Self-Administered Screening for Alcohol, Drugs Useful in Primary Care.

Asking patients to answer very brief screening questions on tablet computers is a valid approach for detecting unhealthy alcohol and other drug use in primary care settings, a new study co-authored by a School of Public Health researcher shows.

The study published in the Journal of General Internal Medicine found that while self-administered “single-item screening questions” (SISQs) may be less accurate than previously validated interviewer-administered versions, they are potentially easier to incorporate into primary care workflows and may encourage more “open disclosure of stigmatized behaviors” than face-to-face interviews.

Substance use screening is widely encouraged in health care settings but often is not done because in-person screening takes up too much clinician time. The research team tested the self-administered SISQs at two urban primary care clinics and found that they had “adequate sensitivity and high specificity” for detecting unhealthy drug and alcohol use among the 460 study participants.

“Screening, even for alcohol use, has proven difficult to implement and sustain in regular primary care practice,” said study co-author Richard Saitz, chairman and professor of community health sciences, who is also a professor of medicine at BU and an internist and researcher at Boston Medical Center. “The SISQs are brief enough to be easily incorporated into time-pressured practice settings.”

Among the study participants, 22 percent reported unhealthy alcohol use and 25 percent reported drug use in the past year. Their self-reported answers were compared to responses in longer diagnostic interviews with research assistants; some participants also underwent saliva testing.

The authors said the self-administered SISQs “may need to be followed by further assessment to guide clinical interventions,” such as determining what substances a patient was using and distinguishing those with disorders from those with risky use.

The study was led by Jennifer McNeely of the Department of Population Health, New York University School of Medicine. Co-authors were from the Center for Drug Use and HIV Research in New York; the NYU College of Nursing; and the Department of Psychiatry, NYU School of Medicine.

—Lisa Chedekel