Prevalence, Clinical Characteristics, and Risk Factors for Non-recording of Alcohol Use in Hospitals across Europe: The ALCHIMIE Study

Rosón, Beatriz; Corbella, Xavier; Perney, Pascal; Santos, Álvaro; Stauber, Rudolf; Lember, Margus; Arutyunov, A. G.; Ruza, Ieva; Václavík, J.; García, Luis Javier Morales; Pujol, Ramón

doi:10.1093/alcalc/agv142

Cited by 10 publications

(7 citation statements)

References 29 publications

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“…One in five inpatients surveyed reported risky drinking behaviours. This is higher than the 16% reported by the European cross‐country study [30], but is comparable to recently reported, Australian national prevalence of risky drinking of approximately 22% [38]. While it could be presumed that hospital inpatient populations would have greater alcohol burden than the general public, especially in our health service which has statewide services such as major trauma and psychiatric intensive care, these figures may have been diluted by our subacute, geriatric hospital campuses which have a skewed demographic profile of females over 70 years (however no significant difference in risky drinking by hospital campus was found).…”

Section: Discussioncontrasting

confidence: 65%

“…Currently, the true burden of high‐risk alcohol use and dependence among inpatients in Australia is not well‐established. A recent European cross‐country study screening 2100 inpatients from 43 hospitals in 8 European countries using the AUDIT‐C (and subsequently the full AUDIT and clinical evaluation for those who screened positive on the AUDIT‐C), reported 16% ( n = 346) fulfilled the World Health Organization criteria for either current or past AUD [30]. Several Australian studies have assessed alcohol use among both general [31,32] and specialised inpatient settings [33,34] using the AUDIT, but contemporary data on Australian general inpatient populations are lacking and premature screening program rollouts could overburden staff, leaving patients at risk.…”

Section: Introductionmentioning

confidence: 99%

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Screening for risky drinkers among hospitalised inpatients using the AUDIT: A feasibility, point prevalence and data linkage study

O’Brien

Rico

Dean

et al. 2021

Drug and Alcohol Review

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Introduction Risky drinking frequently remains undiagnosed or untreated, including in hospitalised inpatients. Using the Alcohol Use Disorders Identification Test (AUDIT), we assessed the feasibility of screening for risky drinking and whether screening results aligned with alcohol‐attributable diagnoses in an inpatient population. Methods We conducted a cross‐sectional survey across a tertiary health service in Melbourne, Australia. Researchers collected demographics, AUDIT scores and acceptability from all eligible adult inpatients available on day of survey. Main outcomes were prevalence of risky drinking (AUDIT ≥8), mean AUDIT score and patient acceptability. Identification of risky drinking by the abbreviated ‘AUDIT‐C’ or discharge diagnoses (extracted by data‐linkage with medical records) was compared. Results Of 473 eligible inpatients, 61% (n = 289) participated, 22% (n = 103) were unavailable and 17% (n = 81) declined. Median age was 64 years (IQR = 48, 76); 54% (n = 157) were male. Mean AUDIT score was 4.4 (SD = 5.5). Risky drinking prevalence was 20% (n = 57), 2% (n = 7) had scores suggestive of dependence (AUDIT ≥20, a subset of risky drinkers). Odds of risky drinking were reduced in females (OR 0.19, 95% CI 0.09, 0.41; P < 0.001) and participants ≥70 years (OR 0.22, 95% CI 0.07, 0.71; P = 0.01). Alcohol‐attributable diagnoses did not consistently align with risky drinking, with half of inpatients with wholly attributable diagnoses classified as low risk. Most inpatients considered screening acceptable (89%, n = 256). Discussion and Conclusions Pre‐admission risky drinking was evident in one‐fifth of hospital inpatients, but alcohol‐attributable diagnoses were unreliable proxy measures of risky drinking. Screening in‐patients with the AUDIT was acceptable to inpatients and can be feasibly implemented in an Australian tertiary hospital setting.

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Section: Discussioncontrasting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Screening for risky drinkers among hospitalised inpatients using the AUDIT: A feasibility, point prevalence and data linkage study

O’Brien

Rico

Dean

et al. 2021

Drug and Alcohol Review

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“…First, it has to be considered that the information on alcohol and cigarette smoking was selfreported and may be subject to underreporting bias. Second, we should bear in mind that alcohol consumption may be under-recorded in PHC medical records, as has been described previously in a study of 9 European general hospitals [37]. From the total sample of patients with information on alcohol consumption registered in the electronic medical record, it was recorded that only 32% were considered drinkers, which is clearly below the national prevalence figures [38].…”

