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Utility of routine alcohol screening for monitoring changes in alcohol consumption
Anna D Rubinsky1, Laura J Chavez2, Douglas Berger3
1Health Services Research and Development (HSR and D) Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way (S-152), Seattle, WA, 98108, USA; Kidney Health Research Collaborative, University of California, San Francisco, and Department of Veterans Affairs San Francisco Health Care System, 4150 Clement Street (111A1), San Francisco, CA, 94121, USA.
Background:
Routine alcohol screening scores are increasingly available in electronic health records (EHRs). Changes in such scores could be useful for monitoring response to brief intervention or treatment of alcohol use disorder. However, it is unclear whether changes in clinically-documented AUDIT-C alcohol screening scores reflect true changes in drinking. This study evaluated associations between changes in EHR AUDIT-C scores and changes in high density lipoprotein cholesterol (HDL), a laboratory test that reflects average alcohol consumption.
Methods:
National U.S. Veterans Affairs EHR data (2004-2007) were used to identify patients screened with the AUDIT-C (0-12 points), on two occasions at least a year apart, who had HDL measured in the year after each screen. First differencing linear regression estimated associations between changes in AUDIT-C score (-12 to 12 points; modeled categorically to allow for non-linear associations) and subsequent changes in HDL (mg/dL), adjusting for baseline HDL. Additional analyses evaluated whether associations between changes in AUDIT-C and changes in HDL were modified by baseline AUDIT-C.
Results:
Among 316,712 patients, increases-but not decreases-in AUDIT-C scores were associated with commensurate changes in HDL. However, a significant interaction was observed with baseline AUDIT-C score (p < 0.00001), which revealed that decreases in AUDIT-C scores were also associated with commensurate decreases in HDL (p-values<0.05) except among the 1.5% of patients with the highest baseline AUDIT-C scores (10-12).
Conclusions:
Findings suggest that changes in EHR AUDIT-C scores reflect changes in drinking. These results support the use of clinically-documented alcohol screening scores for monitoring patients' alcohol use over time.
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