Screening for problem drinking: impact on physician behavior and patient drinking habits.
OBJECTIVE
To assess the effect of a screen for problem drinking on medical residents and their patients.


METHODS
Descriptive cohort study.


METHODS
Veterans Affairs Medical Clinic.


METHODS
Patients were screened 2 weeks before a scheduled visit (n = 714). Physicians were informed if their patients scored positive.


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.
Conigliaro
J
J
Section of General Internal Medicine, VA Pittsburgh Health Care System, Center for Research on Healthcare, University of Pittsburgh, PA 15240, USA.
Lofgren
R P
RP
Hanusa
B H
BH
D000428:Alcohol Drinking; D000437:Alcoholism / Q000175:diagnosis*; D006801:Humans; D007396:Internship and Residency; D008875:Middle Aged; D011320:Primary Health Care; D014481:United States