administered single item administered single item screening questions (SISQs) screening questions (SISQs) for unhealthy alcohol and for unhealthy alcohol and other drug use in primary other drug use in primary care patients at two sites care patients at two sites Jennifer McNeely , Charles M. Cleland, Shiela M. Strauss, Joseph J. Palamar, John Rotrosen, Marc N. Gourevitch, Richard Saitz
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Validation of self-administered single item screening questions (SISQs) for unhealthy alcohol and other drug use in primary care patients at two sites.
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Validation of self-administered Validation of self-administered single item screening questions single item screening questions
(SISQs) for unhealthy alcohol and (SISQs) for unhealthy alcohol and other drug use in primary care other drug use in primary care
patients at two sitespatients at two sites
Jennifer McNeely, Charles M. Cleland, Shiela M. Strauss, Joseph J. Palamar, John Rotrosen, Marc N. Gourevitch, Richard Saitz
No relevant financial relationships to disclose
ObjectivesObjectives
1. Describe the need for a self-administered approach to substance use screening
2. Single Item Screening Questions (SISQs) for alcohol and drug use
3. Present results of a validation study in primary care
4. Discuss feasibility and application
Screening for Screening for substance use in substance use in
primary careprimary care• Medical providers fail to identify
clinically relevant substance use• Barriers to screening:
o Timeo Workflowo Knowledge/Trainingo Discomforto Attitudes
D’Amico, Medical Care 2005
Sterling, Addict Med Clin Pract 2012Friedmann, J Gen Int Med 2000Friedmann, Arch Int Med 2001Anderson, Alcohol Alcoholism 2004McCormick, J Gen Int Med 2006
Self-administered screening Self-administered screening is a more feasible approach is a more feasible approach
Education Monitoring
Office-based counseling
Treatment
Screening
Assessment
Low Risk Moderate RiskHigh Risk or Dependence
+
Screening: SISQ-alcohol and SISQ-drug
Single Item Screening Single Item Screening
QuestionsQuestions
• SISQ-alcoholHow many times in the past year have you had X or
more drinks in a day?(X=5 for men, and X=4 for women)
• SISQ-drugHow many times in the past year have you used an
illegal drug or used a prescription medication for non-medical reasons (for example, because of the experience or feeling it caused?
Prior validation of SISQsPrior validation of SISQs
• Adult primary care patients (N=286)• Single site, urban safety net medical
center• Good sensitivity and specificity for
detection of unhealthy use • SISQ-alcohol: Sensitivity 82%, Specificity
79% • SISQ-drug: Sensitivity 85%, Specificity
96%Smith et al., JGIM 2009Smith et al., Arch Int Med 2010
Oral fluid test results: 8 tested positive, all reported use on SISQ
No change to results
Substance use disorderSubstance use disorder
Substance + on SISQ
N (%)
+ on Reference
N (%)
Sensitivity
%(95% CI)
Specificity
%(95% CI)
AUC
(95% CI)
Alcohol 155 (34) 60 (13) 86.7 (75.4, 94.1)
74.2 (69.6, 78.4)
0.80 (0.76, 0.85)
Drugs 107 (23) 74 (16) 85.1 (75.0, 92.3)
88.6 (85.0, 91.6)
0.87 (0.83, 0.91)
Subgroup AnalysisSubgroup AnalysisSubgroups anticipated to have greater difficulty with self-administered screening:•Male•Age greater than 50•Hispanic/Latino•Primary language other than English•Born outside US•Education or health literacy lower than high school level
Subgroup AnalysisSubgroup Analysis• No differences for SISQ-alcohol• Lower sensitivity of SISQ-drug among:Primary language other than English (p<0.01)
Less than high school education (p<0.01)
Sensitivity Specificity
English 74.3 (65.1, 82.2) 94.4 (90.7, 96.9)
Non-English 46.2 (19.2, 74.9) 94.3 (87.1, 98.1)
Sensitivity Specificity
High school 79.0 (66.8, 88.3) 95.2 (91.0, 97.8)
< High school 63.3 (49.9, 75.4) 93.3 (88.0, 96.7)
LimitationsLimitations
• Safety net primary care populations• English speaking only• Tested in research context, with