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Quality Concerns with Routine Alcohol Screening in VA Clinical Settings

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ABSTRACT

BACKGROUND

Alcohol screening questionnaires have typically been validated when self- or researcher-administered. Little is known about the performance of alcohol screening questionnaires administered in clinical settings.

OBJECTIVE

The purpose of this study was to compare the results of alcohol screening conducted as part of routine outpatient clinical care in the Veterans Affairs (VA) Health Care System to the results on the same alcohol screening questionnaire completed on a mailed survey within 90 days and identify factors associated with discordant screening results.

DESIGN

Cross sectional.

PARTICIPANTS

A national sample of 6,861 VA outpatients (fiscal years 2007–2008) who completed the AUDIT-C alcohol screening questionnaire on mailed surveys (survey screen) within 90 days of having clinical AUDIT-C screening documented in their medical records (clinical screen).

MAIN MEASURES

Alcohol screening results were considered discordant if patients screened positive (AUDIT-C ≥ 5) on either the clinical or survey screen but not both. Multivariable logistic regression was used to estimate the prevalence of discordance in different patient subgroups based on demographic and clinical characteristics, VA network and temporal factors (e.g. the order of screens).

KEY RESULTS

Whereas 11.1% (95% CI 10.4-11.9%) of patients screened positive for unhealthy alcohol use on the survey screen, 5.7% (5.1- 6.2%) screened positive on the clinical screen. Of 765 patients who screened positive on the survey screen, 61.2% (57.7-64.6%) had discordant results on the clinical screen, contrasted with 1.5% (1.2-1.8%) of 6096 patients who screened negative on the survey screen. In multivariable analyses, discordance was significantly increased among Black patients compared with White, and among patients who had a positive survey AUDIT-C screen or who received care at 4 of 21 VA networks.

CONCLUSION

Use of a validated alcohol screening questionnaire does not—by itself—ensure the quality of alcohol screening. This study suggests that the quality of clinical alcohol screening should be monitored, even when well-validated screening questionnaires are used.

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Acknowledgements

The authors greatly appreciate the VA Office of Quality and Performance for sharing their data for use in this study and feedback on several drafts of the manuscript.

The research reported here was supported by Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service. The manuscript was specifically produced with support from the Veterans Affairs Substance Use Disorders Quality Enhancement Research Initiative (SUB 98-000). Data for this study were provided by the VA Office of Quality and Performance.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the University of Washington.

Conflict of Interest

None disclosed.

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Correspondence to Katharine A. Bradley MD, MPH.

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Bradley, K.A., Lapham, G.T., Hawkins, E.J. et al. Quality Concerns with Routine Alcohol Screening in VA Clinical Settings. J GEN INTERN MED 26, 299–306 (2011). https://doi.org/10.1007/s11606-010-1509-4

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  • DOI: https://doi.org/10.1007/s11606-010-1509-4

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