From the Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA (DPA, TWK, JHS, ABC, CWS, RS); Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA (JHS, RS); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (MFB).
J Addict Med. 2022;16(4):e219-e224. doi: 10.1097/ADM.0000000000000917. Epub 2021 Nov 18.
To determine the proportion and characteristics of adults in primary care (PC) who screen positive for unhealthy substance use (SU) (alcohol and/or other drug) 1 year or more after screening negative.
Screening consisted of single-item questions for unhealthy use of alcohol and other drugs (illicit drugs and prescription medications). Health educators conducted in-person screening of patients presenting for a PC appointment. SU severity (low, moderate, high) was assessed with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Multivariate logistic regression models estimated predictors of a positive follow-up screen.
Among 9215 patients who previously screened negative, 237 (2.6%) screened positive for unhealthy SU (42% alcohol only, 43% other drug only, 15% alcohol and other drug). The mean interval between screens was 19 months. Most alcohol use was low risk (ASSIST score ≤10) (81%), whereas most drug use was moderate risk (ASSIST score 4-26) (77%). Patients between ages of 18 to 25 had a higher proportion of positive follow-up screens (7.4% [33/ 443]) as well as those with a self-identified history of SU problems (9.4% [40/421]). Patients with a higher odds of a positive follow-up screen were male (adjusted odds ratio [AOR] 2.64; 95% CI: 2.02-3.45), used tobacco (AOR 2.38; 95% CI: 1.75-3.23), had a longer interval between screenings (AOR 3.26; 95% CI: 1.84-5.75).
Screening for unhealthy SU 1 year or more after screening negative identified additional patients at-risk. These findings highlight the need to empirically determine the incremental benefits of screening all PC patients annually.
确定在初次筛查呈阴性后 1 年或更长时间内，初级保健（PC）中筛查出有不健康物质使用（SU）（酒精和/或其他药物）阳性的成年人的比例和特征。
筛查包括用于筛查酒精和其他药物（非法药物和处方药物）的不良使用的单项问题。健康教育者对因 PC 预约就诊的患者进行面对面筛查。使用酒精、吸烟和物质参与筛查测试（ASSIST）评估 SU 严重程度（低、中、高）。多变量逻辑回归模型估计了随访筛查阳性的预测因素。
在 9215 名先前筛查呈阴性的患者中，有 237 名（2.6%）筛查出有不健康 SU（42%仅为酒精，43%仅为其他药物，15%为酒精和其他药物）阳性。两次筛查之间的平均间隔为 19 个月。大多数酒精使用为低风险（ASSIST 评分≤10）（81%），而大多数药物使用为中风险（ASSIST 评分 4-26）（77%）。年龄在 18 至 25 岁之间的患者有更高比例的阳性随访筛查（7.4%[33/443]）以及自我报告有 SU 问题史的患者（9.4%[40/421]）。有更高可能性进行阳性随访筛查的患者为男性（调整后的优势比 [AOR] 2.64；95%置信区间：2.02-3.45）、使用烟草（AOR 2.38；95%置信区间：1.75-3.23）、两次筛查之间的间隔时间更长（AOR 3.26；95%置信区间：1.84-5.75）。
在初次筛查呈阴性 1 年或更长时间后进行 SU 筛查，发现了更多有风险的患者。这些发现强调了需要通过经验来确定每年对所有 PC 患者进行筛查的额外收益。
