title: Identification of and guidance for problem drinking by general medical providers: results from a national survey.
abstract: BACKGROUND
  Heavy alcohol use is associated with health costs and medical problems. There has been a growing consensus that primary care patients should be screened for alcohol problems.
  
  
  OBJECTIVE
  We examined rates at which patients were asked about alcohol or drug use and problems, extending research in this area by using a standardized problem drinking instrument with a large national sample, examining community level variables, and assessing the extent to which patients who were identified received follow-up.
  
  
  METHODS
  A subsample of 7371 persons from the 1998 Healthcare for Communities survey who reported visiting a general medical provider (GMP) in the past year.
  
  
  METHODS
  Participants completed questionnaires on demographics, mental and physical health, alcohol, drug use and problems, enrollment in a managed health care plan, whether their medical provider asked about alcohol or drug use, and whether they received advice, counseling, or referral.
  
  
  RESULTS
  Being asked about alcohol and drug use was associated with being male, young, highly educated, more health problems, mental health diagnosis, and being classified as a problem drinker. Only 48% of problem drinkers received any follow-up, with most being told to "stop drinking" by their GMP.
  
  
  CONCLUSIONS
  Few people are queried about alcohol or drug use when they visit a GMP. When problem use is identified, most patients do not receive appropriate follow-up and aftercare. The quality of primary care could improve if GMPs were educated about providing brief advice/counseling and were given information concerning resources in their community to make appropriate referrals for patients.
authors.affiliation: RAND, Santa Monica, California 90407-2138, USA. Elizabeth_D'Amico@rand.org
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: D'Amico
authors.forename: Susan M
authors.initials: SM
authors.lastname: Paddock
authors.forename: Audrey
authors.initials: A
authors.lastname: Burnam
authors.forename: Fuan-Yue
authors.initials: FY
authors.lastname: Kung
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000175:diagnosis* / Q000628:therapy; D003376:Counseling / Q000706:statistics & numerical data; D005194:Family Practice / Q000592:standards*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D016017:Odds Ratio; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012017:Referral and Consultation; D014481:United States