The Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital, 225 E. Chicago Avenue, Box 161, Chicago, IL, 60611, USA.
Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Subst Abuse Treat Prev Policy. 2020 May 25;15(1):36. doi: 10.1186/s13011-020-00276-4.
Despite recent reductions, youth substance use continues to be a concern in the United States. Structured primary care substance use screening among adolescents is recommended, but not widely implemented. The purpose of this study was to describe the distribution and characteristics of adolescent substance use screening in outpatient clinics in a large academic medical center and assess related factors (i.e., patient age, race/ethnicity, gender, and insurance type) to inform and improve the quality of substance use screening in practice.
We abstracted a random sample of 127 records of patients aged 12-17 and coded clinical notes (e.g., converted open-ended notes to discrete values) to describe screening cases and related characteristics (e.g., which substances screened, how screened). We then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and used multiple logistic regression to identify related factors.
Among 127 records, rates of screening by providers were 72% (each) for common substances (alcohol, marijuana, tobacco). The primary method of screening was use of clinical mnemonic cues rather than standardized screening tools. A total of 6% of patients reported substance use during screening. Older age and racial/ethnic minority status were associated with provider screening in multiple logistic regression models.
Despite recommendations, low rates of structured screening in primary care persist. Failure to use a standardized screening tool may contribute to low screening rates and biased screening. These findings may be used to inform implementation of standardized and structured screening in the clinical environment.
not applicable.
尽管最近有所减少，但美国青少年的物质使用问题仍然令人担忧。建议对青少年进行结构化的初级保健物质使用筛查，但并未广泛实施。本研究的目的是描述在大型学术医疗中心的门诊诊所中青少年物质使用筛查的分布和特征，并评估相关因素（即患者年龄、种族/民族、性别和保险类型），以了解和提高实践中物质使用筛查的质量。
我们随机抽取了 127 名年龄在 12-17 岁的患者记录，并对临床记录进行了编码（例如，将开放式记录转换为离散值），以描述筛查病例和相关特征（例如，筛查了哪些物质，如何筛查）。然后，我们对数据中的描述性模式进行了分析，以计算筛查率、筛查特征，并使用多因素逻辑回归来确定相关因素。
在 127 份记录中，提供者对常见物质（酒精、大麻、烟草）进行筛查的比例为 72%（各）。筛查的主要方法是使用临床记忆提示，而不是标准化的筛查工具。在筛查期间，共有 6%的患者报告有物质使用。在多因素逻辑回归模型中，年龄较大和少数族裔/少数民族身份与提供者筛查相关。
尽管有建议，但初级保健中结构化筛查的比例仍然很低。未使用标准化筛查工具可能导致筛查率低和筛查偏倚。这些发现可用于为临床环境中标准化和结构化筛查的实施提供信息。
不适用。
