Performance of the tobacco, alcohol, prescription medication, and other substance use (TAPS) tool for substance use screening in primary care patients

Jennifer McNeely, Li Tzy Wu, Geetha Subramaniam, Gaurav Sharma, Lauretta A. Cathers, Dace Svikis, Luke Sleiter, Linnea Russell, Courtney Nordeck, Anjalee Sharma, Kevin E. O-Grady, Leah B. Bouk, Carol Cushing, Jacqueline King, Aimee Wahle, Robert P. Schwartz

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)690-699
Number of pages10
JournalAnnals of Internal Medicine
Volume165
Issue number10
DOIs
StatePublished - Nov 15 2016
Externally publishedYes

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Tobacco
Prescriptions
Primary Health Care
Alcohols
Substance-Related Disorders
Interviews
Cannabis
Prescription Drugs
Workflow
tyrosyl-arginyl-phenylalanyl-sarcosine
Street Drugs
Hypnotics and Sedatives
Cause of Death
Mental Health
Clinical Trials
Research
Pharmaceutical Preparations
Population

ASJC Scopus subject areas

  • Internal Medicine

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Performance of the tobacco, alcohol, prescription medication, and other substance use (TAPS) tool for substance use screening in primary care patients. / McNeely, Jennifer; Wu, Li Tzy; Subramaniam, Geetha; Sharma, Gaurav; Cathers, Lauretta A.; Svikis, Dace; Sleiter, Luke; Russell, Linnea; Nordeck, Courtney; Sharma, Anjalee; O-Grady, Kevin E.; Bouk, Leah B.; Cushing, Carol; King, Jacqueline; Wahle, Aimee; Schwartz, Robert P.

In: Annals of Internal Medicine, Vol. 165, No. 10, 15.11.2016, p. 690-699.

Research output: Contribution to journalArticle

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 2016, 'Performance of the tobacco, alcohol, prescription medication, and other substance use (TAPS) tool for substance use screening in primary care patients', Annals of Internal Medicine, vol. 165, no. 10, pp. 690-699. https://doi.org/10.7326/M16-0317
McNeely, Jennifer ; Wu, Li Tzy ; Subramaniam, Geetha ; Sharma, Gaurav ; Cathers, Lauretta A. ; Svikis, Dace ; Sleiter, Luke ; Russell, Linnea ; Nordeck, Courtney ; Sharma, Anjalee ; O-Grady, Kevin E. ; Bouk, Leah B. ; Cushing, Carol ; King, Jacqueline ; Wahle, Aimee ; Schwartz, Robert P. / Performance of the tobacco, alcohol, prescription medication, and other substance use (TAPS) tool for substance use screening in primary care patients. In: Annals of Internal Medicine. 2016 ; Vol. 165, No. 10. pp. 690-699.
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AU - Sharma, Gaurav

AU - Cathers, Lauretta A.

AU - Svikis, Dace

AU - Sleiter, Luke

AU - Russell, Linnea

AU - Nordeck, Courtney

AU - Sharma, Anjalee

AU - O-Grady, Kevin E.

AU - Bouk, Leah B.

AU - Cushing, Carol

AU - King, Jacqueline

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AU - Schwartz, Robert P.

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N2 - 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.

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