性筛查、简短干预并转介治疗，但初级保健提供者在与儿科患者讨论药物使用问题时做法并不一致（美国儿科学会实践与门诊医学委员会及美国儿科学会光明未来定期检查工作组，2017年）。进一步研究提供者对处理青少年药物使用问题的看法，可能有助于识别并消除一些筛查障碍。然而，针对提供者对患者药物使用看法的有效测量方法很少，且没有专门针对儿科患者的方法。本研究（于2015 - 2017年在马里兰州开展）检验了一项经过改编的测量方法的内部一致性和因子结构，以评估对青少年药物使用的看法。通过对276名医疗从业者（87.7%为女性，12.3%为男性）样本的回答来评估内部一致性。他们的职业包括：认证医疗助理（10.9%）、注册护士（17.8%）、执业护士（8.3%）、医师助理（3.6%）、医生（13.8%）、临床治疗师（10.9%）及其他（21.0%）。确定了一个四因子解决方案，初步证据表明该改编后的测量方法适用于医疗保健提供者。还使用了181名报告以提供者角色与青少年患者直接互动的参与者子样本，来评估与自我报告的筛查实践和有效性的收敛效度。提供者报告的对儿科患者进行酒精和药物使用评估的频率，与所有子量表上对青少年药物使用的积极看法显著相关。该改编后的测量方法可能有助于评估提供者接受青少年药物使用筛查培训的准备情况，并且可以进一步改编以纳入青少年护理特有的项目，包括家长参与情况。
