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Michael Bogenschutz, Dennis Donovan, Cameron Crandall, Robert Lindblad , Raul Mandler , Harold Perl, Alyssa Forcehime

Screening Procedures to Identify Problematic Substance Users in Medical Emergency Departments. Michael Bogenschutz, Dennis Donovan, Cameron Crandall, Robert Lindblad , Raul Mandler , Harold Perl, Alyssa Forcehimes. Goals for This Presentation.

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Michael Bogenschutz, Dennis Donovan, Cameron Crandall, Robert Lindblad , Raul Mandler , Harold Perl, Alyssa Forcehime

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  1. Screening Procedures to Identify Problematic Substance Users in Medical Emergency Departments Michael Bogenschutz, Dennis Donovan, Cameron Crandall, Robert Lindblad, Raul Mandler, Harold Perl, Alyssa Forcehimes

  2. Goals for This Presentation • Describe and provide rationale for screening procedures used in the NIDA CTN SMART-ED study • Describe characteristics of sample screened and recruited to date using these procedures

  3. Screening for Study vs. Clinical Screening • The purpose of screening in this study is to define a population of patients who are likely to have problematic drug use, abuse, or dependence for inclusion in the study, and to do so with minimal interaction (to minimize assessment reactivity). • Priority is high positive predictive value (probability of the disorder given positive test). • Clinical screening instruments are designed to have high sensitivity (probability of a positive test given the disorder).

  4. Recruitment • Total proposed N is 1285 randomized participants. • 6 sites will recruit an average of 215 participants. • Site recruitment target is 6 participants per week. • We estimated that 5% of screened patients would qualify for the study. • Therefore, 120 patients would need to be screened per week at each site to achieve the recruitment target.

  5. Screening • Screened sample must be broadly representative of ED population, but does not need to be a random sample. • RAs screen patients out of the ED flow by identifying potentially eligible participants in the ED log. • Brief Information Tool (BIT) records basic demographics and presenting complaint for all patients for whom screening is attempted.

  6. Screening, cont. • After triage, before or during ED treatment, RA approaches ED patient and invites him/her to participate in anonymous screening for possible study participation. • Screening proceeds following verbal informed consent.

  7. Screening Instrument • Screening instrument is called the TAD (for Tobacco, Alcohol, and Drug). • Administered using tablet PC. • Includes a total of 20 questions: • Heavy Smoking Index (4 items) • AUDIT-C (3 items on quantity/frequency of alcohol) • Drug Abuse Screening Test (DAST-10) • Primary substance, days of use of primary substance in past 30 days, and substance- relatedness of the ED visit.

  8. Screening, cont. • Screening continues for participants who have DAST-10 score of 3 or greater and report at least 1 day of use of the self-identified primary problem substance in the past 30 days. • RA then administers Secondary Prescreening Form (SPF) to assess additional exclusion criteria. • Participants who pass are invited to proceed to written informed consent for the study.

  9. Completion of screening prior to randomization • Before participant can be randomized the RA must complete • Demographics • Locator Information Form • Hair sample (objective measure of substance use) • Enrollment Forms A and B

  10. Screening and Randomization Through Sept 20, 2011

  11. Substance use among those completing the TAD • 2,855 participants endorsed past-30d drug use (25% of TADs). • Of these, 955 have been randomized (33% of drug users). • Most of those not randomized were excluded because they did not meet DAST ≥ 3 criterion.

  12. Drug use by primary substance

  13. Primary Substance by site

  14. Demographics (n = 343, primarily from two wave-1 sites) • 64% male • mean age 39 ± 12 • 54% non-White, 26% Hispanic • 2% were college graduates • 9% were married • 10% had full-time jobs • 79% had household incomes under $15,000.

  15. Conclusions • 6% of those selected for screening, and 9% of those screened, were enrolled in the study. • 25% of those screened endorsed past-month drug use. • Sites differ in prevalence of various classes of drugs and overall rates of drug use.

  16. Conclusions, continued • These screening procedures are identifying heavy users of several types of drugs, as well as a larger number of drug users who do not meet severity criteria for the study. • These procedures would likely need some modification for practical clinical use.

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