Bradley Katharine A, Williams Emily C, Achtmeyer Carol E, Volpp Bryan, Collins Bonny J, Kivlahan Daniel R
Health Services Research and Development (152), VA Puget Sound Health Care System, 1100 Olive Way, Ste 1400, Seattle, WA 98101, USA.
Am J Manag Care. 2006 Oct;12(10):597-606.
Despite evidence-based guidelines, brief alcohol screening and counseling have not been routinely integrated into most primary care practices in the United States.
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.
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.
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.
The VA successfully implemented evidence-based alcohol screening, but the rate of follow-up among screen-positive patients remained low.
尽管有循证指南，但简短的酒精筛查与咨询在美国大多数初级医疗实践中尚未得到常规整合。
描述退伍军人健康管理局（VA）在2004年实施循证酒精筛查的结果，作为实施简短酒精咨询的第一步。
这项对来自所有21个VA网络的门诊患者的观察性研究依赖于VA质量与绩效办公室的以下两个数据源：（1）病历审查，旨在按季度比较VA网络，评估已有的VA患者是否有记录显示对酒精滥用进行了筛查，以及对酒精滥用筛查呈阳性的患者是否有记录显示对酒精使用障碍进行了后续评估（2005年1月至3月）；（2）2004年邮寄的患者满意度调查，该调查对新加入VA的患者进行了过度抽样（回复率>70%），包括酒精使用障碍识别测试-消费量（AUDIT-C）问题，并询问过去一年VA提供者给出的“少饮酒或不饮酒”建议。
基于10115份病历审查，93%（各网络范围为89%-96%）的门诊患者接受了酒精滥用筛查，25%（范围为11%-36%）筛查呈阳性。在筛查呈阳性的患者中，42%（范围为5%-84%）有记录显示进行了后续评估，但各网络评估的筛查呈阳性患者的绝对数量较少（每个网络27-80名患者）。基于235481份患者调查，酒精滥用的患病率为22%（各网络范围为15%-27%），28%（范围为20%-36%）的筛查呈阳性患者报告接受了与酒精相关的建议。与酒精相关的建议随着AUDIT-C分数的增加而增加。
VA成功实施了循证酒精筛查，但筛查呈阳性患者的后续跟进率仍然较低。
