Wakeman Sarah E, Herman Grace, Wilens Timothy E, Regan Susan
Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Subst Abus. 2020;41(3):331-339. doi: 10.1080/08897077.2019.1635961. Epub 2019 Aug 1.
Unhealthy substance use is a growing public health issue. Intersections with the health care system offer an opportunity for intervention; however, recent estimates of prevalence for unhealthy substance use among all types of hospital inpatients are unknown. Universal screening for unhealthy alcohol or drug use was implemented across a 999-bed general hospital between January 1 and December 31, 2015. Nurses completed alcohol screening using the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C) with a cutoff of ≥5 for moderate risk and ≥8 for high risk and drug screening using the single-item screening question with ≥1 episode of use considered positive. Out of 35,288 unique inpatients, screens were completed on 21,519. There were 3,451 positive screens (16% of all completed screens), including 1,291 (6%) moderate risk and 1,111 (5%) high risk screens for alcohol and 1,657 (8%) positive screens for drug use. Among screens that were positive for moderate- or high-risk alcohol use, 221 (17%) and 297 (27%), respectively, were concurrently positive for drug use. The majority (61%) of patients with unhealthy alcohol use was on the medical services. Men, those who were white or Hispanic, middle-aged, single, unemployed, or screened positive for drug use were more likely to screen positive for high-risk alcohol use. Those who were younger, single, worked less than full time, or screened high risk for alcohol were more likely to screen positive for drug use. Discordance between diagnosis coding and screening results was noted: 29% of high-risk alcohol use screens had no alcohol diagnosis coding associated with that admission, and 51% of patients with a DSM-IV () diagnosis code of alcohol dependence had AUDIT-C scores of <8. Across a general hospital, 16% of patients screened positive for unhealthy substance use, with the highest volume on medical floors. Nursing-led screening may offer an opportunity to identify and engage patients with unhealthy substance use during hospitalization.
使用不健康物质是一个日益严重的公共卫生问题。与医疗保健系统的交叉点提供了干预的机会；然而，目前尚不清楚各类医院住院患者中不健康物质使用的流行率最新估计值。2015年1月1日至12月31日期间，一家拥有999张床位的综合医院对不健康酒精或药物使用进行了普遍筛查。护士使用酒精使用障碍识别测试饮酒问题（AUDIT-C）进行酒精筛查，中度风险的临界值为≥5，高风险的临界值为≥8，并使用单项筛查问题进行药物筛查，≥1次使用发作被视为阳性。在35288名不同的住院患者中，对21519名患者进行了筛查。共有3451次筛查呈阳性（占所有完成筛查的16%），包括1291次（6%）酒精中度风险筛查、1111次（5%）酒精高风险筛查以及1657次（8%）药物使用阳性筛查。在中度或高风险酒精使用筛查呈阳性的患者中，分别有221名（17%）和297名（27%）同时药物使用筛查也呈阳性。大多数（61%）不健康酒精使用患者在医疗科室。男性、白人或西班牙裔、中年、单身、失业或药物使用筛查呈阳性的患者更有可能酒精高风险使用筛查呈阳性。年龄较小、单身、非全职工作或酒精筛查高风险的患者更有可能药物使用筛查呈阳性。注意到诊断编码与筛查结果之间存在不一致：29%的酒精高风险使用筛查没有与该次住院相关的酒精诊断编码，51%诊断编码为DSM-IV（）酒精依赖的患者AUDIT-C得分<8。在一家综合医院中，16%的患者不健康物质使用筛查呈阳性，医疗楼层的筛查量最高。由护士主导的筛查可能为在住院期间识别和接触不健康物质使用患者提供机会。
