Drug Screen for Primary Care Patients

初级保健患者的药物筛查

• 批准号: 8597286
• 负责人: Quyen Tiet
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8597286
• 关键词: Advisory Committees; Alcohol abuse; Alcohols; Anxiety Disorders; Area; Area Under Curve; Caring; Clinic; Clinical Practice Guideline; Detection; Development; Diagnosis; Diagnostic; Disease; Drug Use Disorder; Drug usage; Early Diagnosis; Early Intervention; Emergency medical service; Equipment and supply inventories; Foundations; Freedom; Future; Goals; Gold; Guidelines; HIV Infections; Health Care Costs; Health system; Healthcare Systems; Hospitalization; Illicit Drugs; International; Intervention; Interview; Lead; Logistic Regressions; Measures; Medical; Mental Health; Methods; Outcome; Outcome Study; Patient Care; Patients; Pharmaceutical Preparations; Population; Post-Traumatic Stress Disorders; Practice Guidelines; Preclinical Drug Evaluation; Prevalence; Preventive; Primary Health Care; Procedures; Property; Provider; Psychometrics; ROC Curve; Receiver Operating Characteristics; Recommendation; Recruitment Activity; Regression Analysis; Relative (related person); Reporting; Research; Risk; Sensitivity and Specificity; Services; Signal Transduction; Structure; Substance Abuse Treatment Centers; Substance Use Disorder; Symptoms; System; Techniques; Time; Treatment outcome; Trees; United States Substance Abuse and Mental Health Services Administration; Veterans; World Health Organization; base; brief intervention; care systems; clinical practice; drug use screening; dual diagnosis; evidence base; health administration; improved; instrument; medical specialties; meetings; non-compliance; operation; outcome forecast; pressure; prevent; primary care setting; psychoeducation; psychological trauma; screening; service utilization; standard measure; tool; working group

DESCRIPTION (provided by applicant): Background/Rationale: Current guidelines recommend screening for drug use disorders, and referral of patients with drug disorders to substance use disorder (SUD) specialty treatment (SAMHSA, 2005; Sullivan & Fleming, 1997; VA/DoD Evidence-based Clinical Practice Guideline Working Group, 2001; Veterans Health Administration, 2005). However, current guidelines do not recommend a specific instrument because no instrument is appropriate for this purpose (Berman et al., 2005; McPherson & Hersch, 2000; Tiet et al., 2008). There is no instrument that is appropriate for drug-screening purposes that is suitable for VA primary care patients that is brief enough and has been validated (McPherson & Hersch, 2000; Tiet et al., 2008). Objectives: There are three primary aims for this study: Aim 1 is to revise, shorten, and examine the sensitivity and specificity of six existing drug screening instruments for patients in the primary care (PC) settings and to provide six revised, shorter, and more practical drug screening instruments to be used in PC settings. .The revised instruments will be examined against how well they detect (a) drug-related disorders, and (b) drug- related consequences and problems in patients who may not meet diagnostic criteria for a drug use disorder. Aim 2 is to develop a new instrument from combining items across the existing instruments, and the best instrument with the optimal cut-point (considering the relative number of false positives and false negatives) will be identified from comparing the six revised, shortened, existing instruments and the newly constructed instrument. Aim 3 is to examine how well the six revised and one newly developed drug screening instruments perform in detecting drug use disorders and drug-related problems among PC patients with and without Post- Traumatic Stress Disorder (PTSD). Methods: Patients will be recruited from PC clinics at the VA Palo Alto HCS over a 24-month period. Six existing screeners will be revised, shortened, and examined for their psychometric properties, and a new instrument will be developed from choosing and comparing items across existing instruments. The best instrument will be identified from comparing psychometric properties of the six revised, shortened, existing instruments and the newly developed instrument. The criterion measure ("gold standard") for a drug use disorder will be considered present when a drug use diagnosis is detected by a structured diagnostic interview (CIDI, WHO, 1990) conducted by the study team. The Inventory of Drug Use Consequences (InDUC; Tonigan & Miller, 2002) will be used as the second criterion ("gold standard") for measuring drug-related problems for PC patients who may not meet diagnostic criteria for a drug related diagnosis. Tree based signal detection using the receiver operating characteristic (ROC), multivariate logistic regression analyses, and area under the ROC curve (AUC) analytical techniques will be conducted to identify the best screening instrument. Impact: A brief and practical drug screening instrument will have wide-ranging benefits to PC patients with or without PTSD. Early detection and intervention are associated with better PTSD and drug-related outcomes, and reduction of health care cost for the VHA. A validated screener will be the foundation for future studies to identify patients who need differential intensities of interventions to inform clinical practice. Long-term potential impact of the proposed study is information that can lead to the development of VA practice guidelines for screening and managing patients with drug-related disorders or problems in the PC system, and to make detection, assessment, treatment and management or referral for treatment of PTSD patients with drug-related problems an integral part of the treatment system in the VA.

