Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients.
Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients.
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DOI：
10.7326/m16-0317
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发表时间：
2016-11-15
影响因子：
39.2
通讯作者：
Schwartz RP
中科院分区：
文献类型：
--
作者：
McNeely J;Wu LT;Subramaniam G;Sharma G;Cathers LA;Svikis D;Sleiter L;Russell L;Nordeck C;Sharma A;O'Grady KE;Bouk LB;Cushing C;King J;Wahle A;Schwartz RP
物质使用是导致发病率和死亡率的主要原因，但在医疗实践中没有得到充分认识。烟草、酒精、处方药和其他物质使用(TAP)工具的开发是为了满足对包括所有常用物质的简短筛查和评估工具的需求，并符合临床工作流程。这项研究的目的是评估TAPS工具在初级保健患者中的表现。在国家药物滥用治疗临床试验网络内进行的多点研究，将TAPS工具与参考标准测量进行比较。五家成人初级保健诊所。从门诊候诊区连续招募2000名成年患者。面试者和自我管理版本的TAPS工具与参考标准修改后的综合国际诊断访谈(CIDI)进行了比较，CIDI衡量了问题使用和物质使用障碍(SUD)。采访者和自我管理版本的TAPS工具具有相似的诊断特征。对于识别问题使用(以1+为界)，TAPS工具对烟草的敏感度为0.93(95%CI 0.90-0.95)，特异度为0.87(95%CI 0.85-0.89)，对酒精的敏感度为0.74(95%CI 0.70-0.78)，特异度为0.79(95%CI 0.76-0.81)。对于有问题的非法药物和处方药的使用，敏感性从大麻的0.82(95%CI 0.76~0.87)到镇静剂的0.63(95%CI 0.47~0.78)，特异性为0.93或更高。对于任何SUD的识别，敏感性较低，但得分为2+的患者患SUD的可能性大大增加。一些药物类别的低流行率导致一些估计的精确度较低。当研究助理实施CIDI时，他们没有对参与者的TAPS工具反应视而不见。在不同人群的成人初级保健患者中，TAPS工具检测到临床相关问题物质的使用。虽然它也可以检测烟草、酒精和大麻使用障碍，但在TAPS工具被广泛推荐作为SUD的筛查工具之前，还需要进一步的改进。
Substance use is a leading cause of morbidity and mortality that is under-identified in medical practice. The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool was developed to address the need for a brief screening and assessment instrument that includes all commonly used substances, and fits into clinical workflows. The goal of this study was to assess the performance of the TAPS Tool in primary care patients. Multi-site study conducted within the National Drug Abuse Treatment Clinical Trials Network, comparing the TAPS Tool against a reference standard measure. Five adult primary care clinics. 2,000 adult patients were consecutively recruited from clinic waiting areas. Interviewer- and self-administered versions of the TAPS Tool were compared to the reference standard modified Composite International Diagnostic Interview (CIDI), which measures problem use and substance use disorders (SUD). Interviewer- and self-administered versions of the TAPS Tool had similar diagnostic characteristics. For identifying problem use (at a cutoff of 1+), the TAPS Tool had sensitivity 0.93 (95% CI 0.90–0.95) and specificity 0.87 (95% CI 0.85–0.89) for tobacco, and sensitivity 0.74 (95% CI 0.70–0.78), specificity 0.79 (95% CI 0.76–0.81) for alcohol. For problem use of illicit and prescription drugs, sensitivity ranged from 0.82 (95% CI 0.76–0.87) for marijuana to 0.63 (95% CI 0.47–0.78) for sedatives, and specificity was 0.93 or higher. For identifying any SUD, sensitivity was lower, but a score of 2+ greatly increased the likelihood of having a SUD. Low prevalence of some drug classes led to poor precision in some estimates. Research assistants were not blinded to the participant’s TAPS Tool responses when they administered the CIDI. In a diverse population of adult primary care patients, the TAPS Tool detected clinically relevant problem substance use. While it may also detect tobacco, alcohol, and marijuana use disorders, further refinement is needed before the TAPS Tool can be broadly recommended as a screener for SUD.