Citation

Rubinsky AD, Chavez LJ, Berger D, Lapham GT, Hawkins EJ, Williams EC, Bradley KA. Drug Alcohol Depend. 2019; 201: 155-160.

Affiliation

Health Services Research and Development (HSR and D) Center of Innovation for Veteran-Centered and Value-Driven Care, Department of Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way (S-152), Seattle, WA, 98108, USA; Center of Excellence in Substance Addiction Treatment and Education (CESATE), Department of Veterans Affairs Puget Sound Health Care System, 1660 South Columbian Way (S-152), Seattle, WA, 98108, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue Ste. 1600, Seattle, WA, 98101, USA; Department of Health Services, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, USA; Department of Medicine, University of Washington, 1410 NE Campus Parkway, Seattle, WA, 98195, USA. Electronic address: Katharine.A.Bradley@kp.org.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.drugalcdep.2019.03.010

PMID

31229703

Abstract

BACKGROUND: Routine alcohol screening scores are increasingly available in electronic health records (EHRs). Changes in such scores could be useful for monitoring response to brief intervention or treatment of alcohol use disorder. However, it is unclear whether changes in clinically-documented AUDIT-C alcohol screening scores reflect true changes in drinking. This study evaluated associations between changes in EHR AUDIT-C scores and changes in high density lipoprotein cholesterol (HDL), a laboratory test that reflects average alcohol consumption.

METHODS: National U.S. Veterans Affairs EHR data (2004-2007) were used to identify patients screened with the AUDIT-C (0-12 points), on two occasions at least a year apart, who had HDL measured in the year after each screen. First differencing linear regression estimated associations between changes in AUDIT-C score (-12 to 12 points; modeled categorically to allow for non-linear associations) and subsequent changes in HDL (mg/dL), adjusting for baseline HDL. Additional analyses evaluated whether associations between changes in AUDIT-C and changes in HDL were modified by baseline AUDIT-C.

RESULTS: Among 316,712 patients, increases-but not decreases-in AUDIT-C scores were associated with commensurate changes in HDL. However, a significant interaction was observed with baseline AUDIT-C score (p < 0.00001), which revealed that decreases in AUDIT-C scores were also associated with commensurate decreases in HDL (p-values<0.05) except among the 1.5% of patients with the highest baseline AUDIT-C scores (10-12).

CONCLUSIONS: Findings suggest that changes in EHR AUDIT-C scores reflect changes in drinking. These results support the use of clinically-documented alcohol screening scores for monitoring patients' alcohol use over time.

Copyright © 2019. Published by Elsevier B.V.

Language: en

Keywords

AUDIT-C; Alcohol drinking; Monitoring; Screening