Screening for Unhealthy Alcohol Use: Hospital or Primary Care?
One might argue that alcohol screening should have the greatest impact in settings, like hospitals, that have a significant proportion of patients with unhealthy alcohol use. But does hospital-based screening reach at-risk patients too late? To assess this possibility, researchers in the United Kingdom reviewed the medical records of 94 inpatients with alcohol-related cirrhosis and determined how many had a hospital admission before receiving a diagnosis of alcohol-related liver disease. They also interviewed 45 patients with alcohol-related liver disease, who were hospitalized on a liver ward or seen at an outpatient liver specialty service, to assess health services utilization.
- In the record review, 60% (56/94) of inpatients did not have a hospital admission before receiving a diagnosis of alcohol-related liver disease.
- Only one third (31/94) of inpatients had a prior hospitalization for an alcohol-related reason.
- The mean time from first admission to diagnosis of alcohol-related liver disease was 10 years.
- Interviewed patients reported relatively frequent contact (ranging from 2 to 13 visits per year) with their general practitioners in the preceding 5 years.
Most hospitalized patients with alcohol-related liver disease do not have prior hospitalizations. These findings suggest that screening may not have its maximal impact if conducted only with hospitalized patients. Primary care settings provide an opportunity to screen, and therefore to prevent, the consequences of unhealthy alcohol use.Richard Saitz, MD, MPH
Verrill C, Smith S, Sheron N, et al. Are the opportunities to prevent alcohol related liver deaths in the UK in primary or secondary care? A retrospective clinical review and prospective interview study. Subst Abuse Treat Prev Policy. 2006;1:16.