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Practice-Level Documentation of Alcohol-Related Problems in Primary Care
Elizabeth Needham Waddell1, George S Leibowitz2, Levi N Bonnell3
1OHSU-PSU School of Public Health & OHSU School of Medicine, Oregon Health & Science University, Portland.
JAMA Network Open
|October 19, 2023
Summary
Higher social deprivation in primary care practices is linked to fewer documented alcohol-related problems. This highlights disparities in care for alcohol use disorder, especially in disadvantaged areas.
Area of Science:
- Public Health
- Primary Care Medicine
- Health Services Research
Background:
- Alcohol-associated deaths have risen, with significant increases noted between 2019 and 2020.
- Older adults (55-64 years) face the highest rates, often due to alcoholic liver disease and psychiatric disorders.
- Geographic disparities in documenting alcohol-related issues in electronic health records may lead to undertreatment of alcohol use disorder.
Purpose of the Study:
- To investigate geographic disparities in the documentation of alcohol-related problems within primary care electronic health records.
- To examine the association between practice-level social deprivation and the documentation of alcohol-related problems.
Main Methods:
- A cross-sectional study utilized secondary data from 44 primary care practices (September 2017–January 2021).
- The Social Deprivation Index (SDI), a composite measure of socioeconomic factors, was used at the practice level.
- Documentation of alcohol-related problems was identified via ICD codes or medication use; multivariable models adjusted for patient and practice characteristics.
Main Results:
- A total of 3105 participants were analyzed, with a mean age of 63.7 years; 6% had a documented alcohol-related problem.
- Higher practice-level Social Deprivation Index (SDI) scores were inversely associated with the odds of documenting alcohol-related problems (OR, 0.89; 95% CI, 0.80–0.99; P=.03).
- This association persisted after adjusting for individual-level alcohol use, demographics, and health status.
Conclusions:
- Increased social deprivation in primary care practices correlates with decreased documentation of alcohol-related problems.
- Findings underscore the need to address practice-level barriers to diagnosing and documenting alcohol use disorder, particularly in underserved areas.
- Targeted training, resources, and practical tools are essential for practices in high-need settings to improve care for complex patients.
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