Is It Possible to Evaluate Addiction From Clinical Records? Testing a Retrospective Addiction Severity Evaluation Measure

Abstract

Aim. To compare an addiction severity score estimated from clinical records to addiction severity index (ASI) scores. Methods. During April–May 2004, 31 patients treated in a therapeutic community in the Piedmont region (Italy) were interviewed using the ASI questionnaire and their clinical records were used to obtain severity scores in seven areas: physical health, occupational functioning, alcohol use, drug use, legal problems, family/social relationships, psychological health. Correlation, agreement, and discriminatory capacity of the clinical records score in correctly classifying persons with low or high severity were investigated using Spearman, Kappa coefficient, and receiver operating characteristics curves. Conclusions. Clinical records score showed good correlation, agreement, and discriminatory accuracy with respect to ASI scores, especially in the drug use and legal problems areas. Further research is suggested to study the use of the score in other settings.

RÉSUMÉ

Objectif: comparer les scores de sévérité de la dépendance obtenus à partir des dossiers médicaux avec les ceux de l’Addiction Severity Index (ASI). Méthode. Durant la période avril-mai 2004, 31 patients traités dans une communauté thérapeutique de la Région Piémont (Italie) ont été interrogés avec le questionnaire ASI, et leurs dossiers médicaux ont été utilisés pour obtenir des échelles de sévérité dans sept domaines : santé physique, capacité de travail, usage de d’alcool, usage de drogues, problèmes légaux, relations familiales et sociales, santé psychique. Corrélation, concordance et capacité des scores obtenus à partir des dossiers médicaux à déterminer les personnes présentant une sévérité basse ou élevée, ont été étudiées en recourant aux coefficients de Sperman et Kappa, et a la méthodologie des courbes ROC (Receiver Operating Characteristics). Conclusions. Les scores obtenus à partir des dossiers médicaux ont montrés une bonne corrélation, concordance et précision par rapport aux scores ASI, notamment dans les domaines relatifs aux problèmes légaux et à l’usage de drogues. On suggère de procéder à d’autres recherches pour évaluer l’utilisation des scores obtenus à partir des dossiers médicaux dans d’autres contextes.

RESUMEN

Objetivo: comparare puntuaciones de severidad de la dependencia obtenidos da las historias clinicas con las puntuaciones dell’ Addiction Severity Index (ASI). Metodicas. En el periodo 2004, 31 pacientes tratados en la Comunidad Terapeutica de la Region Piemonte (Italia) fueron examinados usando el questionario ASI y las historias clinicas de ellos fueron usadas para obtener las puntuaciones de severidad en siete areas: salud fisica, capacidad lavorativa, uso de alcool, uso de drogas, problemas legales, relaciones familiares y sociales, salud psiquica. Correlaciones, agreement y capacidad de las puntuaciones obtenidos da las historias clinicas de discriminar personas con baja o elevada severidad fueron estudiadas usando coificientes de Spearman y Kappa y usando las curvas ROC (Receiver Operating Characteristics). En conclusion: las puntuaciones obtenidas da las historias clinicas mostraron buena correlacion, agreement y precision discriminante en comparacion de las puntuaciones ASI,specialmente en las areas relativas a los problemas legales y uso de drogas. Se sugieren ulteriores examenes para evaluar el uso de las puntuaciones obtenidas da las cartelas clinicas en otros contestos.

Keywords :

• Addiction severity score
• records abstraction
• validity
• retrospective assessment

THE AUTHORS

Cecilia Quercioli is a medical doctor specialized in Hygiene and Preventive Medicine who works in the Department of Public Health of the University of Siena. She obtained a Master in Epidemiology at the London School of Hygiene and Tropical Medicine and a PhD in Health Services Management at the Catholic University of the Sacred Heart, Rome. She has contributed to research projects on health related quality of life and organisation of health and social services.

Gabriele Messina is a Research Professor in Hygiene and Preventive Medicine at the Faculty of Medicine—Department of Public Health of the University of Siena. He obtained a Master in Epidemiology at the London School of Hygiene and Tropical Medicine. Main research fields of G. Messina are Epidemiology, Risk Adjustment Techniques, Health Related Quality of Life, Health Services Management.

Paolo Fini is a clerical who works in the drug-addicted treatment and rehabilitation field from the 1986. He is graduated in theology and psychology. He is the Vice President of the Social Cooperative “Centro Torinese di Solidarietà” and of the Ethics Committee of the “S. Luigi Gonzaga” Hospital. He taught Occupational Ethics at the Training School of the Italian Federation of Therapeutic Communities. He is member of many regional commissions of the Piedmont Region in the field of addiction and he his a member of the Consulting Committee on Drug Addiction of the National Department for the Anti-Drug Policies.

Claudio Frola is the former Responsible for Public Relations and Communication of the Social Cooperative Centro Torinese di Solidarietà. He is the former President of the Regional Coordination of the not-for-profit Organizations for Addictions of the Piedmont region. He was also member of the Regional Commission for Addiction of the Piedmont region.

Nicola Nante is Full Professor of Public Health at the Faculty of Medicine—University of Siena. He is Head of the Health Services Research Laboratory and of the Environmental Hygiene Laboratory at the Department of Public Health and also Director of the Post Graduate School of Public Health.

His main research fields are: Descriptive and Evaluative Epidemiology, Health Services Management, Environmental Hygiene (in particular water supply and hospital environment), Epidemiology and prevention of infectious diseases (in particular influenza and iatrogenic infections).