Ragan-Burnett Kathleen, Schieber Lyna, Terranella Andrew, Mikosz Christina
Division of Overdose Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
JAMA Netw Open. 2025 May 1;8(5):e2511579. doi: 10.1001/jamanetworkopen.2025.11579.
Despite decreasing substance use by adolescents in recent years, overdose rates continue to rise. Morbidity and mortality from substance use is preventable if detected; however, screening practices among youth-serving clinicians are unknown.
To describe youth-serving clinicians' screening, brief intervention, and referral to treatment practices for substance use disorders (SUDs) among adolescents.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used DocStyles data from September 5 to October 12, 2023, on clinical practice settings in the US. Responding clinicians included family physicians, internal medicine physicians, pediatricians, nurse practitioners, and physician assistants.
Delivery of services to youths aged 17 years or younger.
Screening, brief intervention, and referral to treatment practices, including screening frequency and type of screening tool used, and screening at every well visit using a screening tool were assessed using descriptive statistics and multivariable logistic regression.
Of 1047 youth-serving clinicians (mean [SD] age, 45.3 [11.4] years; 555 male [53.0%]), 467 (44.6%) were family physicians, 250 (23.9%) were pediatricians, 132 (12.6%) were internal medicine physicians, 107 (10.2%) were nurse practitioners, and 91 (8.7%) were physician assistants (survey response rate, 57%). Median years in practice was 13 (IQR, 7-23 years). Most clinicians (634 [60.6%]) reported that skills in SUD diagnosis were relevant to their practice, and 800 (76.4%) reported seeing at least 1 adolescent with an SUD monthly. A majority of clinicians (596 [56.9%]) reported screening for SUDs at every well visit, with a high proportion of pediatricians reporting screening at every well visit (173 of 250 [69.2%]). Clinicians who screened at every well visit were more likely to use a screening tool (odds ratio, 1.87 [95% CI, 1.44-2.44]). Only 411 clinicians (39.3%) reported screening at every well visit using a screening tool; 321 clinicians (30.7%) offered all components of screening, brief intervention, and referral to treatment practice. Clinicians who reported seeing 5 or more adolescents with an SUD per month had a higher odds of screening with a standardized tool at every annual well visit (adjusted odds ratio, 2.19 [95% CI, 1.30-3.71]).
These findings suggest that while most clinicians report screening youths for SUDs at least sometimes, a substantial proportion screened only intermittently. Efforts to improve screening rates through education and systems-based practice changes may facilitate offering anticipatory guidance and SUD treatment in all youth-serving clinical settings.
尽管近年来青少年物质使用呈下降趋势，但过量用药率仍在持续上升。如果能早期发现，物质使用导致的发病率和死亡率是可以预防的；然而，为青少年提供服务的临床医生的筛查情况尚不清楚。
描述为青少年提供服务的临床医生对青少年物质使用障碍（SUDs）的筛查、简短干预及转介治疗情况。
设计、地点和参与者：这项横断面研究使用了2023年9月5日至10月12日来自DocStyles的数据，数据涉及美国的临床实践环境。参与调查的临床医生包括家庭医生、内科医生、儿科医生、执业护士和医师助理。
为17岁及以下青少年提供服务。
采用描述性统计和多变量逻辑回归评估筛查、简短干预及转介治疗情况，包括筛查频率、使用的筛查工具类型，以及每次健康检查时使用筛查工具进行筛查的情况。
在1047名青少年服务临床医生中（平均[标准差]年龄为45.3[11.4]岁；555名男性[53.0%]），467名（44.6%）是家庭医生，250名（23.9%）是儿科医生，132名（12.6%）是内科医生，107名（10.2%）是执业护士，91名（8.7%）是医师助理（调查回复率为57%）。执业年限中位数为13年（四分位间距为7 - 23年）。大多数临床医生（634名[60.6%]）报告称SUD诊断技能与他们的实践相关，800名（76.4%）报告每月至少见到1名患有SUD的青少年。大多数临床医生（596名[56.9%]）报告在每次健康检查时对SUD进行筛查，其中很大比例的儿科医生报告在每次健康检查时进行筛查（250名中的173名[69.2%]）。每次健康检查时进行筛查的临床医生更有可能使用筛查工具（优势比为1.87[95%置信区间为1.44 - 2.44]）。只有411名临床医生（39.3%）报告在每次健康检查时使用筛查工具进行筛查；321名临床医生（30.7%）提供了筛查、简短干预及转介治疗的所有环节。报告每月见到5名或更多患有SUD青少年的临床医生在每年的每次健康检查时使用标准化工具进行筛查的几率更高（调整后优势比为2.19[95%置信区间为1.30 - 3.71]）。
这些发现表明，虽然大多数临床医生报告至少有时会对青少年进行SUD筛查，但仍有相当比例的医生只是间歇性地进行筛查。通过教育和基于系统的实践变革来提高筛查率的努力，可能有助于在所有为青少年服务的临床环境中提供预防性指导和SUD治疗。
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