Screening for alcohol problems in primary care: a systematic review. Academic Article Review uri icon

Overview

MeSH

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Confounding Factors (Epidemiology)
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Middle Aged
  • Sensitivity and Specificity

MeSH Major

  • Alcoholism
  • Mass Screening
  • Primary Health Care
  • Surveys and Questionnaires

abstract

  • Primary care physicians can play a unique role in recognizing and treating patients with alcohol problems. To evaluate the accuracy of screening methods for alcohol problems in primary care. We performed a search of MEDLINE for years 1966 through 1998. We included studies that were in English, were performed in primary care, and reported the performance characteristics of screening methods for alcohol problems against a criterion standard. Two reviewers appraised all articles for methodological content and results. Thirty-eight studies were identified. Eleven screened for at-risk, hazardous, or harmful drinking; 27 screened for alcohol abuse and dependence. A variety of screening methods were evaluated. The Alcohol Use Disorders Identification Test (AUDIT) was most effective in identifying subjects with at-risk, hazardous, or harmful drinking (sensitivity, 51%-97%; specificity, 78%-96%), while the CAGE questions proved superior for detecting alcohol abuse and dependence (sensitivity, 43%-94%; specificity, 70%-97%). These 2 formal screening instruments consistently performed better than other methods, including quantity-frequency questions. The studies inconsistently adhered to methodological standards for diagnostic test research: 3 (8%) provided a full description of patient spectrum (demographics and comorbidity), 30 (79%) avoided workup bias, 12 (of 34 studies [35%]) avoided review bias, and 21 (55%) performed an analysis in pertinent clinical subgroups. Despite methodological limitations, the literature supports the use of formal screening instruments over other clinical measures to increase the recognition of alcohol problems in primary care. Future research in this field will benefit from increased adherence to methodological standards for diagnostic tests.

publication date

  • July 10, 2000

has subject area

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Alcoholism
  • Confounding Factors (Epidemiology)
  • Diagnosis, Differential
  • Female
  • Humans
  • Male
  • Mass Screening
  • Middle Aged
  • Primary Health Care
  • Sensitivity and Specificity
  • Surveys and Questionnaires

Research

keywords

  • Journal Article
  • Meta-Analysis

Identity

Language

  • eng

PubMed ID

  • 10888972

Additional Document Info

start page

  • 1977

end page

  • 1989

volume

  • 160

number

  • 13