Opportunistic screening for alcohol use disorders in primary care: comparative study

doi:10.1136/bmj.38743.421574.7C

BMJ, doi: 10.1136/bmj.38743.421574.7C, (Published 17 February 2006)

RESEARCH

Opportunistic screening for alcohol use disorders in primary care: comparative study

Simon Coulton ¹^*, Colin Drummond ², Darren James ³, Christine Godfrey ¹, J Martin Bland ¹, Steve Parrott ⁴, Timothy Peters ⁵, on behalf of the Stepwice Research Team

¹ Department of Health Sciences, University of York, York YO10 5DD
² Section of Addictive Behaviour, Division of Mental Health, St George's Hospital Medical School, University of London, London SW17 0RE
³ Department of Clinical Psychology Training, Whitchurch Hospital, Cardiff CF14 7XB
⁴ Centre for Health Economics, Alcuin College, University of York
⁵ Department of Biochemistry, King's College, University of London, London WC2R 2LS

^* Correspondence to: sc21{at}york.ac.uk.

Objective To evaluate the efficacy and relative costs of differentscreening methods for the identification of alcohol use disordersin an opportunistic screening programme in primary care in theUnited Kingdom.

Design Comparative study.

Setting Six generalpractices in south Wales.

Participants 194 male primary careattendees aged 18 or over who completed an alcohol use disordersidentification test (AUDIT) questionnaire.

Main outcome measuresScores on alcohol use disorders identification test and measuresof ${gamma}$ -glutamyltransferase, aspartate aminotransferase, per centcarbohydrate deficient transferrin, and erythrocyte mean cellvolume. Hazardous alcohol consumption, weekly binge consumption,and monthly binge consumption were ascertained using the timeline follow back method over the previous 180 days. Alcoholdependence was determined using the Diagnostic and StatisticalManual of Mental Disorders, fourth edition. Unit costs wereestablished from published resource references and from actualcosts of analysing the biochemical tests.

Results A significantcorrelation was observed between alcohol consumption and scoreon the alcohol use disorders identification test (Pearson'scorrelation coefficient r=0.74) and measures of ${gamma}$ -glutamyltransferase(r=0.20) and per cent carbohydrate deficient transferrin (r=0.36)but not aspartate aminotransferase (r=0.08) or erythrocyte meancell volume (r=0.02). The alcohol use disorders identificationtest exhibited significantly higher sensitivity, specificity,and positive predictive value than all of the biochemical markersfor hazardous consumption (69%, 98%, and 95%), weekly bingeconsumption (75%, 90%, and 71%), monthly binge consumption (66%,97%, and 91%), and alcohol dependence (84%, 83%, and 41%). Thequestionnaire was also more cost efficient, with a lower costper true positive for all consumption outcomes.

Conclusion Thealcohol use disorders identification test questionnaire is anefficient and cost efficient diagnostic tool for routine screeningfor alcohol use disorders in primary care.

(Accepted 10 January 2006)

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