Screening for substance use & misuse in the emergency department: Differences in computer prompted vs. physician face-to-face interview

APHA Scientific Session and Event Listing

3001.0: Monday, November 05, 2007 - 9:06 AM

Abstract #162603

Cara J. Hamann, MPH, Surgery Section of Emergency Medicine, Yale University, 464 Congress Ave Suite 260, New Haven, CT 06511, 203-785-6519, cara.hamann@yale.edu and Gregory L. Larkin, MD, MSPH, FACEP, Department of Surgery, Yale University, 464 Congress Ave, New Haven, CT 06510.

Background: Data on sensitivity and validity of face-to-face substance abuse screening methods are mixed. Objective: To examine sensitivity of physician-elicited patient endorsements of substance use and abuse compared to computer-elicited responses. Methods: Participants were given a computerized interview regarding drug and alcohol use, including questions from the SCID-validated, DSM-based, Shedler Quick Psycho-Diagnostics Panel and standard NIAAA quantity-frequency questions. ED physicians used drug and alcohol questions in NIAAA format to interview participants face-to-face. Physician interview data were collected via structured chart review. Heavy drinkers were defined according to NIAAA cut-offs. Frequencies and proportions were calculated to examine discordance between computer interview and physician interviews. Results: 768 patients were enrolled during random time blocks between June and July of 2006 from the emergency department at Parkland Hospital in Dallas, TX. DSM-IV criteria for drug abuse and/or report of illicit drug use was met or endorsed by 175 (22.8%) participants in the computerized interview, while only by 43 (6.3%) participants in physician interview. 24 participants screened positive for substance use and/or abuse via both the computer and the physician. In computerized interview, 94 (12.2%) met NIAAA criteria for heavy drinking, while 154 (20.1%) met these same criteria in physician interview. 30 participants screened positive for heavy drinking in both computerized and physician interviews. Conclusions: Both computerized questioning and physician questioning are imperfect methods of capturing drug and alcohol data. In this sample the computerized questionnaire captured a significantly greater proportion of positive endorsements for drugs, while physician interview captured more participants for alcohol.

Learning Objectives:

Decribe differences in computer elicited and physician elcited screening for alcohol and drugs.
Identify future directions in research regarding computerized versus physician elicited screening.
Discuss the ways and reasons in which a patient's drug and alcohol use report may differ depending upon the method of questioning.

Keywords: Screening, Substance Abuse

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Approaches and Methods: Screening and Brief Intervention

The 135th APHA Annual Meeting & Exposition (November 3-7, 2007) of APHA