Transcript Related Journal Club Presentation

Journal Club
Alcohol, Other Drugs, and Health: Current Evidence
May–June 2015
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Featured Article
A Brief Patient Self-administered
Substance Use Screening Tool for
Primary Care: Two-site Validation
Study of the Substance Use Brief
Screen (SUBS).
McNeely J, et al. Am J Med. 2015 [Epub ahead of print].
doi: 10.1016/j.amjmed.2015.02.007.
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Study Objective
• To evaluate the validity and test-retest
reliability of the Substance Use Brief Screen
(SUBS) in adult primary care patients.
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Study Design
• Two studies of adults (aged 18-65) in primary
care:
– Test-retest reliability study (n = 54)
• SUBS was administered twice within a 2-week period using touchscreen tablet computers.
– 2-site validation study (n = 586).
• SUBS was compared with reference standard measures, including
self-reported measures and oral fluid drug tests.
– Investigators measured test-retest reliability and
diagnostic accuracy of the SUBS for detection of
unhealthy use and substance use disorder for tobacco,
alcohol, and drugs (illicit and prescription drug
misuse).
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Assessing Validity of an
Article About Diagnostic Tests
• Are the results valid?
• What are the results?
• Will the results help me in caring for my
patients?
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Are the Results Valid?
• Was there an independent, blind comparison with a
reference standard?
• Did the patient sample include an appropriate
spectrum of patients to whom the diagnostic test will
be applied in clinical practice?
• Did the results of the test being evaluated influence
the decision to perform the reference standard?
• Were the methods for performing the test described
in sufficient detail to permit replication?
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Was there an independent, blind
comparison with a reference standard?
• Patients completed the SUBS independently.
• Research assistants then administered:
– Previously validated instruments measuring unhealthy
substance use and substance use disorders, and oral
fluid measures:
• ASSIST; Timeline Follow-back; MINI-Plus; Fagerström Test;
NicAlert Oral Fluid Test; Intercept Oral Fluid Test.
• It is not stated that the research assistants were
blinded to the results of the SUBS
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Did the patient sample include an appropriate
spectrum of patients to whom the diagnostic
test will be applied in clinical practice?
• Yes.
• The population included equal numbers of men and
women 18-65 from primary care clinics in two large US
cities, who were English-speaking and current clinic
patients.
• Participants were racially and ethnically diverse, half had
a high school level of education or less, and 26%
reported drug use in the past 3 months.
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Did the results of the test being
evaluated influence the decision to
perform the reference standard?
• No.
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Were the methods for performing
the test described in sufficient
detail to permit replication?
• Yes.
– The verbatim screening questions were
provided in the article.
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What Are the Results?
• Are the likelihood ratios for the test
results presented or data necessary for
their calculation included?
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Are the likelihood ratios for the test
results presented or data necessary for
their calculation included?
• Yes.
– The sensitivity, specificity, and area under the receiver
operating curve (AUC) of the SUBS were calculated for
detection of:
• unhealthy substance use
• substance use disorders
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Will the Results Help Me in
Caring for my Patients?
• Will the reproducibility of the test result and its
interpretation be satisfactory in my setting?
• Are the results applicable to my patients?
• Will the results change my management strategy?
• Will patients be better off as a result of the test?
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Will the reproducibility of the test
result and its interpretation be
satisfactory in my clinical setting?
• Likely so. SUBS can be completed independently
by patients, so it is not necessary to rely upon
providers to administer it.
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Are the results applicable to the
patients in my practice?
• Results likely apply to, at least, urban primary
care settings.
• Non-English speakers were excluded.
• 50% of participants were women.
• The majority of patients identified themselves as
black (~50%), ~19% as white, and ~20% as
Hispanic.
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Will the results change my
management strategy?
• In circumstances in which it would be useful
to quickly screen for substance use and
substance use disorders, the validity and
brevity of the SUBS may make screening
easier.
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Will patients be better off as
a result of the test?
• The SUBS was feasible for self-administration
and generated valid results, and could address
an important need for a brief screen with good
performance characteristics.
• Whether patients are better off will depend on
follow-up of positive screens with skillful
assessment, intervention, and/or referral to
specialized treatment.
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Summary/Clinical Resolution
• The SUBS was a brief screen that was feasible
for self-administration.
• The SUBS had good test-retest reliability,
sensitivity, and specificity for detection of pastyear unhealthy use of tobacco, alcohol, and
other drugs in a large safety-net primary care
population with a high prevalence of alcohol and
illicit substance use, though harmful prescription
drug use was relatively low.
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