Two simple questions could help GPs to identify patients with alcohol problems

How often do you have six or more drinks on one occasion?

As a result of your drinking, did anything happen in the last year that you wish didn’t happen?

Alcohol problems are often undetected in primary care but by asking the two simple questions above, GPs could quickly uncover which patients have drinking problems - including patients who would otherwise remain undetected - according to new research by University of Leicester experts.

Patients’ answers could either rule out alcohol issues, or could bring to light potentially excessive or unsafe drinking habits.

However in the latter case, GPs should follow up the short questions with a longer screening test to find out whether the patient is in need of help, according to the researchers’ paper in the British Journal of General Practice.

The research team, led by Dr Alex Mitchell, honorary senior lecturer at the University's Department of Cancer Studies and Molecular Medicine and an NHS consultant in psycho-oncology at Leicestershire Partnership Trust, believe the findings could make it easier for GPs to identify drinking problems which would otherwise remain hidden.

GPs may not have time to screen patients for alcohol problems as a matter of course, as the standard screening tests tend to be too time-consuming to administer for each person who visits the surgery.

Routine screening would allow GPs to uncover those with alcohol problems who do not necessarily fall into the most “at-risk” groups – such as the unemployed, young people and those with mental health problems.

Dr Mitchell led a team of researchers who analysed 17 previous studies into the effectiveness of simple questions to detect alcohol problems involving a total of 5646 individuals seen in primary care.

Using statistical analysis, they found that asking two questions could correctly identify those with alcohol problems in 87.2 per cent of cases, and correctly identify those who did not have alcohol problems in 79.8 per cent of cases.

For anyone who appears to be at risk based on their responses to the two questions, GPs should follow up the survey with a longer test such as the CAGE questionnaire – a four-question survey widely used to screen for alcoholism or the Alcohol Use Disorders Identification Test (AUDIT) - which consists of ten questions.

The researchers found that using a combination of a short, two-question test with a longer survey correctly identified patients with alcohol problems in 90.9 per cent of all cases.

This means that all patients visiting their GP could potentially be screened for alcohol problems in a relatively short length of time, with a high degree of accuracy, particularly in recognising people who do not need an intervention.

Dr Alex Mitchell said: “There is great time pressure in primary care. GPs don’t have the time to ask a long list of questions for every single patient. The shorter the survey, the more acceptable it is for GP – but the greater the danger that it is inaccurate.

“Our work shows that asking just two questions to patients works modestly well, but they need to be followed up by a longer questionnaire of four questions in those who initially screen positive.”

“At the moment, GPs ask patients about alcohol problems during about 3 per cent of consultations. Routine screening using simple questions are an attempt to improve the situation. The evidence suggests that starting with two questions and then proceeding to either the CAGE or AUDIT surveys would be the best way to go.”


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