Alcohol use screening and intervention by American primary care providers

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_{[1.97, 98.38]}=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_[1.92,96.02]=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.