Systematic Screening Is More Effective than Targeted Screening at Engaging Primary Care Patients in Discussions about Alcohol, Especially Those with Lower Risk Use

Implementing systematic screening for risky drinking can be a burden for primary care practices (PCPs). An alternative is the use of a targeted approach. Both methods were compared in a randomized trial of 16 PCPs in Sweden (N=3609 patients) to assess their impact on alcohol discussions. In the systematic screening (SyS) group, patients were asked to complete the AUDIT-C* and give it to their primary care physician before the consultation. In the consultation-based early identification (CEI) group, clinicians were encouraged to be alert for signs of alcohol-related issues during the consultation but did not receive AUDIT-C screening results; patients completed the AUDIT-C after the consultation.

• Among patients who screened positive for risky drinking** the mean age was 44 years for men and 42 years for women. Among patients with whom the issue of alcohol was brought up, the mean age was 54 years for men and 44 years for women.

• In the SyS group, 62.5% of patients with risky drinking and 64.2% of patients with lower-risk drinking had the issue of alcohol brought up. In the CEI group, the proportions were 29.7% and 30.1%, respectively. Looking at patients with risky drinking only, a higher proportion in the SyS group had the issue brought up compared with the CEI group. This association was significant for men, women, and both genders combined.

• Among patients with risky drinking who had the issue of alcohol brought up, the mean AUDIT-C score was significantly higher in the CEI group (5.8) compared with the SyS group (5.2).

Comments:

The identification method used by PCPs to identify at-risk drinking dramatically impacts the proportion of patients who discuss alcohol with their primary care physicians. Although systematic screening did not lead to systematic conversations about alcohol in this study, it did allow for a much higher proportion of patients with risky alcohol use to engage in such conversations. A targeted approach allows patients with more severe risky use to be identified, but systematic screening helps identify patients with lower-risk alcohol use (potentially even more than it helps identify patients with more severe problems) who may benefit from a single brief intervention.

Nicolas Bertholet, MD, MSc

Reference:

Reinholdz H, Fornazar R, Bendtsen P, et al. Comparison of systematic versus targeted screening for detection of risky drinking in primary care. Alcohol Alcohol. 2013;48(2):172–179.