Sensitivity of health records for self-reported nonfatal drug and alcohol overdose.

Autor: Riggs KR; Birmingham VA Health Care System, Birmingham, Alabama, USA.; University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA., DeRussy AJ; Birmingham VA Health Care System, Birmingham, Alabama, USA., Leisch L; Birmingham VA Health Care System, Birmingham, Alabama, USA.; University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA., Shover CL; University of California David Geffen School of Medicine, Los Angeles, California, USA., Bohnert ASB; Michigan Medicine, Department of Anesthesiology, Ann Arbor, Michigan, USA.; VA Center for Clinical Management Research, Ann Arbor, Michigan, USA., Hoge AE; Birmingham VA Health Care System, Birmingham, Alabama, USA., Montgomery AE; Birmingham VA Health Care System, Birmingham, Alabama, USA.; University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA., Varley AL; Birmingham VA Health Care System, Birmingham, Alabama, USA.; University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA., Jones AL; VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.; University of Utah School of Medicine, Salt Lake City, Utah, USA., Gordon AJ; VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.; University of Utah School of Medicine, Salt Lake City, Utah, USA., Kertesz SG; Birmingham VA Health Care System, Birmingham, Alabama, USA.; University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
Jazyk: angličtina
Zdroj: The American journal on addictions [Am J Addict] 2022 Nov; Vol. 31 (6), pp. 517-522. Date of Electronic Publication: 2022 Aug 24.
DOI: 10.1111/ajad.13327
Abstrakt: Background and Objectives: Public health surveillance for overdose sometimes depends on nonfatal drug overdoses recorded in health records. However, the proportion of total overdoses identified through health record systems is unclear. Comparison of overdoses from health records to those that are self-reported may provide insight on the proportion of nonfatal overdoses that are not identified.
Methods: We conducted a cohort study linking survey data on overdose from a national survey of Veterans to United States Department of Veterans Affairs (VA) health records, including community care paid for by VA. Self-reported overdose in the prior 3 years was compared to diagnostic codes for overdoses and substance use disorders in the same time period.
Results: The sensitivity of diagnostic codes for overdose, compared to self-report as a reference standard for this analysis, varied by substance: 28.1% for alcohol, 23.1% for sedatives, 12.0% for opioids, and 5.5% for cocaine. There was a notable concordance between substance use disorder diagnoses and self-reported overdose (sensitivity range 17.9%-90.6%).
Discussion and Conclusions: Diagnostic codes in health records may not identify a substantial proportion of drug overdoses. A health record diagnosis of substance use disorder may offer a stronger inference regarding the size of the population at risk. Alternatively, screening for self-reported overdose in routine clinical care could enhance overdose surveillance and targeted intervention.
Scientific Significance: This study suggests that diagnostic codes for overdose are insensitive. These findings support consideration of alternative approaches to overdose surveillance in public health.
(© 2022 The American Academy of Addiction Psychiatry (AAAP). This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)
Databáze: MEDLINE
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