Physicians' low detection rates of alcohol dependence or abuse: a matter of methodological shortcomings?
Previous research may have underestimated physicians' detection rates of alcohol dependence or abuse because case findings have been based on screening questionnaires instead of using in-depth diagnostic criteria and detection rates have been assessed by analyzing patient records instead of directly interviewing the physician. To test this hypothesis, consecutive patients of a general hospital (N=436) and of 12 randomly selected general practices (N=929) were examined. A two-step diagnostic procedure included screening questionnaires and a diagnostic interview (SCAN). The analysis compares detection rates based on methods used in previous studies to data using more precise methods. Physicians' detection rates ranged from 37.0% to 88.9% in the general hospital and from 11.1% to 74.7% in general practices depending on methods used. The physicians' detection rates could be improved by 10% (general hospital) and 20% (general practice) through the additional use of a screening questionnaire. Of those patients assessed by the physicians as problem drinkers in the general hospital, 13.9% were referred to an addiction consultation-liaison service. Data reveal that physicians' abilities to detect problem drinkers have been underestimated. Routine screening procedures could play a major role in improving detection rates and reminding the physician to intervene.
Rumpf
H J
HJ
Medical University of Lübeck, Department of Psychiatry and Psychotherapy, Research Group for Substance Abuse: Treatment, Epidemiology, and Prevention (S:TEP), Federal Republic of, Lübeck, Germany. h.rumpf@ukl.mu-luebeck.de
Bohlmann
J
J
Hill
A
A
Hapke
U
U
John
U
U
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D015982:Bias; D005194:Family Practice; D005260:Female; D005858:Germany; D006769:Hospitals, General; D006801:Humans; D007407:Interviews as Topic / Q000379:methods* / Q000592:standards; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008485:Medical Audit; D008487:Medical History Taking / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D010820:Physicians / Q000523:psychology; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000175:diagnosis*; D011795:Surveys and Questionnaires / Q000592:standards*