Proposal: redesign present default eClinicalworks Social History options for Tobacco, Alcohol, Drug Use
Individuals may have already done this, but I don’t see a corporate push for this content change. I propose a shift from the classic “tobacco, alcohol, drugs” breakdown to reflect a more intuitive analysis of ingested non-prescription (and sometimes prescription) substances for the purposes of altered physiology and/or recreation. In my experience the stimulant group is the largest, but I think general categorization by agent is fine. I welcome your thoughts. My proposed list of non-mutually exclusive potential radio buttons is as follows:
SMOKING, DIP, CHEW, and related [header; choice:]
• Never [>ends, or nested questions for secondary smoke exposure]
• Past [nests to:]
o age started
o age or month and/or year quit [ideally auto-calculate and field the difference]
o type [header; choice:]
cigarettes
cigar
pipe
marijuana
hookah
other: [free text]
o amount during that time [free text]
• Ongoing, rarely (e.g. cigar 1-2x/year) [nests to: cigarettes, cigars, pipe, vape, marijuana, hookah below]
• Ongoing, sometimes (e.g. martini smoker) [nests to: cigarettes, cigars, pipe, vape, marijuana, hookah below]
• Ongoing, regularly [nests to: cigarettes, cigars, pipe, vape, marijuana, hookah below]
cigarettes [nests to:]
• 1-10/half-pack/day
• 11-20/pack/day [present breakdown is 1-9, a pack has 20 – why the off-center split? Study based?]
• 21-30/pack-and-a-half/day
• 31-40/2 packs/day
• more than 2 packs/day
• within 5 minutes of awakening [not sure of the utility of these questions]
• within 6-10 minutes of awakening
• within 31-60 minutes of awakening
• after 60 minutes of awakening
cigars [nests to:]
• daily use
• weekly use
• monthly use
• more than monthly use
pipe [nests to:]
• daily use
• weekly use
• monthly use
• more than monthly use
marijuana/THC [nests to:]
• smoke
• edibles
• daily use
• weekly use
• monthly use
• more than monthly use
vape [nests to:]
• brand/type [free text]
• cartridge duration [days]
• daily use
• weekly use
• monthly use
• more than monthly use
dip [nests to:]
• fine cut/moist powdered/“snuff”
• extra-long cut
• wide cut
• long cut
• pouches (fermented)
chew [nests to:]
• loose leaf
• plug
• twist
snuff/nasally inhaled tobacco
snus (pasteurized pouches)
muʽassel, maassel, shisha (hookah)
• daily use
• weekly use
• monthly use
• more than monthly use
CAFFEINE and ENERGY DRINKS (400 mg/day safe) [header; choices:]
• Coffee [nested quantities]
• Espresso [nested quantities]
• Tea [nested quantities]
• Soft-drinks [nested quantities]
• Energy drinks [nested quantities]
• Tablets/Vivarin/NoDoz [nested quantities]
• Other [free text]
PRESCRIPTION STIMUNLANTS
• methylphenidate/Ritalin
o short
o intermediate/Ritalin SR/Metadate ER
o long/Ritalin LA/Metadate CD/Quillivant XR/Concerta/Daytrana
• dexmethylphenidate/Focalin
o short
o long/Focalin XR
• amphetamine-dextroamphetamine salt combination/Adderall
o short
o long
• lisdexafetamine/Vyvanse
ALCOHOL
[Use the present AUDIT-C workflow, which is good, I think
Include other details: beer and/or wine and/or liquor, and standardized quantities
Consider including a section that brings data from elsewhere in the chart that might reinforce the impact of alcohol use: MCV, HDL, PLT, folate, B12, SBP/DPB, AST>ALT, TB, etc.]
ILLICIT or OTHER
• Cocaine
• Amphetamines (illicit)
o Methamphetamine
o MDMA/Ecstacy
o MDA
o MDEA
o Syntheic cathinones/bath salts
• PCP
• ketamine
• mushrooms
• opioids
• kratom
• barbiturates
• GHB
• LSD
• dextromethorphan
• DMT/tryptamines
• msescaline
• psilocybin
PRESENT ATTITUDE ABOUT CHANGE
• Pre-contemplative
• Contemplative
• Changing
• Maintenance of change
WHY
• Why use these agents: [free text]