Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Family Medicine, Mayo Clinic Health System - Red Wing, Red Wing, MN, USA.
J Prim Care Community Health. 2024 Jan-Dec;15:21501319241276817. doi: 10.1177/21501319241276817.
Fatal overdoses are the third leading cause of death in the pediatric population. Substance use disorders (SUD) screening is not routinely done in primary care practices. Early screening and intervention for adolescent SUD could mitigate future harm.
We conducted a 3-month pilot adapting universal screening using the CRAFFT tool in patients aged 12 to 17 presenting to an urban and a rural primary care practice during well-child and acute/sick-child visits. We collaborated with our pediatric addiction service to ensure access availability for further assessment and treatment for all positively screened patients; this was broadly communicated to primary care providers.
There was a higher CRAFFT completion rate in the urban site (90%, vs 52.6% in our rural site). The majority of CRAFFT questionnaires were completed during acute/sick-child visits in both study sites. Moreover, we found a higher positive screen rate in our rural practice (14.6%, vs 2.4% in our urban practice). Only 27% of positively screened patients had substance use addressed by their providers. No pediatric addiction referrals were made.
Findings suggest provider-level barriers exist despite having adequate specialty referral sources and institutional encouragement. Future work is needed to explore these barriers.
在美国儿科人群中，因药物过量致死是导致死亡的第三大原因。但在初级保健实践中，并未常规进行物质使用障碍（SUD）筛查。对青少年 SUD 进行早期筛查和干预可能会减轻未来的危害。
我们开展了一项为期 3 个月的试点研究，在城市和农村的初级保健机构中，对 12 至 17 岁的就诊患者（包括常规儿童保健就诊和急性/患病就诊）使用 CRAFFT 工具进行普遍性筛查。我们与儿科成瘾服务团队合作，以确保所有筛查阳性的患者都能获得进一步评估和治疗的机会；这一举措也向初级保健提供者进行了广泛宣传。
在城市点，CRAFFT 问卷的完成率更高（90%，而农村点为 52.6%）。两个研究地点的 CRAFFT 问卷大多是在急性/患病就诊时填写的。此外，我们发现农村点的阳性筛查率更高（14.6%，而城市点为 2.4%）。仅有 27%的筛查阳性患者的物质使用问题得到了提供者的关注。没有进行儿科成瘾转介。
尽管有足够的专科转诊资源和机构鼓励，但研究结果表明，在提供者层面仍存在障碍。未来需要进一步探索这些障碍。
