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General practitioners recognizing alcohol dependence: a large cross-sectional study in 6 European countries
Jürgen Rehm1, Allaman Allamani1, Roberto Della Vedova1
1Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.).
Purpose:
Although alcohol dependence causes marked mortality and disease burden in Europe, the treatment rate is low. Primary care could play a key role in reducing alcohol-attributable harm by screening, brief interventions, and initiating or referral to treatment. This study investigates identification of alcohol dependence in European primary care settings.
Methods:
Assessments from 13,003 general practitioners, and 9,098 interviews (8,476 joint number of interviewed patients with a physician's assessment) were collected in 6 European countries. Alcohol dependence, comorbidities, and health service utilization were assessed by the general practitioner and independently using the Composite International Diagnostic Interview (CIDI) and other structured interviews. Weighted regression analyses were used to compare the impact of influencing variables on both types of diagnoses.
Results:
The rate of patients being identified as alcohol dependent by the CIDI or a general practitioner was about equally high, but there was not a lot of overlap between cases identified. Alcohol-dependent patients identified by a physician were older, had higher rates of physicial comorbidity (liver disease, hypertension), and were socially more marginalized, whereas average consumption of alcohol and mental comorbidity were equally high in both groups.
Conclusion:
General practitioners were able to identify alcohol dependence, but the cases they identified differed from cases identified using the CIDI. The role of the CIDI as the reference standard should be reexamined, as older alcohol-dependent patients with severe comorbidities seemed to be missed in this assessment.
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