Sahker Ethan, Arndt Stephan
Iowa Consortium for Substance Abuse Research and Evaluation, 100 MTP4, University of Iowa, Iowa City, IA 52245-5000, USA; Department of Psychological and Quantitative Foundations, Counseling Psychology Program, College of Education, University of Iowa, 361 Lindquist Center, Iowa City, IA 52242, USA.
Department of Psychological and Quantitative Foundations, Counseling Psychology Program, College of Education, University of Iowa, 361 Lindquist Center, Iowa City, IA 52242, USA; Department of Psychiatry, Carver College of Medicine, University of Iowa, 451 Newton Road, 200 Medicine Administration Building, Iowa City, IA 52242, USA; Department of Biostatistics, College of Public Health, University of Iowa, 145 N. Riverside Drive, 100 CPHB, Iowa City, IA 52242, USA.
Int J Drug Policy. 2017 Mar;41:29-33. doi: 10.1016/j.drugpo.2016.11.013. Epub 2016 Dec 24.
Regular/chronic drinking, defined by five or more drinks in one sitting on each of five or more occasions in the past 30 days, is a significant problem contributing to negative health outcomes, morbidity, and mortality. Regular/chronic and heavy episodic drinking largely goes undetected by primary care providers due to a lack of screening and intervention. The present study explores the extent to which healthcare practitioners screen for alcohol use, provide interventions, and refer to treatment across different types of drinkers.
A retrospective analysis of the 2014 National Survey on Drug Use and Health was analysed in 2016. Respondents who visited primary care settings were asked if healthcare providers queried them about their drinking, amount they drank, frequency of drinking, and if they received interventions. Simple tests among proportions and logistic regression were used to analyse these data.
Healthcare professionals asked 76.5% of patients if they drank alcohol at all in the past year, and only 11.8% were asked if they had a drinking problem. The chance of being asked increased for heavy episodic and regular/chronic drinkers (F=44.81, p<0.001). Healthcare providers infrequently suggested cutting down on drinking (5.5% overall), but the chance of receiving a suggestion increased across heavy episodic and regular/chronic drinkers (F=196.22, p<0.001). Information about alcohol treatment referral was rarely given (7.3% of regular/chronic drinkers). Moreover, minority, older, male, and uninsured patients were queried about alcohol use less often.
Healthcare practitioners in primary care are screening for alcohol use at moderate rates, yet follow-up questions, brief advice, and treatment referrals are inconsistently targeted. There is a need for consistent screening of all patients and systematic follow-up protocols in primary care delivery.
经常/长期饮酒被定义为在过去30天内有5次或更多次单次饮酒量达到5杯或以上，这是一个导致负面健康结果、发病和死亡的重大问题。由于缺乏筛查和干预，初级保健提供者很大程度上未能发现经常/长期和大量偶尔饮酒的情况。本研究探讨了医疗从业者针对不同类型饮酒者筛查酒精使用情况、提供干预措施以及转介治疗的程度。
2016年对2014年全国药物使用和健康调查进行了回顾性分析。询问了前往初级保健机构就诊的受访者，医疗保健提供者是否询问过他们的饮酒情况、饮酒量、饮酒频率以及他们是否接受过干预措施。使用比例间的简单检验和逻辑回归分析这些数据。
医疗保健专业人员询问了76.5%的患者在过去一年是否饮酒，而只有11.8%的患者被询问是否有饮酒问题。大量偶尔饮酒者和经常/长期饮酒者被询问的可能性增加（F = 44.81，p < 0.001）。医疗保健提供者很少建议减少饮酒（总体为5.5%），但大量偶尔饮酒者和经常/长期饮酒者接受建议的可能性增加（F = 196.22，p < 0.001）。很少提供关于酒精治疗转介的信息（经常/长期饮酒者中有7.3%）。此外，少数族裔、老年、男性和未参保患者被询问饮酒情况的频率较低。
初级保健中的医疗从业者以中等比例筛查酒精使用情况，但后续问题、简短建议和治疗转介的针对性不一致。在初级保健服务中，需要对所有患者进行一致的筛查并制定系统的随访方案。
