Low Reach of Four Different Alcohol Screening Approaches in the Absence of Population-Based Screening: Results From One Large Integrated Health Care System

Background/Aims: Population-based alcohol screening is recommended for identifying patients who may benefit from brief alcohol interventions. Although few health systems universally screen primary care patients for unhealthy alcohol use, some may offer screening at specific appointments or through online health risk assessments. However, little is known about the reach of various alcohol screening approaches in the absence of universal alcohol screening. The objective was to evaluate the proportion of primary care patients who were: 1) screened for unhealthy alcohol use, and 2) screened positive as a result of four different screening approaches. Methods: This project included 262,616 adults enrolled in Group Health in 2012 who had at least one primary care visit. Electronic medical record documentation of Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) screening results were obtained from four screening approaches: online health risk assessment; progress note documentation through a template completed at preventive visits; paper-based questionnaire completed at mental health visits; and ad-hoc screening when providers had concerns. AUDIT-C results, ranging from 0–12 points, were positive for unhealthy alcohol use at scores of ≥ 3 and ≥ 4 points for women and men, respectively. The percentage of patients screened and the percentage of screened patients who were positive for unhealthy alcohol use were estimated overall and across the four screening approaches. Results: Overall, 14% (36,435) were screened with the AUDIT-C. The approach-specific percentages of patients screened were 8% online, 3% at preventive visits, 1% at mental health visits and 3% by ad-hoc screening. Of those screened, 33% were positive for unhealthy alcohol use and the approach-specific percentages of patients who screened positive were 35% online, 28% at preventive visits, 40% at mental health visits and 45% by ad-hoc screening. Discussion: Despite four approaches to alcohol screening, 86% of primary care patients were not screened for unhealthy alcohol use. Formal implementation of universal screening is likely necessary to achieve high rates of alcohol screening