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Journal Club

Study evaluating validity and reliability of SUBS for primary care patients, comparing with reference standards and self-reported measures.

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Journal Club

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  1. Journal Club Alcohol, Other Drugs, and Health: Current Evidence May–June 2015 www.alcoholandhealth.org

  2. 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. www.alcoholandhealth.org

  3. Study Objective • To evaluate the validity and test-retest reliability of the Substance Use Brief Screen (SUBS) in adult primary care patients. www.alcoholandhealth.org

  4. 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 touch-screen 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). www.alcoholandhealth.org

  5. 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? www.alcoholandhealth.org

  6. 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? www.alcoholandhealth.org

  7. 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 www.alcoholandhealth.org

  8. 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. www.alcoholandhealth.org

  9. Did the results of the test being evaluated influence the decision to perform the reference standard? • No. www.alcoholandhealth.org

  10. Were the methods for performing the test described in sufficient detail to permit replication? • Yes. • The verbatim screening questions were provided in the article. www.alcoholandhealth.org

  11. What Are the Results? • Are the likelihood ratios for the test results presented or data necessary for their calculation included? www.alcoholandhealth.org

  12. 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 www.alcoholandhealth.org

  13. 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? www.alcoholandhealth.org

  14. 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. www.alcoholandhealth.org

  15. 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. www.alcoholandhealth.org

  16. 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. www.alcoholandhealth.org

  17. 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. www.alcoholandhealth.org

  18. 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 past-year 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. www.alcoholandhealth.org

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