Stepped-Up Alcohol Screening in the Veterans Affairs System: Inconsistent Results
Although clinical trials demonstrate that screening for alcohol use in primary care is efficacious in identifying alcohol use disorders, the performance of screening in real-world settings has not been assessed. Using a national sample of 6861 Veterans Affairs (VA) outpatients, investigators compared AUDIT-C* results obtained during clinical care with AUDIT-C results obtained via mailed survey. A score ≥5 was considered positive.
- Results were discordant in 561 patients (8% overall): 468 of 765 patients (61%) who screened positive on the mailed survey had a negative clinical screen, while 93 of 390 patients (24%) who screened positive in the clinic screened negative on the survey.
- Factors independently associated with discordance in multivariable analysis included black/African American race (odds ratio [OR], 2.1), VA network site (highest OR, 11.7), and mailed survey score (compared with a score of 0, a score of 3–4=OR, 8.9; a score of 5– 7=OR, 69; and a score of 8–12=OR, 46).