Comparison of Medical Cannabis Use Reported on a Confidential Survey vs Documented in the Electronic Health Record Among Primary Care Patients

Lapham, Gwen T.; Matson, Theresa E.; Carrell, David; Bobb, Jennifer F.; Luce, Casey; Oliver, Malia; Ghitza, Udi E.; Hsu, Clarissa; Browne, Kendall C.; Binswanger, Ingrid A.; Campbell, Cynthia I.; Saxon, Andrew J.; Vandrey, Ryan G.; Schauer, Gillian L.; Pacula, Rosalie Liccardo; Horberg, Michael A.; Bailey, Steffani R.; McClure, Erin A.; Bradley, Katharine A.

doi:10.1001/jamanetworkopen.2022.11677

Cited by 25 publications

(42 citation statements)

References 66 publications

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“…Despite increasing trends, a very small portion of notes overall documented cannabis use (<2%), which for the most part contained insufficient information (i.e., duration, frequencies, amount). These findings are in line with recent studies indicating discrepancies between patient reported cannabis (e.g., surveys) and cannabis use documentation in health records [30], while showing a much lower rate than those previously reported.…”

Section: Resultssupporting

confidence: 92%

“…However, whether the use of cannabis has downstream effects on the treatment choices and outcomes requires further evaluations. The high prevalence of cast/splint procedures, often done for treatment of bone fractures, among cannabis users along with prior reports of changes in bone remodeling due to cannabis use [3,4,30,[33][34][35][36][37] further highlight the importance of proper cannabis use documentation to improve treatment outcomes.…”

Section: Resultsmentioning

confidence: 99%

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A Natural Language Processing Pipeline to Study Disparities in Cannabis Use and Documentation Among Children and Young Adults A Survey of 21 Years of Electronic Health Records

Tavabi

Raza

Singh

et al. 2022

Preprint

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The legalizations of medical and recreational cannabis have generated a great deal of interest in studying the health impacts of cannabis products. Despite increases in cannabis use, its documentation during clinical visits is not yet mainstream. This lack of information hampers efforts to study cannabis effects on health outcomes. A clear and in-depth understanding of current trends in cannabis use documentation is necessary to develop proper guidelines to screen and document cannabis use. Here we have developed and used a hierarchical natural language processing pipeline (AUROC=0.94) to evaluate the trends and disparities in cannabis documentation on more than 23 million notes from a large cohort of 370,087 patients seen in a high-volume multi-site pediatric and young adult clinic over a period of 21 years. Our findings show a very low but growing rate of cannabis use documentation (<2%) in electronic health records with significant demographic and socioeconomic disparities in both documentation and use, which requires further attention.

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Section: Resultssupporting

confidence: 92%

Section: Resultsmentioning

confidence: 99%

A Natural Language Processing Pipeline to Study Disparities in Cannabis Use and Documentation Among Children and Young Adults A Survey of 21 Years of Electronic Health Records

Tavabi

Raza

Singh

et al. 2022

Preprint

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“…Using EHR data, 5000 patients were randomly sampled for the survey. As detailed elsewhere, 35 we oversampled for higher frequency of past-year cannabis use (58% daily, 24% weekly, 7% monthly, 6% less than monthly, 6% no use) and ensured 35% of the sample were individuals who belonged to minoritized racial and ethnic groups to obtain representation from important subgroups.…”

Section: Methodsmentioning

confidence: 99%

“… 55 Comparisons of the eligible primary care population, eligible survey sample, nonrespondents, respondents, and the weighted primary care sample have been previously reported. 35 …”

Section: Methodsmentioning

confidence: 99%

Validity of the Single-Item Screen–Cannabis (SIS-C) for Cannabis Use Disorder Screening in Routine Care

et al. 2022

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ImportanceCannabis use is prevalent and increasing, and frequent use intensifies the risk of cannabis use disorder (CUD). CUD is underrecognized in medical settings, but a validated single-item cannabis screen could increase recognition.ObjectiveTo evaluate the Single-Item Screen–Cannabis (SIS-C), administered and documented in routine primary care, compared with a confidential reference standard measure of CUD.Design, Setting, and ParticipantsThis diagnostic study included a sample of adult patients who completed routine cannabis screening between January 28 and September 12, 2019, and were randomly selected for a confidential survey about cannabis use. Random sampling was stratified by frequency of past-year use and race and ethnicity. The study was conducted at an integrated health system in Washington state, where adult cannabis use is legal. Data were analyzed from May 2021 to March 2022.ExposuresThe SIS-C asks about frequency of past-year cannabis use with responses (none, less than monthly, monthly, weekly, daily or almost daily) documented in patients’ medical records.Main Outcomes and MeasuresThe Diagnostic and Statistical Manual, Fifth Edition (DSM-5) Composite International Diagnostic Interview–Substance Abuse Module (CIDI-SAM) for past-year CUD was completed on a confidential survey and considered the reference standard. The SIS-C was compared with 2 or more criteria on the CIDI-SAM, consistent with CUD. All analyses were weighted, accounting for survey design and nonresponse, to obtain estimates representative of the health system primary care population.ResultsOf 5000 sampled adult patients, 1688 responded to the cannabis survey (34% response rate). Patients were predominantly middle-aged (weighted mean [SD] age, 50.7 [18.1]), female or women (weighted proportion [SE], 55.9% [4.1]), non-Hispanic (weighted proportion [SE], 96.7% [1.0]), and White (weighted proportion [SE], 74.2% [3.7]). Approximately 6.6% of patients met criteria for past-year CUD. The SIS-C had an area under receiver operating characteristic curve of 0.89 (95% CI, 0.78-0.96) for identifying CUD. A threshold of less than monthly cannabis use balanced sensitivity (0.88) and specificity (0.83) for detecting CUD. In populations with a 6% prevalence of CUD, predictive values of a positive screen ranged from 17% to 34%, while predictive values of a negative screen ranged from 97% to 100%.Conclusions and RelevanceIn this diagnostic study, the SIS-C had excellent performance characteristics in routine care as a screen for CUD. While high negative predictive values suggest that the SIS-C accurately identifies patients without CUD, low positive predictive values indicate a need for further diagnostic assessment following positive results when screening for CUD in primary care.

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“…In the Original Investigation titled “Comparison of Medical Cannabis Use Reported on a Confidential Survey vs Documented in the Electronic Health Record Among Primary Care Patients,” 1 published May 23, 2022, there was an error in the Role of the Funder/Sponsor. This section should have stated that a National Institute on Drug Abuse–appointed Data and Safety Monitoring Board (DSMB) reviewed the design and conduct of the study.…”

mentioning

confidence: 99%

Error in Role of the Funder/Sponsor

2022

JAMA Netw Open

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Comparison of Medical Cannabis Use Reported on a Confidential Survey vs Documented in the Electronic Health Record Among Primary Care Patients

Abstract: This survey study compares the use of cannabis for medical purposes as reported in electronic health records (EHRs) with use reported in a confidential survey.

Cited by 25 publications

References 66 publications

A Natural Language Processing Pipeline to Study Disparities in Cannabis Use and Documentation Among Children and Young Adults A Survey of 21 Years of Electronic Health Records

A Natural Language Processing Pipeline to Study Disparities in Cannabis Use and Documentation Among Children and Young Adults A Survey of 21 Years of Electronic Health Records

Validity of the Single-Item Screen–Cannabis (SIS-C) for Cannabis Use Disorder Screening in Routine Care

Error in Role of the Funder/Sponsor

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