Screening for alcohol use disorders among medical outpatients: the influence of individual and facility characteristics.
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.
Desai
Mayur M
MM
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
Rosenheck
Robert A
RA
Craig
Thomas J
TJ
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