Health Services Research & Development (HSR&D), Veterans Affairs (VA) Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA.
J Gen Intern Med. 2011 Mar;26(3):299-306. doi: 10.1007/s11606-010-1509-4. Epub 2010 Sep 22.
Alcohol screening questionnaires have typically been validated when self- or researcher-administered. Little is known about the performance of alcohol screening questionnaires administered in clinical settings.
The purpose of this study was to compare the results of alcohol screening conducted as part of routine outpatient clinical care in the Veterans Affairs (VA) Health Care System to the results on the same alcohol screening questionnaire completed on a mailed survey within 90 days and identify factors associated with discordant screening results.
Cross sectional.
A national sample of 6,861 VA outpatients (fiscal years 2007-2008) who completed the AUDIT-C alcohol screening questionnaire on mailed surveys (survey screen) within 90 days of having clinical AUDIT-C screening documented in their medical records (clinical screen).
Alcohol screening results were considered discordant if patients screened positive (AUDIT-C ≥ 5) on either the clinical or survey screen but not both. Multivariable logistic regression was used to estimate the prevalence of discordance in different patient subgroups based on demographic and clinical characteristics, VA network and temporal factors (e.g. the order of screens).
Whereas 11.1% (95% CI 10.4-11.9%) of patients screened positive for unhealthy alcohol use on the survey screen, 5.7% (5.1- 6.2%) screened positive on the clinical screen. Of 765 patients who screened positive on the survey screen, 61.2% (57.7-64.6%) had discordant results on the clinical screen, contrasted with 1.5% (1.2-1.8%) of 6096 patients who screened negative on the survey screen. In multivariable analyses, discordance was significantly increased among Black patients compared with White, and among patients who had a positive survey AUDIT-C screen or who received care at 4 of 21 VA networks.
Use of a validated alcohol screening questionnaire does not-by itself-ensure the quality of alcohol screening. This study suggests that the quality of clinical alcohol screening should be monitored, even when well-validated screening questionnaires are used.
酒精筛查问卷通常在自我或研究者管理时进行验证。在临床环境中进行酒精筛查问卷的表现知之甚少。
本研究的目的是比较退伍军人事务部（VA）医疗保健系统中作为常规门诊临床护理的一部分进行的酒精筛查结果与在 90 天内完成的邮寄调查中相同的酒精筛查问卷的结果，并确定与不一致筛查结果相关的因素。
横断面研究。
一项全国性的 VA 门诊患者样本（2007-2008 财年），他们在 90 天内完成了邮寄调查中的 AUDIT-C 酒精筛查问卷（调查筛查），并在病历中记录了临床 AUDIT-C 筛查（临床筛查）。
如果患者在临床或调查筛查中任何一项筛查阳性（AUDIT-C≥5）但两项均未筛查阳性，则认为筛查结果不一致。多变量逻辑回归用于根据人口统计学和临床特征、VA 网络和时间因素（例如筛查顺序）估计不同患者亚组中不一致的发生率。
虽然 11.1%（95%CI 10.4-11.9%）的患者在调查筛查中筛查出不健康的饮酒，但 5.7%（5.1-6.2%）的患者在临床筛查中筛查出阳性。在 765 名在调查筛查中筛查阳性的患者中，61.2%（57.7-64.6%）在临床筛查中存在不一致的结果，而在 6096 名在调查筛查中筛查阴性的患者中，这一比例为 1.5%（1.2-1.8%）。在多变量分析中，与白人相比，黑人患者的不一致率显著增加，与调查 AUDIT-C 筛查阳性的患者或在 21 个 VA 网络中的 4 个接受治疗的患者相比也是如此。
使用经过验证的酒精筛查问卷本身并不能保证酒精筛查的质量。本研究表明，即使使用经过良好验证的筛查问卷，也应监测临床酒精筛查的质量。
