评估肝病患者的饮酒史：改善早期干预的机会。

Assessment of alcohol histories obtained from patients with liver disease: opportunities to improve early intervention.

机构信息

Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Centre for Liver Disease Research, School of Medicine, The University of Queensland, Translational Research Institute, Brisbane, Queensland, Australia.

出版信息

Intern Med J. 2013 Oct;43(10):1096-102. doi: 10.1111/imj.12229.

DOI:10.1111/imj.12229

PMID:23834077

Abstract

BACKGROUND

Alcohol is an important primary and comorbid cause of liver injury in patients referred for investigation and management of liver disease. Early assessment and documentation of alcohol consumption is therefore essential, and recommended in both general practice and hospital settings.

AIMS

To determine the extent and accuracy of documentation of alcohol consumption in patients referred for evaluation of liver disease.

METHODS

Patients were interviewed using a structured questionnaire. The medical records of all patients interviewed were reviewed to obtain information from the referral letter and the hepatology consultations.

RESULTS

Eighty-three patients were surveyed. Only 14 referrals had an informative alcohol history, despite 27 patients admitting risky alcohol consumption at the initial hepatology consultation. Ninety per cent of initial consultations had an informative alcohol history documented, whereas only 56% of patients attending a follow-up appointment had informative documentation. Assessment of alcohol consumption was comparable between the hepatology consultation and the structured questionnaire, but four subjects had substantially different alcohol histories. Alcohol Use Disorders Identification Test identified all patients reporting harmful alcohol consumption on the questionnaire.

CONCLUSIONS

Hazardous alcohol use is prevalent in subjects attending hepatology clinics, but informative alcohol histories, which are crucial to patient management, are rarely documented in referrals. Screening tools improve documentation and accuracy of alcohol histories, and their use by general practitioners and hospital clinicians would improve detection rates of hazardous drinking and allow earlier intervention. Systematic use of screening tools in hepatology clinics will provide opportunities for education and reinforce recommendations to reduce hazardous or harmful alcohol consumption.

摘要

背景

酒精是导致患者肝脏损伤的一个重要原发性和并发原因，这些患者因肝脏疾病的诊断和治疗而就诊。因此，早期评估和记录酒精摄入量至关重要，这在普通科医生和医院环境中都有推荐。

目的

确定在因肝脏疾病就诊的患者中，记录酒精摄入量的程度和准确性。

方法

对患者使用结构化问卷进行访谈。对所有接受访谈的患者的病历进行回顾，以从转诊信和肝病咨询中获取信息。

结果

共调查了 83 名患者。尽管有 27 名患者在初次肝病咨询时承认有风险的饮酒行为，但只有 14 份转诊有详细的饮酒史。90%的初次咨询记录了有意义的饮酒史，但只有 56%的患者在随访时记录了有意义的饮酒史。在肝病咨询和结构化问卷中，对酒精摄入量的评估是可比的，但有 4 位患者的饮酒史有很大的不同。酒精使用障碍识别测试（Alcohol Use Disorders Identification Test）在问卷中识别出所有报告有有害饮酒行为的患者。

结论

在接受肝病诊所治疗的患者中，危险饮酒行为很常见，但在转诊中很少有记录详细的饮酒史，这对患者的管理至关重要。筛查工具可提高酒精史的记录和准确性，普通科医生和医院临床医生使用这些工具将提高危险饮酒的检出率，并允许更早进行干预。在肝病诊所中系统地使用筛查工具将提供教育机会，并加强减少危险或有害饮酒的建议。