Implementation of evidence-based alcohol screening in the Veterans Health Administration.
BACKGROUND
Despite evidence-based guidelines, brief alcohol screening and counseling have not been routinely integrated into most primary care practices in the United States.


OBJECTIVE
To describe the results of the implementation of evidence-based alcohol screening by the Veterans Health Administration (VA) in 2004, as the first step toward implementation of brief alcohol counseling.


METHODS
This observational study of outpatients from all 21 VA networks relied on the following 2 data sources from the VA Office of Quality and Performance: (1) Medical record reviews, designed to compare VA networks quarterly, evaluated whether established VA patients had documented screening for alcohol misuse and documented follow-up assessment for alcohol use disorders among those who screened positive for alcohol misuse (January-March 2005); and (2) Mailed patient satisfaction surveys from 2004, which oversampled patients new to the VA (response rate, >70%), included the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions and asked about past-year advice "to drink less or not to drink alcohol" from a VA provider.


RESULTS
Based on 10 115 medical record reviews, 93% (range, 89%-96% across networks) of outpatients were screened for alcohol misuse, and 25% (range, 11%-36%) screened positive. Among screen-positive patients, 42% (range, 5%-84%) had documented follow-up assessment, but absolute numbers of screen-positive patients evaluated were small (27-80 patients per network). Based on 235 481 patient surveys, the prevalence of alcohol misuse was 22% (range, 15%-27% across networks), and 28% (range, 20%- 36%) of screen-positive patients reported receiving alcohol-related advice. Alcohol-related advice increased as AUDIT-C scores increased.


CONCLUSIONS
The VA successfully implemented evidence-based alcohol screening, but the rate of follow-up among screen-positive patients remained low.
Bradley
Katharine A
KA
Health Services Research and Development (152), VA Puget Sound Health Care System, 1100 Olive Way, Ste 1400, Seattle, WA 98101, USA. willi@u.washington.edu
Williams
Emily C
EC
Achtmeyer
Carol E
CE
Volpp
Bryan
B
Collins
Bonny J
BJ
Kivlahan
Daniel R
DR
D000437:Alcoholism / Q000175:diagnosis*; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D019538:Health Care Surveys; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D008485:Medical Audit; D011216:Practice Management, Medical; D014481:United States; D014493:United States Department of Veterans Affairs