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Lanier D, Ko S. Screening in Primary Care Settings for Illicit Drug Use: Assessment of Screening Instruments: A Supplemental Evidence Update for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Jan. (Evidence Syntheses, No. 58.2.)

2Methods

We undertook a systematic review of documents identified as of August 2006, from a number of databases. We aimed to identify appropriate, validated screening instruments for the detection of drug misuse among asymptomatic patients seen in ambulatory general medical settings.

We first searched the Substance Abuse Screening and Assessment Instruments database (http://adai.washington.edu/instruments) maintained by the University of Washington's Alcohol and Drug Abuse Institute. This regularly updated, comprehensive database contains information on more than 310 questionnaires and interviews that have been offered for detecting or assessing patients with alcohol and/or drug problems. Information on each questionnaire in the database was examined and questionnaires were eliminated from further consideration using the following exclusion criteria:

(1)

Instrument is designed to detect misuse of alcohol only, or of a single drug.

(2)

Instrument is designed primarily for diagnostic purposes or for assessment of those already known to have a substance abuse problem.

(3)

Instrument is not available to the public (not yet published, or subject to a fee for reproduction or downloading)

(4)

Instrument requires specific training to administer or to score/interpret results.

(5)

Instrument contains more than 20 items or takes more than 5 minutes to administer and score.

Using the title or acronym of each remaining questionnaire (i.e., those not excluded using the above criteria), we conducted searches of Ovid Medline and PsychINFO, for the period from 1980 through August 2006, for published evidence in English of the instrument's validity, reliability, and clinical utility. Abstracts of identified articles were screened and rejected if they met the following exclusion criteria:

(1)

Not a study of the specified screening instrument

(2)

Editorial, letter, or other opinion piece

(3)

Study conducted using only a non-English version of the instrument

(4)

Study that examined use of the instrument for a purpose other than screening

Full text articles of non-excluded studies were then examined and critically appraised. When available, the following data were extracted from each study:

(1)

Type of patient population

(2)

Sample size

(3)

Reference standard used

(4)

Sensitivity

(5)

Specificity

(6)

Positive predictive value

(7)

Negative predictive value

(8)

Internal consistency (alpha score)

(9)

Test-retest coefficients (kappa values)

We also noted if the instrument measured recent use or lifetime use, and if it had been evaluated for feasibility and/or clinical utility. We asked if assessment studies were conducted in primary care practice settings.

Studies were rated using previously published USPSTF grading scales. Studies were considered of good quality if they used a credible reference standard, interpreted the reference standard independently of the questionnaire, and included more than 100 patients with and without a drug use problem, some of whom were from a general clinic population.

Studies were considered of fair quality if they used a reasonable, although not the best possible, reference standard, interpreted the reference standard independently of the questionnaire, and included a sample size of 50–100.

Studies were considered of poor quality if an inappropriate reference standard was used, there was a potentially biased ascertainment of the reference standard, or the study included a small (<50) sample size.

Cover of Screening in Primary Care Settings for Illicit Drug Use: Assessment of Screening Instruments
Screening in Primary Care Settings for Illicit Drug Use: Assessment of Screening Instruments: A Supplemental Evidence Update for the U.S. Preventive Services Task Force [Internet].
Evidence Syntheses, No. 58.2.
Lanier D, Ko S.

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