title: Screening for At-Risk Alcohol Consumption in Primary Care: A Randomized Evaluation of Screening Approaches.
abstract: OBJECTIVE
  The aim of the study was to explore the relative efficiency and effectiveness of targeted versus universal screening for at-risk alcohol use in a primary care population in the UK.
  
  
  METHODS
  The study was a randomized evaluation of screening approach (targeted versus universal) for consecutive attendees at primary care aged 18 years or more. Targeted screening involved screening any patient attending with one of the targeted presentations, conditions associated with excessive alcohol consumption: mental health, gastrointestinal, hypertension, minor injuries or a new patient registration. In the universal arm of the study all presentations in the recruitment period were included. Universal screening included all patients presenting to allocated practices.
  
  
  RESULTS
  A total of 3562 potential participants were approached. The odds ratio of being screen positive was higher for the targeted group versus the universal group. Yet the vast majority of those screening positive in the universal group of the study would have been missed by a targeted approach. A combination of age and gender was a more efficient approach than targeting by clinical condition or context.
  
  
  CONCLUSIONS
  While screening targeted by age and gender is more efficient than universal screening, targeting by clinical condition or presentation is not. Further universal screening is more effective in identifying the full range of patients who could benefit from brief alcohol interventions, and would therefore have greater public health impact.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN06145674.
authors.affiliation: Centre for Health Services Studies, University of Kent, Canterbury CT2 7NZ, Kent, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Coulton
authors.affiliation: Department of Health Sciences, University of York, York YO10 5DD, UK.
authors.forename: Veronica
authors.initials: V
authors.lastname: Dale
authors.affiliation: Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Deluca
authors.affiliation: Plummer Court - Northumberland Tyne and Wear NHS Foundation Trust, Newcastle NE1 6UR, UK.
authors.forename: Eilish
authors.initials: E
authors.lastname: Gilvarry
authors.affiliation: Department of Health Sciences, University of York, York YO10 5DD, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Godfrey
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle NE2 4AX, UK.
authors.forename: Eileen
authors.initials: E
authors.lastname: Kaner
authors.affiliation: Institute of Health and Society, Newcastle University, Newcastle NE2 4AX, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: McGovern
authors.affiliation: School of Health and Social Care, Teesside University, Middlesbrough TS1 3BX, UK.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Newbury-Birch
authors.affiliation: School of Psychology, University of Surrey, Guildford GU2 7XH, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Patton
authors.affiliation: Department of Health Sciences, University of York, York YO10 5DD, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Parrott
authors.affiliation: Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester M13 9PL, UK.
authors.forename: Katherine
authors.initials: K
authors.lastname: Perryman
authors.affiliation: Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.|Humber NHS Foundation Trust, Willerby HU10 6ED, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Phillips
authors.affiliation: Crime and Security Research Group, Cardiff University, Cardiff CF10 3DB, Wales, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Shepherd
authors.affiliation: Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Drummond
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology* / Q000639:trends; D000437:Alcoholism / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards* / Q000639:trends; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods / Q000592:standards* / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult