Point prevalence of alcoholism in hospitalized patients: continuing challenges of detection, assessment, and diagnosis (original) (raw)
The detection of alcohol problems in a primary care clinic
Journal of Community Health, 1992
The CAGE is a four item questionnaire which is used to help clinicians identify alcohol problems. Charts of 433 primary care patients who were given a medical health form containing the CAGE questions (experimental patients) were compared with charts of 451 patients given a similar form that did not contain the CAGE questions (control patients). Alcohol problems were detected more frequently in the experimental patients (10.6%) than in the control patients (6.7%) (p<0.05). This difference in detection tended to be most evident for persons with milder alcohol problems (problem drinking) as opposed to more well developed alcohol abuse. Experimental patients (3.7%) also tended to be more likely than control patients (2.9%) to receive active alcohol treatment during their initial medical visit. Medical health screening forms which include the CAGE questions may promote the identification of alcohol problems in primary care.
Prevalence and record of alcoholism among emergency department patients
Clinics, 2009
OBJECTIVES: The purpose of this study was to investigate the prevalence of alcoholism among inpatients, to identify social and demographic factors associated with this prevalence and to determine its rate of recognition by the medical team. METHODS: The study population consisted of all patients admitted to the emergency room at Hospital São Lucas, Porto Alegre, Brazil, between July and September of 2005. The data were collected in two steps: an interview with the patient and a review of the medical records to investigate the cases of alcoholism recorded by the medical team. The questionnaire consisted of questions concerning social and demographic data, smoking habits and Alcohol Use Disorders Identification Test. RESULTS: We interviewed 248 patients. Twenty-eight (11.3%) were identified as alcoholics. Compared to the patients with a negative Alcohol Use Disorders Identification Test value (less than 8), those with a positive Alcohol Use Disorders Identification Test were more likely to be male, illiterate and smokers. The medical records of 217 (87.5%) patients were reviewed. Only 5 (20.0%) of the 25 patients with a positive Alcohol Use Disorders Identification Test whose medical records were reviewed were identified as alcoholics by the medical team. The diagnosis made by the medical team, compared to Alcohol Use Disorders Identification Test, shows only a 20% sensitivity, 93% specificity and positive and negative predictive values of 29% and 90%, respectively. CONCLUSION: Alcoholism has been underrecognized in patients who are hospitalized, and, as such, this opportunity for possible early intervention is often lost. Key social and demographic factors could provide physicians with risk factors and, when used together with a standardized diagnostic instrument, could significantly improve the rate of identification of alcoholic patients.
Detection of alcohol problems in primary care outpatients under different conditions
Drug and Alcohol Dependence, 1996
Outpatients from two primary care clinics in a county hospital were screened for alcohol problems under three conditions. The objective was to determine whether patients would report more drinking and alcohol-related problems if self-report information was gathered in a research setting and/or if patients knew that their doctors would not be informed about their self-reports. The data indicate that patients' self-reports of alcohol consumption or problems were not affected by their knowledge that doctors would know their responses, and that interviews conducted in medical settings did not corrupt self-report data.
Alcoholism: Clinical and Experimental Research, 1998
Little Is known about the utility of collateral reports in substantiating self-report for individuals assessed in nonalcoholism treatment contexts. This study examined the concordance of 581 pairs of medical patient and collateral responses to a commonly used alcohol screening instrument, the CAGE Questions, as well as to reports of the patient's drinking consequences and alcohol consumption. Results demonstrated that patientkollateral concordance was marginal, but acceptable, on CAGE cut-off scores and, that similar to reports from alcoholism treatment settings, patients generally repofied more drinking consequences than collaterals. Patient and collateral reports of the patient's alcohol consumption did not differ significantly. This pattern of patient and collateral reporting of alcohol consequences and consumption was found for both men and women, as well as for patients with a DSM-Ill-R diagnosis of alcohol dependence. The findings support the validity of patient self-report on alcoholism screening measures in medical settings. Furthermore, results demonstrated that the addition of collateral reports to information directly obtained from patients only modestly improved the Identification of alcohol dependence. The overall findings indicate that alcohol screening can be done effectively and efficiently in medical settings.
