1
|
Schwartz RP, McNeely J, Wu LT, Sharma G, Wahle A, Cushing C, Nordeck CD, Sharma A, O'Grady KE, Gryczynski J, Mitchell SG, Ali RL, Marsden J, Subramaniam GA. Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST. J Subst Abuse Treat 2017; 76:69-76. [PMID: 28159441 DOI: 10.1016/j.jsat.2017.01.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST. METHODS Two thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses. RESULTS The interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications. CONCLUSIONS The TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months.
Collapse
Affiliation(s)
- R P Schwartz
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
| | - J McNeely
- New York University School of Medicine, Department of Population Health, 550 First Avenue, VZ30 6th floor, New York, NY 10016, USA.
| | - L T Wu
- Duke University, Department of Psychiatry and Behavioral Sciences and Department of Medicine, Duke University Medical Center, Durham, NC, USA.
| | - G Sharma
- Emmes Corporation, 401 North Washington Street, Suite 700, Rockville, MD 20850, USA.
| | - A Wahle
- Emmes Corporation, 401 North Washington Street, Suite 700, Rockville, MD 20850, USA
| | - C Cushing
- National Institute on Drug Abuse, 6001 Executive Boulevard, Rockville, MD 20852, USA
| | - C D Nordeck
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - A Sharma
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - K E O'Grady
- University of Maryland, College Park, Department of Psychology, 4094 Campus Dr., College Park, MD 20742, USA
| | - J Gryczynski
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - S G Mitchell
- Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA
| | - R L Ali
- University of Adelaide, Department of Pharmacology, Frome Road, Level 5, Medical School North Bldg, The University of Adelaide, Adelaide, SA 5005, Australia.
| | - J Marsden
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addiction Sciences Building, 4 Windsor Walk, Denmark Hill, SE5 8BB London, United Kingdom.
| | - G A Subramaniam
- National Institute on Drug Abuse, 6001 Executive Boulevard, Rockville, MD 20852, USA.
| |
Collapse
|
2
|
McNeely J, Wu LT, Subramaniam G, Sharma G, Cathers LA, Svikis D, Sleiter L, Russell L, Nordeck C, Sharma A, O'Grady KE, Bouk LB, Cushing C, King J, Wahle A, Schwartz RP. Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients. Ann Intern Med 2016; 165:690-699. [PMID: 27595276 PMCID: PMC5291717 DOI: 10.7326/m16-0317] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Substance use, a leading cause of illness and death, is underidentified in medical practice. OBJECTIVE The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool was developed to address the need for a brief screening and assessment instrument that includes all commonly used substances and fits into clinical workflows. The goal of this study was to assess the performance of the TAPS tool in primary care patients. DESIGN Multisite study, conducted within the National Drug Abuse Treatment Clinical Trials Network, comparing the TAPS tool with a reference standard measure. (ClinicalTrials.gov: NCT02110693). SETTING 5 adult primary care clinics. PARTICIPANTS 2000 adult patients consecutively recruited from clinic waiting areas. MEASUREMENTS Interviewer- and self-administered versions of the TAPS tool were compared with a reference standard, the modified World Mental Health Composite International Diagnostic Interview (CIDI), which measures problem use and substance use disorder (SUD). RESULTS Interviewer- and self-administered versions of the TAPS tool had similar diagnostic characteristics. For identifying problem use (at a cutoff of 1+), the TAPS tool had a sensitivity of 0.93 (95% CI, 0.90 to 0.95) and specificity of 0.87 (CI, 0.85 to 0.89) for tobacco and a sensitivity of 0.74 (CI, 0.70 to 0.78) and specificity of 0.79 (CI, 0.76 to 0.81) for alcohol. For problem use of illicit and prescription drugs, sensitivity ranged from 0.82 (CI, 0.76 to 0.87) for marijuana to 0.63 (CI, 0.47 to 0.78) for sedatives; specificity was 0.93 or higher. For identifying any SUD (at a cutoff of 2+), sensitivity was lower. LIMITATIONS The low prevalence of some drug classes led to poor precision in some estimates. Research assistants were not blinded to participants' TAPS tool responses when they administered the CIDI. CONCLUSION In a diverse population of adult primary care patients, the TAPS tool detected clinically relevant problem substance use. Although it also may detect tobacco, alcohol, and marijuana use disorders, further refinement is needed before it can be recommended broadly for SUD screening. PRIMARY FUNDING SOURCE National Institute on Drug Abuse.
Collapse
Affiliation(s)
- Jennifer McNeely
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Li-Tzy Wu
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Geetha Subramaniam
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Gaurav Sharma
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Lauretta A Cathers
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Dace Svikis
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Luke Sleiter
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Linnea Russell
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Courtney Nordeck
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Anjalee Sharma
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Kevin E O'Grady
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Leah B Bouk
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Carol Cushing
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Jacqueline King
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Aimee Wahle
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| | - Robert P Schwartz
- From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina
| |
Collapse
|