Wake ForestCenter. US: When it comes to detecting alcohol misuse,
newly minted primary care physicians ask the wrong questions at the wrong
times, according to a study led by researchers at Wake Forest Baptist Medical
Center.
The
study, published in the current online issue of the Journal of General Internal
Medicine, surveye
d 210 resident
physicians in three family medicine and three internal medicine programs at
medical centers in the Southeast. The
researchers found that these doctors rarely perform alcohol screening and brief
intervention – asking patients questions to detect hazardous drinking and
discussing alcohol misuse, its consequences and ways to address it with at-risk
drinkers.
“Binge
drinking among American adults is four times more common than chronic alcohol
dependence but physicians often fail to detect binge drinking, despite its
prevalence,” said Kristy Barnes Le, M.D., assistant professor of internal
medicine at Wake Forest Baptist and lead author of the study. “We know that
alcohol screening and brief intervention detects and reduces unhealthy alcohol
use, and the U.S. Preventive Services Task Force has recommended that it be
used in all primary care settings. Unfortunately, that’s not being done often
enough. ”
Binge
drinking can result in accidents leading to acute-care visits. However, only 17
percent of the physicians in the study asked patients about hazardous drinking
at this type of visit. Most of the residents (60 percent) said they “usually”
or “always” screen patients for alcohol misuse at initial clinic visits, but
over 80 percent reported using questions incapable of picking up binge
drinking.
Not
surprisingly, only one in five of the residents surveyed expressed confidence
in their ability to help at-risk drinkers, and just one in six thought they had
been successful in doing so in the past. And more than half of the study’s
participants cited lack of adequate training as a significant obstacle in
dealing with hazardous drinking.
“Our
study reveals a clear need to improve alcohol-related training and screening
processes in primary care residencies,” Le said. “Medical school curricula have
traditionally focused on alcohol dependence, not binge drinking, so it’s up to
residency programs to provide the training and clinical systems that can
effectively address the widespread problem of hazardous drinking among American
adults.”
Co-authors
of the study are David P. Miller, M.D., of Wake Forest Baptist; J. Aaron
Johnson, Ph.D., of Georgia Regents University; J. Paul Seale, M.D., David C.
Parish, M.D., and Denice C. Clark, M.F.T., of Mercer University School of
Medicine & Medical Center of Central Georgia; and Hunter Woodall, M.D., of
AnMed Health, Anderson, South Carolina.