BMJ, 1997
Objective: To determine the properties of the alcohol use disorders identification test in screening primary care attenders for alcohol problems. Design: A validity study among consecutive primary care attenders aged 18-65 years. Every third subject completed the alcohol use disorders identification test (a 10 item self report questionnaire on alcohol intake and related problems) and was interviewed by an investigator with the composite international diagnostic interview alcohol use module (a standardised interview for the independent assessment of alcohol intake and related disorders). Setting: 10 primary care clinics in Verona, north eastern Italy. Patients: 500 subjects were approached and 482 (96.4%) completed evaluation. Results: When the alcohol use disorders identification test was used to detect subjects with alcohol problems the area under the receiver operating characteristic curve was 0.95. The cut off score of 5 was associated with a sensitivity of 0.84, a specificity of 0.90, and a positive predictive value of 0.60. The screening ability of the total score derived from summing the responses to the five items minimising the probability of misclassification between subjects with and without alcohol problems provided an area under the receiver operating characteristic curve of 0.93. A score of 5 or more on the five items was associated with a sensitivity of 0.79, a specificity of 0.95, and a positive predictive value of 0.73. Conclusions: The alcohol use disorders identification test performs well in detecting subjects with formal alcohol disorders and those with hazardous alcohol intake. Using five of the 10 items on the questionnaire gives reasonable accuracy, and these are recommended as questions of choice to screen patients for alcohol problems.
Prevalence of unhealthy alcohol use in hospital outpatients
Drug and alcohol dependence, 2014
Few studies have examined the prevalence of unhealthy alcohol use in the hospital outpatient setting. Our aim was to estimate the prevalence of unhealthy alcohol use among patients attending a broad range of outpatient clinics at a large public hospital in Australia. Adult hospital outpatients were invited to complete the Alcohol Use Disorders Identification Test Consumption questions (AUDIT-C) using an iPad as part of a randomised trial testing the efficacy of alcohol electronic screening and brief intervention. Unhealthy alcohol use was defined as an AUDIT-C score ≥5 among men and ≥4 among women. Sixty percent (3616/6070) of invited hospital outpatients consented, of whom 89% (3206/3616) provided information on their alcohol consumption (either reported they had not consumed any alcohol in the last 12 months or completed the AUDIT-C). The prevalence of unhealthy alcohol use was 34.7% (95% confidence interval [CI]: 33.0-36.3%). The prevalence among men aged 18-24 years, 25-39 years...
JAMA Network Open
The study by Sterling et al 1 in this issue of JAMA Network Open used electronic health recorddocumented alcohol screening data from nearly 3 million patients receiving care at Kaiser Permanente Northern California to assess cross-sectional associations between 26 medical conditions and levels of alcohol use. The authors found that not drinking alcohol was generally more common among patients with medical conditions than among those without (likely reflecting abstinence owing to poor health). In adjusted analyses among patients reporting any alcohol use, those with chronic liver disease, chronic obstructive pulmonary disease, hypertension, and diabetes
Journal of substance abuse, 1994
There is a need to improve the diagnosis of alcoholism in clinical settings because alcoholism, particularly in its early stages, is often unrecognized in general medical practice and in hospitals. In this study the CAGE questionnaire was used to detect alcoholism or heavy drinking in three populations, namely, alcoholics in treatment (ALC), primary-care outpatients (PC), and the general population (GP). Nearly all the ALC tested positive on the CAGE (97.8%), both for current (past year) and for lifetime alcohol-related problems. Among the PC subjects, 44.8% tested positive for lifetime alcohol problems, but the prevalence decreased to 17.2% when only past-year problems were considered. Likewise, 38.3% of the GP sample tested positive for lifetime, but half of these did not meet the 1-year recency criterion. Compared to DSM-III-R criteria during the same time intervals, the sensitivity/specificity of the lifetime CAGE was 91.2%/84.0% and 76.9%/85.1% in the PC and GP, respectively. T...