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Am J Manag Care. 2006 Oct;12(10):597-606.

Implementation of evidence-based alcohol screening in the Veterans Health Administration.

Author information

  • 1Health Services Research and Development (152), VA Puget Sound Health Care System, 1100 Olive Way, Ste 1400, Seattle, WA 98101, USA. willi@u.washington.edu

Abstract

BACKGROUND:

Despite evidence-based guidelines, brief alcohol screening and counseling have not been routinely integrated into most primary care practices in the United States.

OBJECTIVE:

To describe the results of the implementation of evidence-based alcohol screening by the Veterans Health Administration (VA) in 2004, as the first step toward implementation of brief alcohol counseling.

STUDY DESIGN:

This observational study of outpatients from all 21 VA networks relied on the following 2 data sources from the VA Office of Quality and Performance: (1) Medical record reviews, designed to compare VA networks quarterly, evaluated whether established VA patients had documented screening for alcohol misuse and documented follow-up assessment for alcohol use disorders among those who screened positive for alcohol misuse (January-March 2005); and (2) Mailed patient satisfaction surveys from 2004, which oversampled patients new to the VA (response rate, >70%), included the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions and asked about past-year advice "to drink less or not to drink alcohol" from a VA provider.

RESULTS:

Based on 10 115 medical record reviews, 93% (range, 89%-96% across networks) of outpatients were screened for alcohol misuse, and 25% (range, 11%-36%) screened positive. Among screen-positive patients, 42% (range, 5%-84%) had documented follow-up assessment, but absolute numbers of screen-positive patients evaluated were small (27-80 patients per network). Based on 235 481 patient surveys, the prevalence of alcohol misuse was 22% (range, 15%-27% across networks), and 28% (range, 20%- 36%) of screen-positive patients reported receiving alcohol-related advice. Alcohol-related advice increased as AUDIT-C scores increased.

CONCLUSION:

The VA successfully implemented evidence-based alcohol screening, but the rate of follow-up among screen-positive patients remained low.

PMID:
17026414
[PubMed - indexed for MEDLINE]
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