RESUMO
BACKGROUND: Alcohol consumption is a risk factor for traumatic injury, but it is unknown whether responses to alcohol screening questionnaires administered routinely in primary care are associated with subsequent hospitalization for traumatic injury. OBJECTIVE: We evaluated the association between alcohol screening scores and the risk for subsequent hospitalizations for trauma among Veterans Affairs (VA) general medicine patients. METHOD: This study included VA outpatients (n = 32,623) at seven sites who returned mailed surveys (1997-1999). Alcohol Use Disorders Identification Test Consumption (AUDIT-C) scores grouped patients into six drinking categories representing nondrinkers, screen-negative drinkers, and drinkers who screened positive for mild, moderate, severe, and very severe alcohol misuse (scores 0, 1-3, 4-5, 6-7, 8-9, 10-12, respectively). VA administrative and Medicare data identified primary discharge diagnoses for trauma. Cox proportional hazard models were used to estimate the risk of trauma-related hospitalization for each drinking group adjusted for demographics, smoking, and comorbidity. RESULTS: Compared with screen-negative drinkers, patients with severe and very severe alcohol misuse (AUDIT-C 8-9 and ≥10) were at significantly increased risk for trauma-related hospitalization over the follow-up period (adjusted hazard ratios AUDIT-C: 8-9 2.06, 95% confidence interval (CI) 1.31- 3.24 and AUDIT-C≥10 2.13, 95% CI 1.32-3.42). CONCLUSIONS: Patients with severe and very severe alcohol misuse had a twofold increased risk of hospital admission for trauma compared to drinkers without alcohol misuse. SCIENTIFIC SIGNIFICANCE: Alcohol screening scores could be used to provide feedback to patients regarding risk of trauma-related hospitalization. Findings could be used by providers during brief alcohol-related interventions with patients with alcohol misuse.
Assuntos
Alcoolismo/diagnóstico , Veteranos/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Alcoolismo/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Risco , Inquéritos e Questionários , Saúde dos VeteranosRESUMO
Hospitalizations for ambulatory care sensitive conditions (ACSCs) are used to assess quality of care, but studies rarely adjust for health behaviors. This study evaluated whether results of smoking or alcohol screening were associated with hospitalizations for ACSCs. Participants included 33,273 male Veterans Affairs general medicine outpatients who returned mailed surveys. The main outcome was hospitalization with a primary discharge diagnosis for an ACSC in the year following screening. Analyses were adjusted for demographics, comorbidity, and other health behaviors. Current and previous smoking and abstaining from alcohol were associated with significantly increased risk of hospitalization for ACSCs, but alcohol misuse was not. However, severe alcohol misuse was associated with increased risk of hospitalizations with a primary or secondary ACSC discharge diagnosis. When ACSCs are used to evaluate the quality of care, health systems caring for populations with higher rates of smoking or nondrinking could falsely appear to have poorer quality care if alcohol and tobacco use are not considered.
Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Assistência Ambulatorial , Hospitalização/estatística & dados numéricos , Fumar/efeitos adversos , Veteranos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/epidemiologia , Alcoolismo/epidemiologia , Comorbidade , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde , Modelos de Riscos Proporcionais , Qualidade da Assistência à Saúde , Risco , Fumar/epidemiologia , Estados Unidos , United States Department of Veterans Affairs/estatística & dados numéricos , Adulto JovemRESUMO
BACKGROUND: The American Board of Internal Medicine (ABIM) recommends internal medicine residents perform at least 3-5 Pap smears during training. We evaluated whether doing more than the required minimum Pap smears was associated with greater confidence and less desire for more Pap smear training. METHODS: We surveyed all 142 internal medicine residents at one university training program. Participants were asked how many Pap smears they had performed during residency and to rank their confidence and desire for more training in performing Pap smears. We compared confidence and desire for more training across three groups of residents reporting varying experience (Assuntos
Competência Clínica/normas
, Medicina Interna/educação
, Internato e Residência
, Teste de Papanicolaou
, Prática Psicológica
, Esfregaço Vaginal/normas
, Atitude do Pessoal de Saúde
, Intervalos de Confiança
, Feminino
, Humanos
, Masculino
, Razão de Chances
, Inquéritos e Questionários
, Estados Unidos