Screening for adolescent alcohol and drug use in pediatric health-care settings predictors and implications for practice and policy 英文参考文献.docVIP

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Screening for adolescent alcohol and drug use in pediatric health-care settings predictors and implications for practice and policy 英文参考文献.doc

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Screening for adolescent alcohol and drug use in pediatric health-care settings predictors and implications for practice and policy 英文参考文献

Sterlingetal.AddictionScienceClinicalPractice2012,7:13 /content/7/1/13 RESEARCH OpenAccess Screeningforadolescentalcoholanddrugusein pediatrichealth-caresettings:predictorsand implicationsforpracticeandpolicy StacySterling1*,AndreaHKline-Simon1,CharlesWibbelsman2,AnnaWong3andConstanceWeisner1,4 Abstract Objective:Thispaperuseddatafromastudyofpediatricprimarycareprovider(PCP)screeningpracticesto examinebarrierstoandfacilitatorsofadolescentalcoholandotherdrug(AOD)screeninginpediatricprimarycare. Methods:Aweb-basedsurvey(N=437)wasusedtoexaminetheinfluenceofPCPfactors(attitudesand knowledge,training,self-efficacy,comfortwithalcoholanddrugissues);patientcharacteristics(age,gender, ethnicity,comorbiditiesandriskfactors);andorganizationalfactors(screeningbarriers,staffingresources, confidentialityissues)onAODscreeningpractices.Self-reportedandelectronicmedicalrecord(EMR)-recorded screeningrateswerealsoassessed. Results:MorePCPsfeltunpreparedtodiagnosealcoholabuse(42%)andotherdrugabuse(56%)thandepression (29%)(p0.001).Overall,PCPsweremorelikelytoscreenboysthangirls,andmalePCPswereevenmorelikely thanfemalePCPstoscreenboys(23%versus6%,p0.0001).Havingmoretimeandhavingotherstaffscreenand reviewresultswereidentifiedaspotentialscreeningfacilitators.Self-reportedscreeningratesweresignificantly higherthanactual(EMR-recorded)ratesforallsubstances.FeelingpreparedtodiagnoseAODproblemspredicted higherself-reportedscreeningrates(OR=1.02,p0.001),andidentifyingtimeconstraintsasabarriertoscreening predictedlowerself-reportedscreeningrates(OR=0.91,p0.001).Higheraveragepanelagewasasignificant predictorofincreasedEMR-recordedscreeningrates(OR=1.11,p0.001). Conclusions:Organizationalfactors,lackoftraining,anddiscomfortwithAODscreeningmayimpactadolescent substance-abusescreeningandintervention,butorganizationalapproaches(e.g.,EMRtoolsandworkflow)may mattermorethanPCPorpatientfactorsindeterminingscreening. Keywords:Adolescent,Screening,Briefintervention,Alcohol,Drugs,Primarycare,Behavioral,SBI