title: Clinician suspicion of an alcohol problem: an observational study from the AAFP National Research Network.
abstract: OBJECTIVE
  In clinical practice, detection of alcohol problems often relies on clinician suspicion instead of using a screening instrument. We assessed the sensitivity, specificity, and predictive values of clinician suspicion compared with screening-detected alcohol problems in patients.
  
  
  METHODS
  We undertook a cross-sectional study of 94 primary care clinicians' office visits. Brief questionnaires were completed separately after a visit by both clinicians and eligible patients. The patient's anonymous exit questionnaire screened for hazardous drinking based on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and for harmful drinking (alcohol abuse or dependence) based on 2 questions from the Diagnostic and Statistical Manual of Mental Disorders. After the visit, clinicians responded to the question, "Does this patient have problems with alcohol?" with answer options including "yes, hazardous drinking" and "yes, alcohol abuse or dependence." Analyses assessed the associations between patients' responses to screening questions and clinician's suspicions.
  
  
  RESULTS
  Of 2,518 patients with an office visit, 2,173 were eligible, and 1,699 (78%) completed the exit questionnaire. One hundred seventy-one (10.1%) patients had a positive screening test for hazardous drinking (an AUDIT-C score of 5 or greater) and 64 (3.8%) for harmful drinking. Clinicians suspected alcohol problems in 81 patients (hazardous drinking in 37, harmful drinking in 40, and both in 4). The sensitivity of clinician suspicion of either hazardous or harmful drinking was 27% and the specificity was 98%. Positive and negative predictive values were 62% and 92%, respectively.
  
  
  CONCLUSIONS
  Clinician suspicion of alcohol problems had poor sensitivity but high specificity for identifying patients who had a positive screening test for alcohol problems. These data support the routine use of a screening tool to supplement clinicians' suspicions, which already provide reasonable positive predictive value.
authors: Department of Family and Community Medicine, University of Missouri, Columbia, 65212, USA. VinsonD@health.missouri.edu
authors: Daniel C
authors: DC
authors: Vinson
authors: Barbara J
authors: BJ
authors: Turner
authors: Brian K
authors: BK
authors: Manning
authors: James M
authors: JM
authors: Galliher
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D005194:Family Practice; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010817:Physician-Patient Relations; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011581:Psychological Tests; D011594:Psychometrics; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014481:United States