Under the radar: a cross-sectional study of the challenge of identifying at-risk alcohol consumption in the general practice setting.
BACKGROUND
Primary care providers are an important source of information regarding appropriate alcohol consumption. As early presentation to a provider for alcohol-related concerns is unlikely, it is important that providers are able to identify at-risk patients in order to provide appropriate advice. This study aimed to report the sensitivity, specificity, positive predictive value and negative predictive value of General Practitioner (GP) assessment of alcohol consumption compared to patient self-report, and explore characteristics associated with GP non-detection of at-risk status.


METHODS
GP practices were selected from metropolitan and regional locations in Australia. Eligible patients were adults presenting for general practice care who were able to understand English and provide informed consent. Patients completed a modified AUDIT-C by touchscreen computer as part of an omnibus health survey while waiting for their appointment. GPs completed a checklist for each patient, including whether the patient met current Australian guidelines for at-risk alcohol consumption. Patient self-report and GP assessments were compared for each patient.


RESULTS
GPs completed the checklist for 1720 patients, yielding 1565 comparisons regarding alcohol consumption. The sensitivity of GPs' detection of at-risk alcohol consumption was 26.5%, with specificity of 96.1%. Higher patient education was associated with GP non-detection of at-risk status.


CONCLUSIONS
GP awareness of which patients might benefit from advice regarding at-risk alcohol consumption appears low. Given the complexities associated with establishing whether alcohol consumption is 'at-risk', computer-based approaches to routine screening of patients are worthy of exploration as a method for prompting the provision of advice in primary care.
Health Behaviour Research Group, Priority Research Centre for Health Behaviour and Hunter Medical Research Institute, The University of Newcastle, Callaghan, NSW, Australia. Chris.Paul@newcastle.edu.au.
Christine
C
Paul
Sze Lin
SL
Yoong
Rob
R
Sanson-Fisher
Mariko
M
Carey
Grant
G
Russell
Meredith
M
Makeham
D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D001315:Australia / Q000453:epidemiology; D057189:Checklist; D002983:Clinical Competence / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D010361:Patients / Q000523:psychology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards; D018570:Risk Assessment / Q000706:statistics & numerical data*; D057566:Self Report; D012680:Sensitivity and Specificity; D055815:Young Adult