描述（由申请人提供）： 背景/依据：目前的指南建议筛查药物使用障碍，并将药物障碍患者转诊至物质使用障碍（SUD）专科治疗（SAMHSA，2005; Sullivan & Fleming，1997; VA/DoD循证临床实践指南工作组，2001;退伍军人健康管理局，2005）。然而，目前的指南不推荐特定的仪器，因为没有仪器适合于此目的（Berman等人，2005;麦克弗森& Hersch，2000; Tiet等人，2008年）。没有适合于药物筛选目的的仪器适合于VA初级护理患者，其足够简短并且已经过验证（麦克弗森& Hersch，2000; Tiet等人，2008年）。目的：本研究有三个主要目的：目的1是修改，缩短，并检查现有的药物筛选工具的敏感性和特异性，为患者在初级保健（PC）设置，并提供六个修改后，更短，更实用的药物筛选工具，用于PC设置。将对修订后的工具进行审查，以了解它们在检测（a）与毒品有关的病症和（B）可能不符合吸毒病症诊断标准的患者中与毒品有关的后果和问题方面的情况。目标2是通过合并现有仪器的项目开发一种新仪器，并通过比较六种经修订、缩短的现有仪器和新构建的仪器，确定具有最佳临界点（考虑假阳性和假阴性的相对数量）的最佳仪器。目的3是研究如何以及六个修订和一个新开发的药物筛选工具在检测药物使用障碍和药物相关的问题PC患者和没有创伤后应激障碍（PTSD）。方法：将在24个月期间从VA Palo Alto HCS的PC诊所招募患者。六个现有的筛选器将被修改，缩短，并检查他们的心理测量特性，并将开发一个新的工具，从选择和比较现有的工具项目。最好的工具将被确定从比较心理测量特性的六个修订，缩短，现有的工具和新开发的工具。当通过研究小组进行的结构化诊断访谈（CIDI，WHO，1990）检测到吸毒诊断时，将认为存在吸毒障碍的标准测量（“金标准”）。药物使用后果清单（InDUC; Tonigan &米勒，2002）将用作第二个标准（“金标准”），用于测量可能不符合药物相关诊断标准的PC患者的药物相关问题。将使用受试者工作特征（ROC）、多变量逻辑回归分析和ROC曲线下面积（AUC）分析技术进行基于树的信号检测，以确定最佳筛选工具。影响：一个简单实用的药物筛选工具将有广泛的好处PC患者或没有PTSD。早期发现和干预与更好的PTSD和药物相关的结果，以及VHA的医疗保健成本降低有关。一个经过验证的筛选将是未来研究的基础，以确定需要不同强度干预的患者，以告知临床实践。拟议研究的长期潜在影响是信息，可以导致VA实践指南的发展，用于筛查和管理PC系统中药物相关疾病或问题的患者，并使检测，评估，治疗和管理或转诊治疗药物相关问题的PTSD患者成为VA治疗系统的一个组成部分。