Section: Discussionmentioning

confidence: 98%

Risky Alcohol Use: The Impact on Health Service Use

et al. 2018

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Objective: To examine health services use on the basis of alcohol consumption. Material and Methods: A cross-sectional study was carried out on patients visiting the Primary Health Care (PHC) settings in Catalonia during 2011 and 2012; these patients had a history of alcohol consumption. Information about outpatient visits in the PHC setting, hospitalizations, specialists’ visits and emergency room visits for the year 2013 was obtained from 2 databases (the Information System for the Development of Research in PHC and the Catalan Health Surveillance System). Risky drinkers were defined as those who consumed more than 280 g per week for men or more than 170 g per week for women, or any amount of alcohol while being involved in a high risk work activity, or taking medication that significantly interferes with alcohol or when being pregnant. Binge drinkers (> 60 g in men or > 50 g in women in a short amount of time more than once a month) were also considered risky drinkers. Results: A total of 606,948 patients reported consuming alcohol (of which 10.5% were risky drinkers). Risky drinkers were more likely to be admitted to hospitals or emergency departments (range of ORs 1.08–1.18) compared to light drinkers. Male risky drinkers used fewer PHC services than male light drinkers (OR 0.89, 95% CI 0.87–0.92). In general, risky alcohol users used services more and had longer hospital stays. When stratifying by socioeconomic level of the residential area, we found that risky drinking failed significance, while current or past cigarette smoking was associated with higher healthcare use. Conclusions: Risky drinkers use more expensive services, such as hospitals and emergency rooms, but not PHC services, which may suggest that prevention strategies and alcohol interventions should also be implemented in those settings.

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“…Between 15% and 30% of hospitalized patients have an alcohol-related condition ( 183 – 185 ). For many, treatment of the primary diagnosis necessitating hospitalization (e.g., infection, trauma, organ failure, etc.)…”

Section: Section 2: Translation Of Research To Patients (T 2 Research)mentioning

confidence: 99%

“…Treatment studies use various CIWA-Ar thresholds (of 8–20) to initiate pharmacotherapy and monitoring for patients at evaluation intervals ranging from every 10 minutes to four times daily ( 177 , 178 , 185 ). No study has documented a relationship between the frequency of assessments and patient outcomes.…”

Section: Section 2: Translation Of Research To Patients (T 2 Research)mentioning

confidence: 99%

Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome: An Official American Thoracic Society Research Statement

Steel¹,

Afshar²,

Edwards³

et al. 2021

Am J Respir Crit Care Med

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Background: Severe alcohol withdrawal syndrome (SAWS) is highly morbid, costly, and common among hospitalized patients, yet minimal evidence exists to guide inpatient management. Research needs in this field are broad, spanning the translational science spectrum. Goals: This research statement aims to describe what is known about SAWS, identify knowledge gaps, and offer recommendations for research in each domain of the Institute of Medicine T 0 –T 4 continuum to advance the care of hospitalized patients who experience SAWS. Methods: Clinicians and researchers with unique and complementary expertise in basic, clinical, and implementation research related to unhealthy alcohol consumption and alcohol withdrawal were invited to participate in a workshop at the American Thoracic Society 2019 International Conference. The committee was subdivided into four groups on the basis of interest and expertise: T 0 –T 1 (basic science research with translation to humans), T 2 (research translating to patients), T 3 (research translating to clinical practice), and T 4 (research translating to communities). A medical librarian conducted a pragmatic literature search to facilitate this work, and committee members reviewed and supplemented the resulting evidence, identifying key knowledge gaps. Results: The committee identified several investigative opportunities to advance the care of patients with SAWS in each domain of the translational science spectrum. Major themes included 1 ) the need to investigate non–γ-aminobutyric acid pathways for alcohol withdrawal syndrome treatment; 2 ) harnessing retrospective and electronic health record data to identify risk factors and create objective severity scoring systems, particularly for acutely ill patients with SAWS; 3 ) the need for more robust comparative-effectiveness data to identify optimal SAWS treatment strategies; and 4 ) recommendations to accelerate implementation of effective treatments into practice. Conclusions: The dearth of evidence supporting management decisions for hospitalized patients with SAWS, many of whom require critical care, represents both a call to action and an opportunity for the American Thoracic Society and larger scientific communities to improve care for a vulnerable patient population. This report highlights basic, clinical, and implementation research that diverse experts agree will have the greatest impact on improving care for hospitalized patients with SAWS.

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Prevalence, Clinical Characteristics, and Risk Factors for Non-recording of Alcohol Use in Hospitals across Europe: The ALCHIMIE Study

Cited by 10 publications

References 29 publications

Screening for risky drinkers among hospitalised inpatients using the AUDIT: A feasibility, point prevalence and data linkage study

Screening for risky drinkers among hospitalised inpatients using the AUDIT: A feasibility, point prevalence and data linkage study

Risky Alcohol Use: The Impact on Health Service Use

Research Needs for Inpatient Management of Severe Alcohol Withdrawal Syndrome: An Official American Thoracic Society Research Statement

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