Physician detection of drinking problems in patients attending a general medicine practice

Buchsbaum, David G.; Buchanan, R; Poses, Roy M.; Schnoll, Sidney H.; Lawton, Marcia J.

doi:10.1007/bf02599456

Cited by 112 publications

(60 citation statements)

References 38 publications

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“…For example, in a large primary care clinic, physicians detected alcohol problems in fewer than half of their patients with current alcohol abuse or dependence. 12,13 In another study, only 25% of patients found to be alcoholdependent were warned of the health risks of drinking by their health care provider or advised to reduce or stop using alcohol, and fewer than 1 in 10 were referred for alcohol treatment. 11 The discrepancy between what physicians see as their responsibility and what they do suggests that there are several barriers to physicians intervening with patients who have alcohol problems.…”

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confidence: 99%

Alcohol counseling

et al. 1998

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OBJECTIVE:To assess the use of a brief provider-delivered alcohol counseling intervention of 5 to 10 minutes with highrisk drinking patients by primary care providers trained in the counseling intervention and provided with an office support system. DESIGN:A group randomized study design was used. Office sites were randomized to either a usual care or special intervention condition, within which physicians and patients were nested. The unit of analysis was the patient. SETTING:Primary care internal medicine practices affiliated with an academic medical center. PARTICIPANTS:Twenty-nine providers were randomized by practice site to receive training and an office support system to provide an alcohol counseling special intervention or to continue to provide usual care. INTERVENTION:Special intervention providers received 2 1/2 hours of training in a brief alcohol-counseling intervention and were then supported by an office system that screened patients, cued providers to intervene, and made patient education materials available as tip sheets. MEASUREMENTS AND MAIN RESULTS:Implementation of the counseling steps was measured by patient exit interviews (PEI) immediately following the patient visit. The interval between the date of training and the date of the PEI ranged from 6 to 32 months. Special intervention providers were twice as likely as usual care providers to discuss alcohol use with their patients. They carried out every step of the counseling sequence significantly more often than did usual care providers ( p Ͻ .001). This intervention effect persisted over the 32 months of follow-up. CONCLUSIONS:Physicians and other health-care providers trained in a brief provider-delivered alcohol intervention will counsel their high-risk drinking patients when cued to do so and supported by a primary care office system.

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confidence: 99%

Alcohol counseling

et al. 1998

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“…43 Although patients who do not respond to such mailed surveys must be screened during clinical encounters, the same computer-scannable survey could be administered by clerical staff. Taking screening off the shoulders of primary care clinicians will not only increase the number of problem drinking patients identified, 44 but also increase counseling and referral. 45,46 …”

Section: Discussionmentioning

confidence: 99%

Screening for problem drinking

et al. 1998

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OBJECTIVE:To compare self-administered versions of three questionnaires for detecting heavy and problem drinking: the CAGE, the Alcohol Use Disorders Identification Test (AUDIT), and an augmented version of the CAGE. DESIGN:Cross-sectional surveys. SETTING: Three Department of Veterans Affairs general medical clinics.PATIENTS: Random sample of consenting male outpatients who consumed at least 5 drinks over the past year ("drinkers"). Heavy drinkers were oversampled. MEASUREMENTS:An augmented version of the CAGE was included in a questionnaire mailed to all patients. The AUDIT was subsequently mailed to "drinkers." Comparison standards, based on the tri-level World Health Organization alcohol consumption interview and the Diagnostic Interview Schedule, included heavy drinking ( Ͼ 14 drinks per week typically or Ն 5 drinks per day at least monthly) and active DSM-IIIR alcohol abuse or dependence (positive diagnosis and at least one alcohol-related symptom in the past year). Areas under receiver operating characteristic curves (AUROCs) were used to compare screening questionnaires. MAIN RESULTS:Of 393 eligible patients, 261 (66%) returned the AUDIT and completed interviews. For detection of active alcohol abuse or dependence, the CAGE augmented with three more questions (AUROC 0.871) performed better than either the CAGE alone or AUDIT (AUROCs 0.820 and 0.777, respectively). For identification of heavy-drinking patients, however, the AUDIT performed best (AUROC 0.870). To identify both heavy drinking and active alcohol abuse or dependence, the augmented CAGE and AUDIT both performed well, but the AUDIT was superior (AUROC 0.861). CONCLUSIONS:For identification of patients with heavy drinking or active alcohol abuse or dependence, the self-administered AUDIT was superior to the CAGE in this population.

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“…In a similar study, Buchsbaum et al administered the alcohol module of the Diagnostic Interview Schedule to patients in a medical clinic at an urban university teaching hospital staffed by interns and residents and studied patient and physician characteristics that influence detection of problem drinking. 15 Resident physicians, unaware of the interview results, noted alcohol problems in the chart of 49% of patients who met criteria for current alcohol abuse or dependence. Previous medical record reference of alcohol problems, number of concurrent medical problems, patient gender, and gastrointestinal problems were associated with detection of alcohol problems by residents.…”

Section: Discussionmentioning

confidence: 99%

“…13 However, primary care providers often fail to recognize alcohol problems especially in problem drinkers. 14,15 This failure has led to recent efforts focusing on improving the early detection of patients with alcohol problems by students, residents, and primary care providers. [16][17][18][19] Identification of alcohol problems in primary care patients is a first step in dealing with this prevalent problem.…”

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confidence: 99%

Screening for problem drinking

1998

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OBJECTIVE:To assess the effect of a screen for problem drinking on medical residents and their patients. DESIGN:Descriptive cohort study. SETTING: Veterans Affairs Medical Clinic.PATIENTS: Patients were screened 2 weeks before a scheduled visit ( n ‫؍‬ 714). Physicians were informed if their patients scored positive. MEASUREMENTS AND MAIN RESULTS:Physician discussion of alcohol use was documented through patient interview and chart review. Self-reported alcohol consumption was recorded. Of 236 current drinkers, 28% were positive for problem drinking by the Alcohol Use Disorders Identification Test (AUDIT). Of 58 positive patients contacted at 1 month, 78% recalled a discussion about alcohol use, 58% were advised to decrease drinking, and 9% were referred for treatment. In 57 positive patient charts, alcohol use was noted in 33 (58%), and a recommendation in 14 (25%). Newly identified patients had fewer notations than patients with prior alcohol problems. Overall, 6-month alcohol consumption decreased in both AUDIT-positive and AUDIT-negative patients. The proportion of positive patients who consumed more than 16 drinks per week (problem drinking) decreased from 58% to 49%. Problem drinking at 6 months was independent of physician discussion or chart notation. CONCLUSIONS:Resident physicians discussed alcohol use in a majority of patients who screened positive for alcohol problems but less often offered specific advice or treatment. Furthermore, residents were less likely to note concerns about alcohol use in charts of patients newly identified. Finally, a screen for alcohol abuse may influence patient consumption.KEY WORDS: alcohol abuse; problem drinking; screening; brief interventions. J GEN INTERN MED 1998;13:251-256.

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Physician detection of drinking problems in patients attending a general medicine practice

Cited by 112 publications

References 38 publications

Alcohol counseling

Alcohol counseling

Screening for problem drinking

Screening for problem drinking

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