Screening for Alcohol Use Disorders Among Medical Outpatients: The Influence of Individual and Facility Characteristics

• Published in: The American journal of psychiatry 2005-08, Vol.162 (8), p.1521-1526
• Main Authors: Desai, Mayur M., Rosenheck, Robert A., Craig, Thomas J.
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Aged; Alcohol use; Alcohol-Related Disorders - diagnosis; Alcohol-Related Disorders - epidemiology; Alcoholism; Ambulatory Care; Biological and medical sciences; Diagnosis, Dual (Psychiatry); Female; Follow-Up Studies; Health Facility Size; Health risk assessment; Hospitals, Veterans - statistics & numerical data; Humans; Male; Mass Screening - methods; Medical disorders; Medical Records - statistics & numerical data; Medical sciences; Medical screening; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Middle Aged; Prevalence; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Risk Factors; United States - epidemiology; United States Department of Veterans Affairs; Veterans - statistics & numerical data
• ISSN: 0002-953X; 1535-7228
• DOI: 10.1176/appi.ajp.162.8.1521

OBJECTIVE: Screening of adults in primary care has been recommended to reduce alcohol misuse. This study determined the rates and predictors of alcohol screening, screening positive, follow-up evaluation, and subsequently diagnosed alcohol use disorder in a national sample of Department of Veterans Affairs (VA) medical outpatients. METHOD: Chart-abstracted quality improvement data from the VA's 2002 External Peer Review Program were merged with records for 15,580 medical outpatients drawn from 139 VA facilities nationwide. RESULTS: Nearly three-quarters of eligible patients (N=11,553) had chart-documented alcohol screening in the past year. Of these, 4.2% (N=484) screened positive. Of those who screened positive, three-fourths (N=370) received follow-up evaluation, and of these, 53.5% (N=198) were subsequently diagnosed with an alcohol use disorder-1.7% of the originally screened sample. Multivariate logistic regression revealed that several factors generally associated with increased risk of alcohol use disorders-including being younger, unmarried, and disabled, as well as having greater medical and psychiatric comorbidities-were actually associated with a decreased likelihood of alcohol screening. At the facility level, screening was less likely at more academically affiliated centers, and follow-up evaluation of a positive screening was less likely at the largest facilities. CONCLUSIONS: Routine alcohol screening yielded relatively few positive cases, raising questions about its cost-effectiveness. Targeted strategies may increase the value of case-finding activities among patients at greatest risk for alcohol use disorders and at more academically affiliated facilities. Targeted efforts are also needed to ensure proper follow-up evaluation at larger medical centers where patients may experience greater system-level barriers.