Singer Alexander, Kosowan Leanne, Loewen Shilpa, Spitoff Sheryl, Greiver Michelle, Lynch Joanna
Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
Prev Med Rep. 2021 Mar 9;22:101346. doi: 10.1016/j.pmedr.2021.101346. eCollection 2021 Jun.
Documentation of alcohol use in electronic medical record (EMR) informs interventions to reduce alcohol-related morbidity and mortality. This retrospective cohort study explored EMR data from 960 primary care providers participating in the Canadian Primary Care Sentinel Surveillance Network to describe documentation of alcohol use (e.g. none, current or past use) in the EMR. Included providers represented 700,620 adult patients from across Canada with an encounter between 2015 and 2018. Bivariate comparisons characterized the patients with, and without, documentation of alcohol use. Multivariate generalized estimating equation models with logit function assessed patient and provider characteristics associated with (1) documentation of alcohol and (2) patients with heightened risk for alcohol-related problems. Forty percent of patients had alcohol use documentation in the EMR. Light alcohol consumption was recorded for 43.6% of these patients. Male patients (OR1.09, CI 1.07-1.12), who were older (OR1.26, CI 1.23-1.30), had more frequent visits to their provider (OR1.11, CI 1.09-1.13) and had hypertension (OR1.07, CI 1.06-1.09) or depression (OR1.07, CI 1.09-1.14) had higher odds of alcohol documentation. There were 4.7% of patients with a record indicating heightened risk for alcohol-related problems. Male patients (OR3.27 CI 3.14-3.4), patients with depression (OR2.01 CI1.93-2.1) and rural residency (OR1.35 CI1.29-1.42) was associated with risk for alcohol-related problems. Heavy alcohol consumption is associated with an increased risk of negative health outcomes, particularly for patients with certain chronic conditions. However, these patients do not have alcohol use consistently documented in the EMR. Strategies should be designed and implemented to support more consistent alcohol-screening among high-risk patients.
电子病历（EMR）中关于酒精使用的记录有助于采取干预措施，以降低与酒精相关的发病率和死亡率。这项回顾性队列研究探讨了来自参与加拿大初级保健哨点监测网络的960名初级保健提供者的EMR数据，以描述EMR中酒精使用的记录情况（例如无、当前或过去使用）。纳入的提供者代表了2015年至2018年间来自加拿大各地的700,620名成年患者的就诊情况。双变量比较对有和没有酒精使用记录的患者进行了特征描述。采用具有logit函数的多变量广义估计方程模型评估与（1）酒精记录以及（2）酒精相关问题风险较高的患者相关的患者和提供者特征。40%的患者在EMR中有酒精使用记录。这些患者中有43.6%记录了轻度饮酒情况。男性患者（比值比1.09，可信区间1.07 - 1.12）、年龄较大的患者（比值比1.26，可信区间1.23 - 1.30）、更频繁就诊的患者（比值比1.11，可信区间1.09 - 1.13）以及患有高血压（比值比1.07，可信区间1.06 - 1.09）或抑郁症（比值比1.07，可信区间1.09 - 1.14）的患者有更高的酒精记录几率。有4.7%的患者记录显示存在与酒精相关问题的较高风险。男性患者（比值比3.27，可信区间3.14 - 3.4）、患有抑郁症的患者（比值比2.01，可信区间1.93 - 2.1）以及居住在农村地区的患者（比值比1.35，可信区间1.29 - 1.42）与酒精相关问题的风险相关。大量饮酒与负面健康结果风险增加相关，尤其是对于某些慢性病患者。然而，这些患者在EMR中并没有始终如一地记录酒精使用情况。应设计并实施相关策略，以支持对高危患者进行更一致的酒精筛查。
