Problem Statement: An internal chart review of a rural patient health clinic demonstrated there was no adequate or consistent screening to evaluate for potential alcohol misuse. Therefore, there was a need to implement an evidence-based screening tool to assess alcohol consumption behavior.
Purpose: This project was to evaluate the Alcohol Use Disorders Identification Test (AUDIT) on the prevalence rates of potential alcohol misuse among adult patients in a rural health clinic. This was in tandem with the implementation of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) process in order to establish Behavioral Health services within the clinic via the Access Increases in Mental Health and Substance Abuse Services (AIMS) grant. Medical clinic staff were assessed for knowledge regarding SBIRT and the AUDIT tool via an in-service training session utilizing pre- and post-tests, purpose and implementation of the AUDIT screening tool, and screening compliance rate of eligible adults.
Method: This project was a pre- and post-implementation design in which retrospective chart data was gathered regarding individual patient AUDIT scores. The setting was a Federally Qualified Health Center (FQHC) with two rural locations in Illinois. Each clinic day provided the medical clinic with convenience opportunity sampling based on the clinic schedule and walk-in-patients. Adult patients ages 18-80 years that met inclusion criteria were provided a paper AUDIT screening form during the intake process. The results of the patient self-reported form were also entered by nursing staff into the patient’s individual Electronic Health Record. Individual patient scores were discussed between the patient and provider. Following the implementation period of 16-weeks, the principal investigator conducted a retrospective chart review on daily patient charts that met inclusion criteria for screening with the AUDIT. The data was then entered into an SPSS data sheet for analysis.
Results: Healthcare staff SBIRT and AUDIT scores yielded a statistically significant difference between pretest and posttest scores (paired samples t-test; pretest m=6.10, sd=1.20; posttest m=7.7, sd=1,34; p=<.001). Frequencies for patients actually screened with the AUDIT demonstrated that 288 (80%) scored 0-7 (Zone 1: abstainers or low risk), 22 patients (7%) scored 8-19 (Zone 2: misuse), and 1 patient scored 35 (Zone 3: likely alcohol dependence). The screening compliance rate (staff screening appropriate adult patients meeting inclusion criteria) was 86%, exceeding the Centers for Disease Control recommended screening rate benchmark of 80% of the eligible target population. Independent samples t-tests were conducted for two genders and AUDIT scores, patients with and without depression and AUDIT scores, and patients with and without anxiety and AUDIT scores. A statistically significant difference was found between two genders and AUDIT scores. The mean AUDIT score for males (m=2.65, sd=3.15) was higher than females (m=1.64, sd= 3.5), and with males scoring higher than females (p=.008), which is consistent with national data findings. Levene's F (F=4.36, p=0.38) demonstrated there was insufficient evidence to assume equal variances (homogeneity), so results were taken from the Welch t-test for equality of means. Therefore, the null hypothesis that there is no statistically significant difference between males and females and mean AUDIT scores was correctly rejected. There was no statistically significant differences found for patients with and without depression and AUDIT scores, nor for patients with and without anxiety and AUDIT scores.
Conclusion and significance:The sample population did not have prevalence of self-reported alcohol consumption at the misuse or Alcohol Use Disorder diagnostic level. It is essential to continue to screen and provide early intervention for at risk patients. Therefore, the clinic chose to adopt the AUDIT-C, a 3-question version of the full AUDIT that identifies patients with hazardous alcohol consumption behaviors or active alcohol use disorders, as the sustainable quality standard for continued alcohol screening of its adult population.
Keywords:alcohol screening and brief intervention, AUDIT, primary care
See more of: Invited Posters