The Alcohol Use Disorders Identification Test (AUDIT) as a screen for at-risk drinking in primary care patients of different racial/ethnic backgrounds.

This study examined the operating characteristics of the Alcohol Use Disorders Identification Test (AUDIT) as a screen for "at-risk" drinking in a multi-ethnic sample of primary care patients, from a family practice center located in the southwestern United States. A probability sample of 1,333 family medicine patients, stratified by gender and racial/ethnic background (white, African-American and Mexican-American) completed the AUDIT, followed by the Alcohol Use Disorders and Associated Disabilities Interview Schedule (AUDADIS) to determine ICD-10 diagnoses. Indicators of hazardous alcohol use and alcohol-related problems were included as measures of "at-risk" drinking. Despite differences in the spectrum of alcohol problems across patient subgroups, there was no evidence of gender or racial/ethnic bias in the AUDIT as indicated by Receiver Operating Characteristic Curve analysis. Excluding abstainers from the analysis and little impact on screening efficacy. In this population, the AUDIT appears to be an unbiased measure of "at-risk" drinking.

Patient factors influencing variation in the use of preventive interventions for alcohol abuse by primary care physicians.

OBJECTIVE: To identify patient factors associated with primary care physicians asking about alcohol consumption, warning of harmful ethanol effects, and advising modification of alcohol use in their patients. METHOD: A cross-sectional design was used, with a probability sample of 1,333 adult family medicine patients, stratified by sex and racial/ethnic background, drawn from a university-based, family medicine clinic. Patients completed self-report screens for alcohol-related problems (including the CAGE) and questionnaires on their experiences with the primary care provider. RESULTS: Over 64% of male and female patients indicated their physician had asked them at some time about their alcohol consumption. Logistic regression models indicated that male patients were 1.5 times as likely to have been warned about alcohol and three times as likely to have been told to stop or modify their consumption compared to female patients. Patients with lower educational attainment were more likely to have been warned, while the likelihood of ever being told to stop or modify consumption increased with age. These associations were significant after controlling for patient race/ethnicity, cigarette use and CAGE scores. CONCLUSIONS: Patient factors including sex, educational attainment, age, cigarette use and problem alcohol use appear to explain some of the variation in the use of preventive interventions for alcohol abuse by primary care providers. Yet, different patient factors appear to be related to the use of different preventive interventions. The role of patient factors, and in particular sex of patient, in the use of preventive intervention strategies for alcohol abuse by primary care physicians should be further explored.

Osteoarthritis.

Osteoarthritis is a frequent cause of physical impairment in the elderly. The disease has a slow, progressive course that ends with joint failure and subsequent disability. The hands and the large weight-bearing joints are most commonly affected. The cause of osteoarthritis is unknown. The strongest risk factor is age, but age alone does not cause the disease. Clinically, osteoarthritis is manifested by joint pain and stiffness. Radiographs reveal joint space narrowing, subchondral sclerosis, osteophytes and, later, subchondral cysts and intra-articular osseous bodies. Biochemically, the cartilage in osteoarthritis differs from normal cartilage in elderly patients. The goals of treatment are to control pain, maintain function through strengthening and range-of-motion exercises, protect the joint and limit iatrogenic injury by selecting treatment options that minimize complications. Even when cure is not possible, appropriate medical care can improve the patient's functioning and well-being.

Item bias in the CAGE screening test for alcohol use disorders.

