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Alcohol:
A Standard Practice of Screening for Alcohol Problems is Essential for Quality Care in Health Systems and Hospitals

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Health outcomes and quality of care would improve markedly if health care systems and hospitals routinely screened all outpatients and inpatients for alcohol use, intervening when appropriate. Over-consumption of alcohol complicates many chronic and acute conditions.1 In a typical primary care practice of 2,000 patients, 400 have problems with alcohol, with 100 patients severely dependent, or alcoholic, and the other 300 drinking at levels greater than their bodies can safely handle.2 Alcohol abuse is correlated with violence3 and accidents. It compromises sleep4 and, because alcohol is a depressant, it can worsen depression. Inappropriate levels of alcohol consumption affect many chronic and acute conditions. Over-use of alcohol, thus, is a factor in development of many problems that require hospital admission. Research on the relation of alcohol to hospital admissions has been limited but shows that almost 30 percent of general hospital admissions for men involved alcohol-related disorders.5,6

Health care systems and hospitals are in an excellent position to help lower or eliminate patients' alcohol consumption by routinely screening all outpatients and inpatients for alcohol use, and intervening where appropriate. While the need for standardized alcohol screening and intervention is clear, such screening is not currently mandated by NCQA or JCAHO. Nor does it occur in most in-patient or out-patient settings. Most physicians7 simply do not take the initiative on their own to routinely screen and intervene with patient alcohol problems.

What Can Be Done?

Most alcohol screening tools can be added to already-existing questionnaires given to patients at an annual exam, with little added time for the physician or health team member devoted to follow-up. Standards have been developed to help hospitals and health systems measure quality and consistency of alcohol screening and intervention.8 HMOs, insurance plans and benefits purchasers can require a basic level of alcohol screening by hospitals and health care systems.

Health care systems are in an excellent position to screen for alcohol during routine patient visits. Providers have at their disposal a number of good screening tools as well as specific protocols for referring and following up with these at-risk patients.

Click here for instructions on screening with the CAGE.

Notes:
  1. Medical Consequences, Tenth Special Report to the U.S. Congress on Alcohol and Health, National Institute for Alcohol Abuse and Alcoholism (NIAAA), Washington, DC, pp. 197-282, 2000.


  2. Fleming, M, Cotter, F, and Talboy, E. Training Physicians in Techniques for Alcohol Screening and Brief Intervention.U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Washington, DC, 1997.


  3. Alcohol and Crime: An analysis of National Data on the Prevalence of Alcohol Involvement in Crime. Report prepared for Assistance Attorney Generals National Symposium on Alcohol Abuse and Crime, Washington, DC: U.S. Department of Justice, 1998.


  4. Vitiello, MV. "Sleep, Alcohol and Alcohol Abuse." Addict Biol (2):151-158, 1997.


  5. Piette, JD, Barnett, PG, and Moos, RH. "First-time Admissions with Alcohol-related Medical Problems: A 10-year Follow-up of a National Sample of Alcoholic Patients." Journal of Studies on Alcohol 59(1):89-96, January 1998.


  6. Gerke, P, Hapke, U, and Rumpf, HJ. "Alcohol-related Diseases in General Hospital Patients." Alcohol & Alcoholism 32(2):179-84, March-April 1997.


  7. Missed Opportunity: The National Survey of Primary Care Physicians and Patients on Substance Abuse. The National Center on Addiction and Substance Abuse at Columbia University (CASA), New York, 2000.


  8. Bethell, Christina. Development of Measures of Health System Performance in the Early Identification and Reduction of Alcohol-Related Problems. FACCT, Inc., Portland, OR. February 2000.
  
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