From data to evidence, to action: findings from a systematic review of hospital screening studies for high risk alcohol consumption

Documentation of Alcohol Use in Hospital Records of Newly Diagnosed Cancer Patients: A Population-Based Study

Alcohol use has been associated with increased risk and poorer prognosis of various types of cancer, but the extent of actual screening for alcohol use in hospitalized cancer patients has received limited attention. In a random sample of 618 Connecticut patients diagnosed in 2002 with invasive cancer at age 20 + years, ascertained from a population-based registry, some information on usual frequency of drinking was found in hospital records for 478 (77.3%), but 143 (57.2%) of the 250 current drinkers were poorly described (e.g., "social," "occasional"). Alcohol use disorders were rarely mentioned. Gamma glutamyl transpeptidase was found for only 21 (3.4%). Mean corpuscular volume (MCV) was found for 434 (70.2%) and was associated with heavier drinking, independent of other predictors of MCV. Better screening is needed for all hospitalized cancer patients, to plan for interventions and conduct follow-up studies of prognosis.

Substance dependence and psychiatric disorders are related to outcomes in a mixed ICU population

OBJECTIVE

Substance dependence disorders are common in hospitalized patients and are associated with poor recovery. We compared mortality and discharge disposition in critically ill patients with and without substance dependence and patients with and without psychiatric disorders. We also compared the prevalence of substance dependence and psychiatric disorders to population data.

METHODS

All medical records of shock trauma intensive care unit (ICU) patients (mixed medical and surgical) at LDS Hospital were reviewed for pre-critical illness alcohol dependence, drug dependence, and psychiatric disorders.

RESULTS

There were 742 critically ill patients of whom 54% were male, acute respiratory distress syndrome developed in 5.5% and hospital mortality was 21%. The mean acute physiology and chronic health evaluation II scores were 16.5 +/- 7.9, sequential organ failure assessment scores were 6.7 +/- 4.2, duration of mechanical ventilation was 5 +/- 6.2 days, ICU length of stay (LOS) was 7.3 +/- 10.1 days, hospital LOS was 12.3 +/- 12.9 days. Multivariable regression analyses found psychiatric disorders predicted higher hospital mortality (Odds ratio = 1.50), but was not statistically significant (p = 0.08); substance dependence predicted shorter hospital LOS (R ( 2 ) = 0.08, p = 0.01) after controlling for covariates. There was a higher prevalence of substance dependence compared to Utah (p < 0.001) and US population data (p < 0.001). The prevalence of psychiatric disorders was significantly lower in our patients compared to US population data (19 vs. 26%, p < 0.001).

CONCLUSIONS

Our data suggest that substance dependence increases hospital LOS and that patients with drug or alcohol dependence are at higher risk for ICU admission compared to the general population.

Alcohol problem drinking among general hospital inpatients in northeastern Germany

OBJECTIVE

To estimate proportions of alcohol problem drinking: alcohol use disorders (AUDs) and drinking above recommended levels among general hospital inpatients in northeastern Germany.

METHOD

The sample includes consecutively admitted inpatients (n=14,332) between 18 and 64 years old. This study adopted a two-stage-sampling approach including screening and ascertainment of diagnosis based on DSM-IV criteria and a quantity-frequency index.

RESULTS

In total, 20.4% of all inpatients screened positive. Nine percent of the total sample were identified with current problem drinking in the following descending order: 5.3% AUD and 3.6% drinking above recommended levels. In addition, 3.1% of persons were diagnosed with alcohol dependence in remission. Proportions differed significantly among men and women (P<.001). Higher proportions of problem drinking were found at rural sites compared to urban sites (13.7% vs. 7.5%, P<.001).

CONCLUSIONS

In addition to AUDs, drinking above recommended levels is a common problem among general hospital inpatients. Thus, the implementation of systematic alcohol screening and brief interventions should be considered.

Prevalence of dependence on prescription drugs and associated mental disorders in a representative sample of general hospital patients

OBJECTIVES

The aim of this study was to determine the prevalence of dependence on prescription drugs (DPD) and associated comorbid disorders in consecutive general hospital inpatients.

METHODS

The sample consisted of 952 volunteer patients (age range, 18 to 64 years) in a German general hospital. The screening instrument was a self-administered questionnaire. A personal interview containing the Structured Clinical Interview for DSM-IV (SCID, Axis I) was used to evaluate positive screening results and to diagnose comorbid disorders.

RESULTS

The current prevalence of DPD was 4.7% [95% confidence interval (CI), 3.40-6.18; n=45). The current prevalence of single sedative dependence was 1.4% (95% CI, 0.62-2.14); of single hypnotic dependence, 1.2% (95% CI, 0.47-1.87); and of painkillers, 1.3% (95% CI, 0.54-2.01). In addition, dependence on sedatives and hypnotics was found in 0.1% of screened patients, painkillers and sedatives in 0.2%, painkillers and hypnotics in 0.4% and all three substances in 0.2%. Women were slightly overrepresented. The average age was 50.3 years. Psychiatric Axis I comorbidities were diagnosed in 66.7% of all cases, mostly anxiety disorders, followed by comorbid substance use and affective disorders.

CONCLUSION

The results indicate that the prevalence of DPD in general hospitals is frequent and should therefore become an important subject for health care providers. The general hospital might serve as an appropriate setting to provide early interventions for this group of patients.

The severity of unhealthy alcohol use in hospitalized medical patients. The spectrum is narrow

BACKGROUND

Professional organizations recommend screening and brief intervention for unhealthy alcohol use; however, brief intervention has established efficacy only for people without alcohol dependence. Whether many medical inpatients with unhealthy alcohol use have nondependent use, and thus might benefit from brief intervention, is unknown.

OBJECTIVE

To determine the prevalence and spectrum of unhealthy alcohol use in medical inpatients.

DESIGN

Interviews of medical inpatients (March 2001 to June 2003).

SUBJECTS

Adult medical inpatients (5,813) in an urban teaching hospital.

MEASUREMENTS

Proportion drinking risky amounts in the past month (defined by national standards); proportion drinking risky amounts with a current alcohol diagnosis (determined by diagnostic interview).

RESULTS

Seventeen percent (986) were drinking risky amounts; 97% exceeded per occasion limits. Most scored > or =8 on the Alcohol Use Disorders Identification Test, strongly correlating with alcohol diagnoses. Most of a subsample of subjects who drank risky amounts and received further evaluation had dependence (77%).

CONCLUSIONS

Drinking risky amounts was common in medical inpatients. Most drinkers of risky amounts had dependence, not the broad spectrum of unhealthy alcohol use anticipated. Screening on a medicine service largely identifies patients with dependence--a group for whom the efficacy of brief intervention (a recommended practice) is not well established.