title: Can routine information from electronic patient records predict a future diagnosis of alcohol use disorder?
abstract: OBJECTIVE
  To explore whether information regarding potentially alcohol-related health incidents recorded in electronic patient records might aid in earlier identification of alcohol use disorders.
  
  
  METHODS
  We extracted potentially alcohol-related information in electronic patient records and tested if alcohol-related diagnoses, prescriptions of codeine, tramadol, ethylmorphine, and benzodiazepines; elevated levels of gamma-glutamyl-transferase (GGT), and mean cell volume (MCV); and new sick leave certificates predicted specific alcohol use disorder.
  
  
  METHODS
  Nine general practitioner surgeries with varying size and stability.
  
  
  METHODS
  Totally 20,764 patients with active electronic patient record until data gathering and with a history of at least four years without a specific alcohol use disorder after turning 18 years of age.
  
  
  METHODS
  The Cox proportional hazard analysis with time-dependent covariates of potential accumulated risks over the previous four years.
  
  
  METHODS
  Time from inclusion until the first specific alcohol use disorder, defined by either an alcohol specific diagnostic code or a text fragment documenting an alcohol problem.
  
  
  RESULTS
  In the unadjusted and adjusted Cox-regression with time-dependent covariates all variables were highly significant with adjusted hazard ratios ranging from 1.25 to 3.50. Addictive drugs, sick leaves, GGT, MCV and International Classification for Primary Care version 2 (ICPC-2), and International Classification of Diseases version 10 (ICD-10) diagnoses were analyzed. Elevated GGT and MCV, ICD-10-diagnoses, and gender demonstrated the highest hazard ratios.
  
  
  CONCLUSIONS
  Many frequent health problems are potential predictors of an increased risk or vulnerability for alcohol use disorders. However, due to the modest hazard ratios, we were unable to establish a clinically useful tool. KEY POINTS Alcohol is potentially relevant for many health problems, but current strategies for identification and intervention in primary health care have not been successful. Many frequent clinical problems recorded in electronic patient records may indicate an increased risk for alcohol related health problems. The hazard ratios were modest and the resulting predictive model was unsatisfactory for diagnostic purposes. If we accepted a sensitivity as low as 0.50, the specificity slightly exceeded 0.75. With a low prevalent condition, it is obvious that the false positive problem will be vast. In addition to responding to elevated blood levels of liver enzymes, general practitioners should be aware of alcohol as a potentially relevant factor for patients with repeated events of many mental and psychosocial diagnoses and new sick leaves and repeated prescriptions of addictive drugs.
authors.affiliation: a Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway ;|b Research Unit for General Practice , Uni Health, Uni Research , Bergen , Norway ;|c Centre for Alcohol and Drug Research, Stavanger University Hospital , Stavanger , Norway ;
authors.forename: Torgeir Gilje
authors.initials: TG
authors.lastname: Lid
authors.affiliation: a Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway ;|d Centre for Clinical Research, Haukeland University Hospital , Bergen , Norway ;
authors.forename: Geir Egil
authors.initials: GE
authors.lastname: Eide
authors.affiliation: e Department of Research , Stavanger University Hospital , Stavanger , Norway.
authors.forename: Ingvild
authors.initials: I
authors.lastname: Dalen
authors.affiliation: a Department of Global Public Health and Primary Care , University of Bergen , Bergen , Norway ;
authors.forename: Eivind
authors.initials: E
authors.lastname: Meland
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D003061:Codeine / Q000627:therapeutic use; D042241:Early Diagnosis; D057286:Electronic Health Records; D004909:Erythrocyte Indices; D005036:Ethylmorphine / Q000627:therapeutic use; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D016016:Proportional Hazards Models; D012307:Risk Factors; D018582:Sick Leave; D014147:Tramadol / Q000627:therapeutic use; D055815:Young Adult; D005723:gamma-Glutamyltransferase
chemical_list: D000701:Analgesics, Opioid; D001569:Benzodiazepines; D014147:Tramadol; D005723:gamma-Glutamyltransferase; D005036:Ethylmorphine; D003061:Codeine
keywords: Alcohol-related disorders; Norway; computerized patient records; early diagnosis; general practice