Electronic self-administered screening for substance use in adult primary care patients: feasibility and acceptability of the tobacco, alcohol, prescription medication, and other substance use (myTAPS) screening tool

Abstract

Background The TAPS Tool is a substance use screening and brief assessment instrument that was developed for use in primary care medical settings. It is one of the first screening instruments to provide rapid assessment of all commonly used substance classes, including illicit and prescription opioids, and is one of the only available screeners designed and validated in an electronic self-administered format (myTAPS). This secondary analysis of data from the TAPS Tool validation study describes the feasibility and acceptability of the myTAPS among primary care patients. Methods Adult patients (N = 2000) from five primary care clinics completed the TAPS Tool on a tablet computer (myTAPS), and in an interviewer-administered format. Requests for assistance and time required were tracked, and participants completed a survey on ease of use, utilization of audio guidance, and format preference. Logistic regression was used to examine outcomes in defined subpopulations, including groups that may have greater difficulty completing an electronic screener, and those that may prefer an electronic self-administered approach. Results Almost all participants (98.3%) reported that the myTAPS was easy to use. The median time to complete myTAPS screening was 4.0 min (mean 4.48, standard deviation 2.57). More time was required by participants who were older, Hispanic, Black, or reported non-medical prescription drug use, while less time was required by women. Assistance was requested by 25% of participants, and was more frequently requested by those who with lower education (OR = 2.08, 95% CI 1.62–2.67) or age > 65 years (OR = 2.79, 95% CI 1.98–3.93). Audio guidance was utilized by 18.3%, and was more frequently utilized by participants with lower education (OR = 2.01, 95% CI 1.54–2.63), age > 65 years (OR = 1.79, 95% CI 1.22–2.61), or Black race (OR = 1.30, 95% 1.01–1.68). The myTAPS format was preferred by women (OR = 1.29, 95% CI 1.00–1.66) and individuals with drug use (OR = 1.43, 95% CI 1.09–1.88), while participants with lower education preferred the interviewer-administered format (OR = 2.75, 95% CI 2.00–3.78). Conclusions Overall, myTAPS screening was feasible and well accepted by adult primary care patients. Clinics adopting electronic screening should be prepared to offer assistance to some patients, particularly those who are older or less educated, and should have the capacity to use an interviewer-administered approach when required.

Comparison of Methods for Alcohol and Drug Screening in Primary Care Clinics

“…Two study clinics achieved rates of positive screening results for moderate- to high-risk alcohol use that exceeded general population estimates, and all 5 clinics using a self-administered approach detected a greater than 14% prevalence of moderate- to high-risk alcohol use (vs <2% for the clinic that used staff-administered screening). Our findings are consistent with those of previous studies using self-administered screening, which typically produces more accurate reporting among patients with stigmatized conditions . Our findings could also reflect problems with the quality of screening when administered by staff, who may change the wording of validated screening questions in an effort to hasten the process or reduce perceived patient discomfort …”

“…Our findings are consistent with those of previous studies using self-administered screening, which typically produces more accurate reporting among patients with stigmatized conditions. [53][54][55] Our findings could also reflect problems with the quality of screening when administered by staff, who may change the wording of validated screening questions in an effort to hasten the process or reduce perceived patient discomfort. 56,57 Screening rates were similar for alcohol and drug use, likely reflecting the fact that most clinics administered the alcohol and drug screenings simultaneously.…”

Patient and provider perspectives on self-administered electronic substance use and mental health screening in HIV primary care

“…All patients indicated that the self-administered screening was highly acceptable, consistent with previous findings [33,49]. Prior research has provided evidence for patient acceptability of a self-administered TAPS format [33,49,50], while our results build on those findings to show the utility of multiple modes of self-administration (online patient portal and in-clinic tablet) in meeting the needs of different patient populations. Both patients and providers felt that having both options available allowed for more flexibility in administration and an increased likelihood of completion.…”

Screening for opioid use disorder and co-occurring depression and post-traumatic stress disorder in primary care in New Mexico

“…In the universal screening survey, probable OUD was screened for using items adapted from the myTAPS screener, a self-administered version of the National Institute on Drug Abuse Tobacco, Alcohol, Prescription medication and other Substance use (TAPS) screener [37]. When used for screening problematic heroin and prescription opioid use, the original TAPS instrument had sensitivity of 0.77 and 0.73 and specificity of 0.99 and 0.98, respectively.…”