Improving screening and brief intervention activities in primary health care: Secondary analysis of professional accuracy based on the <scp>AUDIT‐C</scp>

Palacio-Vieira, Jorge; Segura, Lídia; Anderson, Peter; Wolstenholme, Amy; Drummond, Colin; Bendtsen, Preben; Wojnar, Marcin; Kaner, Eileen; Keurhorst, Myrna; Steenkiste, Ben van; Kłoda, Karolina; Mierzecki, Artur; Parkinson, Kathryn; Newbury‐Birch, Dorothy; Okulicz-Kozaryn, Katarzyna; Deluca, Paolo; Colom, Joan; Gual, Antoni

doi:10.1111/jep.12854

Cited by 6 publications

(2 citation statements)

References 22 publications

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“…Low levels of documentation among participants who self-reported higher-risk drinking and scored positively on the GAIN-SS indicate a need for increased substance use screening, brief intervention, and access to specialty addiction treatment. Our finding that higher practice-level SDI is associated with reduced odds of documenting alcohol-related problems supports previous work citing clinical barriers, including training in and confidence using evidence-based tools, availability of appropriate screening tools, time, and staffing . Primary care practices in counties with higher levels of social deprivation may be more likely than practices in better-resourced counties to identify and document alcohol-related problems among their patients with multiple chronic conditions.…”

Section: Discussionmentioning

confidence: 99%

Practice-Level Documentation of Alcohol-Related Problems in Primary Care

Waddell,

Leibowitz,

Bonnell

et al. 2023

JAMA Netw Open

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ImportanceRates of alcohol-associated deaths increased over the past 20 years, markedly between 2019 and 2020. The highest rates are among individuals aged 55 to 64 years, primarily attributable to alcoholic liver disease and psychiatric disorders due to use of alcohol. This study investigates potential geographic disparities in documentation of alcohol-related problems in primary care electronic health records, which could lead to undertreatment of alcohol use disorder.ObjectiveTo identify disparities in documentation of alcohol-related problems by practice-level social deprivation.Design, Setting, and ParticipantsA cross-sectional study using secondary data from the Integrating Behavioral Health and Primary Care clinical trial (September 21, 2017, to January 8, 2021) was performed. A national sample of 44 primary care practices with co-located behavioral health services was included in the analysis. Patients with 2 primary care visits within 2 years and at least 1 chronic medical condition and 1 behavioral health condition or at least 3 chronic medical conditions were included.ExposureThe primary exposure was practice-level Social Deprivation Index (SDI), a composite measure based on county income, educational level, employment, housing, single-parent households, and access to transportation (scores range from 0 to 100; 0 indicates affluent counties and 100 indicates disadvantaged counties).Main Outcomes and MeasuresDocumentation of an alcohol-related problem in the electronic health record was determined by International Classification of Diseases, 9th Revision, Clinical Modification and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification codes or use of medications for alcohol use disorder in past 2 years. Multivariable models adjusted for alcohol consumption, screening for a substance use disorder, urban residence, age, sex, race and ethnicity, income, educational level, and number of chronic health conditions.ResultsA total of 3105 participants (mean [SD] age, 63.7 [13.0] years; 64.1% female; 11.5% Black, 7.0% Hispanic, 76.7% White, and 11.9% other race or chose not to disclose; 47.8% household income &lt;$30 000; and 80.7% urban residence). Participants had a mean (SD) of 4.0 (1.7) chronic conditions, 9.1% reported higher-risk alcohol consumption, 4% screened positive for substance use disorder, and 6% had a documented alcohol-related problem in the electronic health record. Mean (SD) practice-level SDI score was 45.1 (20.9). In analyses adjusted for individual-level alcohol use, demographic characteristics, and health status, practice-level SDI was inversely associated with the odds of documentation (odds ratio for each 10-unit increase in SDI, 0.89; 95% CI, 0.80 to 0.99; P = .03).Conclusions and RelevanceIn this study, higher practice-level SDI was associated with lower odds of documentation of alcohol-related problems, after adjusting for individual-level covariates. These findings reinforce the need to address primary care practice-level barriers to diagnosis and documentation of alcohol-related problems. Practices located in high need areas may require more specialized training, resources, and practical evidence-based tools that are useful in settings where time is especially limited and patients are complex.

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Section: Discussionmentioning

confidence: 99%

Practice-Level Documentation of Alcohol-Related Problems in Primary Care

Waddell,

Leibowitz,

Bonnell

et al. 2023

JAMA Netw Open

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“…In relation to physical activity, the fundamental components of the training load (27) are included: (1) the frequency with which physical activity is performednone, 1-2 sessions per week or greater than or equal to 3 sessions; (2) the volume of time per sessionless than 30 min, 30 min to one hour or more than 1 hour and (3) the subjective intensity of the exercise performedlight, moderate, intense or maximum. Alcohol consumption was also collected, including questions from the AUDIT-C questionnaire (28)(29)(30) , a short version of the AUDIT test consisting of the first three items of the AUDIT, including frequency and amount of alcohol consumption and frequency of binge drinking. The AUDIT-C cut-off point of ≥ 4 in men and ≥ 3 in women was used to identify hazardous alcohol consumption (30) .…”

Section: Variables Of Interest and Data Collectionmentioning

confidence: 99%

Adherence to the Mediterranean Diet in medical students

González-Sosa

Ruiz-Hernández

Puente-Fernández

et al. 2023

Public Health Nutr.

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Objective The protective effect of the Mediterranean Diet (MeDi) is undisputed. However, adherence to MeDi has decreased in recent years, particularly in young people. The aim of this study was to evaluate adherence to MeDi in medical students and to assess the influence of knowledge acquisition as well as other factors on dietary compliance. Design A cross-sectional study was conducted on medical students. The data were obtained through anonymous surveys that collected demographic characteristics, medical history, alcohol and tobacco consumption, physical activity and adherence to MeDi – using 14-point Mediterranean Diet Adherence Score (MEDAS)-. Adherence to MeDi and related factors were evaluated by univariate and multivariable analysis. Participants Medical students from the first to the sixth year of the 2018-2019 academic year. Setting The study was conducted at the university of Las Palmas de Gran Canaria. Results Of 589 respondents (73% women) mean aged 22 years (range 18 to 39), 58.9% showed good adherence to MeDi. Adherence was significantly associated with age (p=0.017) but not with sex or the presence of comorbidities. Independently, adherence to MeDi was higher in last academic courses (OR=2.1; 95% CI=1.3-3.2; p=0.001), in those who consumed alcohol more frequently (OR=1.5; 95% CI=1.0-2.1; p=0.039) and in those who practiced more exercise (OR=1.5; 95% CI=1.2-1.9; p<0.001). Conclusions Half of all medical students did not have a good adherence to MeDi. Adherence was higher at older age, in higher academic years and related to greater physical activity. It would be convenient to quantify dietary knowledge as well as implement nutritional educational programs, favoring a healthy lifestyle.

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