Identifying Patients With Problematic Drug Use in the Emergency Department: Results of a Multisite Study
Identifying Patients With Problematic Drug Use in the Emergency Department: Results of a Multisite Study
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DOI：
10.1016/j.annemergmed.2014.05.012
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发表时间：
2014-11-01
影响因子：
6.2
通讯作者：
Weiss, Roger D.
中科院分区：
文献类型：
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作者：
Konstantopoulos, Wendy L. Macias;Dreifuss, Jessica A.;Weiss, Roger D.
研究目的：与药物有关的急诊室（艾德）访问稳步增加，药物使用者严重依赖艾德的医疗护理。本研究的目的是确定临床相关的药物使用问题，这将有助于识别艾德患者需要的物质使用treatment.Methods：使用以前验证的测试，15,224成人艾德患者在6个学术机构进行了预筛选药物使用的一部分，一个大型随机前瞻性试验。包括过去30天内报告药物使用的3，240名参与者的数据。自我报告的人口统计学，物质使用，和艾德访问相关的变量进行了检查，以确定其相关值为有问题的药物use.Results：在3,240例患者，2,084（64.3%）符合标准的有问题的药物使用（药物滥用筛查测试得分>= 3）。年龄大于或等于30岁、吸烟、每日或酗酒、每日药物使用、主要非大麻药物使用、资源密集型艾德分诊水平和艾德就诊的药物相关性与问题药物使用高度相关。在主要的大麻用户，相关的问题药物使用的年龄小于30岁，吸烟，酗酒，每日药物使用，并认为相关性的艾德访问药物use.Conclusion：药物使用问题的临床相关性可能有助于识别的艾德患者谁将受益于全面的筛查，干预和转诊治疗。提出了一种临床决策规则。有问题的药物使用和资源密集型艾德分诊水平之间的相关性表明，基于ED的努力，以减少未满足的物质使用治疗的需求可能有助于降低整体医疗保健成本。
Study objective: Drug-related emergency department (ED) visits have steadily increased, with substance users relying heavily on the ED for medical care. The present study aims to identify clinical correlates of problematic drug use that would facilitate identification of ED patients in need of substance use treatment.Methods: Using previously validated tests, 15,224 adult ED patients across 6 academic institutions were prescreened for drug use as part of a large randomized prospective trial. Data for 3,240 participants who reported drug use in the past 30 days were included. Self-reported variables related to demographics, substance use, and ED visit were examined to determine their correlative value for problematic drug use.Results: Of the 3,240 patients, 2,084 (64.3%) met criteria for problematic drug use (Drug Abuse Screening Test score >= 3). Age greater than or equal to 30 years, tobacco smoking, daily or binge alcohol drinking, daily drug use, primary noncannabis drug use, resource-intense ED triage level, and perceived drug-relatedness of ED visit were highly correlated with problematic drug use. Among primary cannabis users, correlates of problematic drug use were age younger than 30 years, tobacco smoking, binge drinking, daily drug use, and perceived relatedness of the ED visit to drug use.Conclusion: Clinical correlates of drug use problems may assist the identification of ED patients who would benefit from comprehensive screening, intervention, and referral to treatment. A clinical decision rule is proposed. The correlation between problematic drug use and resource-intense ED triage levels suggests that ED-based efforts to reduce the unmet need for substance use treatment may help decrease overall health care costs.