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Probability and Predictors of Patients Converting from Negative to Positive Screens for Alcohol Misuse
Author(s) -
Lapham Gwen T.,
Rubinsky Anna D.,
Heagerty Patrick J.,
Achtmeyer Carol,
Williams Emily C.,
Hawkins Eric J.,
Maynard Charles,
Kivlahan Daniel R.,
Au David,
Bradley Katharine A.
Publication year - 2014
Publication title -
alcoholism: clinical and experimental research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.267
H-Index - 153
eISSN - 1530-0277
pISSN - 0145-6008
DOI - 10.1111/acer.12260
Subject(s) - alcohol , medicine , psychology , psychiatry , chemistry , biochemistry
Background Medicare reimburses providers for annual alcohol screening. However, the benefit of rescreening patients a year after a negative screen for alcohol misuse is unknown. We hypothesized that some subgroups of patients who screen negative would have a very low probability of converting to a positive subsequent screen (e.g., <0.1%), calling into question the value of annual alcohol screening for some patient subgroups. Methods This retrospective cohort study estimated the probability of converting to a positive screen for alcohol misuse a year after a negative screen among outpatients from 30 Veterans Health Administration ( VA ) medical centers. Alcohol Use Disorders Identification Test—Consumption ( AUDIT‐C ) alcohol screening scores (range 0 to 12 points) from 2004 to 2008 were obtained from electronic health record data. Eligible patients screened negative on their initial screen ( AUDIT‐C scores 0 to 3 for men; 0 to 2 for women). The main outcome was a positive subsequent screen ( AUDIT‐C scores ≥4 men; ≥3 women). Results Among 21,081 women and 323,913 men who screened negative on an initial screen, 5.4% and 6.0%, respectively, screened positive a year later. The adjusted probability of converting to a positive subsequent screen varied from 2.1 to 38.9% depending on age, gender, and initial negative screen score. Women, older patients, and those with initial AUDIT‐C scores of 0 were least likely to a convert to a positive subsequent screen, while younger men with AUDIT‐C scores of 3 were most likely to a convert to a positive subsequent screen. Conclusions The probability of a positive subsequent screen varied depending on age, gender, and initial negative screen score but exceeded 2% in all patient subgroups. Annual rescreening appears reasonable for all VA patients who had a negative screen the year prior.