Intended for healthcare professionals

Bmj Usa

Alcohol screening in primary care

BMJ 2003; 327 doi: (Published 18 December 2003) Cite this as: BMJ 2003;327:263
  1. Evelyn P Whitlock, senior investigator (
  1. Kaiser Permanente Center for Health Research (a partner in the Oregon Evidence-based Practice Center) Portland, OR

    Behind the numbers

    What should primary care doctors do about screening for alcohol problems? Beich and colleagues (p 590) seem to have provided the answer: Nothing. Some will consider their results authoritative and conclude these activities are ineffective in general practice. But as with all systematic reviews and meta-analyses, there can be devils in the details.

    Beich et al have addressed a clinically important question: “How effective is screening in general practice for identifying drinkers who can and do benefit from brief intervention?” The most trustworthy answer would come from a randomized controlled trial of screening and brief intervention compared with no systematic screening or intervention, but no such studies exist.1 The results of such a trial would provide a direct measurement of the number needed to screen (NNS) to benefit one patient.2 In the absence of studies evaluating such direct evidence, reviewers are forced to examine and link separate bodies of evidence (Is the screening test accurate? How effective is the intervention?). With the …

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