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Drug Testing of Adolescents in Ambulatory Medicine
Physician Practices and Knowledge
Sharon Levy, MD, MPH;
Sion Kim Harris, PhD;
Lon Sherritt, MPH;
Michelle Angulo, BA;
John R. Knight, MD
Arch Pediatr Adolesc Med. 2006;160:146-150.
Objective To determine physicians' knowledge of urine drug testing and usual practices when performing drug testing on adolescent patients at a time when interest in drug testing of adolescents is on the rise and physicians may be consulted for advice and requests to perform tests.
Design and Participants Multimodal survey conducted April to July 2004 consisting of 42 forced-choice response items. Participants were practicing physicians randomly selected from the national membership rolls of the American Academy of Pediatrics, Society of Adolescent Medicine, and American Academy of Family Physicians who provided care for 10 or more adolescents per week. We computed simple frequencies and sample design-adjusted 95% confidence intervals for each item.
Results The survey was completed by 359 eligible physicians (response rate, 42%). More than 95% of respondents had ever ordered urine drug tests. Only 23% used an effective urine sample collection procedure, and only 7% used specific gravity and measurement of urine creatinine level to ensure validity of the sample, as recommended. When asked which drugs can be detected in routine panels, only 10% answered all items correctly, 47% did not know for 1 or more items, and 75% responded incorrectly for 1 or more items.
Conclusions Primary care physicians do not always use proper urine sample collection and validation procedures, and they are not aware of important limitations of drug testing. The primary care workforce is not prepared to assist with drug testing programs. Physicians who order these tests need more training and access to consultation with experts.
Author Affiliations: Department of Pediatrics (Drs Levy, Harris, and Knight) and Division on Addictions (Drs Levy, Harris, and Knight, and Mss Sherritt and Angulo), Harvard Medical School, and Center for Adolescent Substance Abuse Research (Drs Levy, Harris, and Knight and Mss Sherritt and Angulo) and Divisions of General Pediatrics (Drs Levy and Knight and Ms Sherritt) and Adolescent/Young Adult Medicine (Drs Harris and Knight), Children's Hospital Boston, Boston, Mass.
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