Prevalence of Screening for Alcohol Use by Physicians During Routine Physical Examinations.

This Epidemiologic Bulletin examines the screening of patients for alcohol consumption by physicians during routine office visits. Screening is a medical procedure designed to identify a treatable disease. preferably in its early or presymptomatic stage. Respondents' reports of screening for alcohol consumption by their physicians during an office visit are compared with their reported typical alcohol consumption patterns and with selected demographic characteristics. Data for our analysis were extracted from the 1991 National Health Interview Survey (NHIS) of Health Promotion and Disease Prevention (HPDP).The NHIS is an ongoing, nationally representative, household interview survey of the population, conducted by trained interviewers for the National Center for Health Statistics (NCHS). Interviewers travel to eligible households and conduct face-to-face interviews with all available family members. Of the 48,853 households eligible for interview in 1991. 46,761 households were interviewed. resulting in a sample of 120,032 people. The HPDP contains questions on basic health habits, including alcohol use, as well as questions on disease prevention knowledge and practices. The HPDP sample consists of adults age 18 and older, randomly selected from the NHIS sample. One adult per family is selected to answer questions on the HPDP portion of the NHIS.BACKGROUNDAlcohol abuse and alcoholism are major public health concerns. The misuse of alcohol contributes to an array of health and social problems, including, but not limited to, liver and neurologic disease, accidents, birth defects, disability, and homelessness. The economic costs of these problems to the Nation are staggering. When direct costs (i.e., treatment and support) and indirect costs (e.g., productivity loss and property damage) are combined, the resulting costs are estimated to be in the billions (Rice 1993).The adverse health consequences of alcohol consumption have been documented extensively (National Center for Health Statistics 1992). It has been estimated that 20 percent or more of all general hospital admissions are alcohol related (Lewis and Gordon 1983) and that in the ambulatory care sector, approximately 15 percent of all office visits to a physician may be related to problems with alcohol (Hingson et al. 1982). The amount of alcohol consumed is closely related to health outcomes, and a 1988 study by Babor and colleagues indicated that there is generally a direct relationship between the level of alcohol consumed and the extent of problems experienced.Despite the documented relationship between health problems and alcohol, many people will seek help from their physicians without readily acknowledging, or being aware of, the critical role that alcohol consumption may be playing in the etiology of their complaints. Consequently, the responsibility for identification, and subsequent treatment of alcohol-related problems, rests within the physicians' domain.The importance of screening for alcohol problems in general medical practice has been stressed by medical professionals (Bowen and Sammons 1988). The office visit provides a valuable opportunity for the physician to discuss general health habits, including alcohol consumption, with the patient, and the clinical setting is an effective and appropriate place for the delivery of preventive services, including screening and counseling. The overall effectiveness of preventive services in reducing disease, disability, and premature death is well documented (U.S. Department of Health and Human Services [USDHHS] 1991).Accordingly, national support for the prevention of health problems through screening, education, and early detection and intervention is demonstrated in the agenda for Healthy People 2000. This program's purpose is to decrease preventable diseases and deaths via three broad categories of activities: health promotion, health protection, and preventive services (USDHHS 1991). …