OBJECTIVE: To explore potential item bias in the CAGE questions (mnemonic for cut-down, annoyed, guilty, and eye-opener) when used to screen for alcohol use disorders in primary care patients. DESIGN AND SETTING: Cross-sectional study, conducted in a university-based, family practice clinic, with the presence of an alcohol use disorder determined by structured diagnostic interview using the Alcohol Use Disorder and Associated Disabilities Interview Schedule. PATIENTS: A probability sample of 1,333 adult primary care patients, with oversampling of female and minority (African-American and Mexican-American) patients. MAIN RESULTS: Unadjusted analyses showed marked differences in the sensitivity and specificity of each CAGE question against a lifetime alcohol use disorder, across patient subgroups. Women, Mexican-American patients, and patients with annual incomes above $40,000 were consistently less likely to endorse each CAGE question "yes," after adjusting for the presence of an alcohol use disorder and pattern of alcohol consumption. In results from logistic regression analyses predicting an alcohol use disorder, cut-down was the only question retained in models for each of the subgroups. The guilty question did not contribute to the prediction of an alcohol use disorder; annoyed and eye-opener were inconsistent predictors. CONCLUSIONS: Despite its many advantages, the CAGE questionnaire is an inconsistent indicator of alcohol use disorders when used with male and female primary care patients of varying racial and ethnic backgrounds. Gender and cultural differences in the consequences of drinking and perceptions of problem alcohol use may explain these effects. These biases suggest the CAGE is a poor "rule-out" screening test. Brief and unbiased screens for alcohol use disorders in primary care patients are needed.

Alcohol use disorders, consumption patterns, and health-related quality of life of primary care patients.

This study examined the association of alcohol use disorders and consumption patterns with various dimensions of Health-Related Quality of Life (HRQOL) in primary care patients, as measured by the SF-36 Health Survey. A probability sample of 1333 primary care patients completed the Alcohol Use Disorder and Associated Disabilities Interview Schedule to determine the presence of alcohol abuse or dependence disorders, and answered questions about patterns of alcohol consumption. Physical and Mental Health Component Summaries and primary scales of the SF-36 were used as measures of HRQOL. Patients meeting criteria for alcohol dependence scored lower (poorer HRQOL) on the Mental Health Component Summary and each primary scale of the SF-36, whereas no differences were observed for alcohol abusers compared with patients not meeting criteria for a disorder. The association of alcohol dependence with diminished mental health functioning was mediated by its co-occurrence with mood and anxiety disorders. Patients who drank in a Frequent, Low-Quantity pattern generally had better overall HRQOL than patients from other consumption groups. Binge drinkers and Frequent, High-Quantity Drinkers showed markedly lower scores in the areas of Role Functioning and Mental Health. In contrast to recent studies of mental health problems in primary care, alcohol use disorders and consumption patterns seem to have a modest impact on patients' HRQOL. These effects, though, vary by dimension of functioning, the presence of alcohol dependence rather than abuse, and pattern of alcohol consumption. Global measures of HRQOL such as the SF-36 Health Survey may provide important indicators of treatment effectiveness in primary care intervention studies for patients with drinking problems.

Ethnic and sex bias in primary care screening tests for alcohol use disorders.

BACKGROUND: The use of self-report screening tests for alcohol use disorders in the primary care setting has been advocated. OBJECTIVE: To test for ethnic and sex bias in three self-report screening tests for alcohol use disorders in a primary care population. DESIGN: Cross-sectional study with patients randomly selected from appointment lists. SETTING: University-based family practice clinic. PATIENTS: Probability sample of 1333 adult family practice patients stratified by sex and ethnicity. MEASUREMENTS: Patients completed 1) a diagnostic interview to determine the presence of a current alcohol use disorder and 2) three screening tests: the CAGE questionnaire, the Self-Administered Alcoholism Screening Test (SAAST), and the Alcohol Use Disorders Identification Test (AUDIT). RESULTS: The areas under the receiver-operating characteristic (ROC) curves for the CAGE questionnaire and the SAAST ranged from 0.61 to 0.88 and were particularly poor for African-American men and Mexican-American women. For the AUDIT, the area under the ROC curves was greater than 0.90 for each patient subgroup. The sensitivity of the CAGE questionnaire and the SAAST at standard cut-points was lowest for Mexican-American women (0.21 and 0.13, respectively). Positive likelihood ratios for the AUDIT were similar to or higher than those for the other screening tests, whereas negative likelihood ratios were lowest for the AUDIT (<0.33), indicating the superiority of this test in ruling out a disorder. CONCLUSIONS: A marked inconsistency in the accuracy of common self-report screening tests for alcohol use disorders was found when these tests were used in a single clinical site with male and female family practice patients of different ethnic backgrounds. The AUDIT does not seem to be affected by ethnic and sex bias.