title: Screening for alcohol use disorders among medical outpatients: the influence of individual and facility characteristics.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, NEPEC (182), 950 Campbell Ave., West Haven, CT 06516, USA. mayur.desai@yale.edu
authors.forename: Mayur M
authors.initials: MM
authors.lastname: Desai
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Craig
mesh_terms: D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D000553:Ambulatory Care; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005500:Follow-Up Studies; D006276:Health Facility Size; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008499:Medical Records / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data