Leicester University researchers have discovered that medical staff struggle to spot problem drinking in their patients unless they are already intoxicated. The new study, published in the August edition of the British Journal of Psychiatry shows that clinical staff often remains unaware of patients with alcohol problems unless these are intoxicated.
Dr Alex J Mitchell, consultant at Leicestershire Partnership NHS Trust and honorary senior lecturer at the University and his team performed a study in which medical staff assessed 20,000 patients for alcohol problems, finding that all clinicians had difficulties identifying alcohol problems in patients, regardless of whether or not these volunteered information regarding their drinking habits.
In the UK, 1 in 4 adults, i.e. 33% of men and 16% of women have an alcohol consumption, which could be harmful to their health, and 6% of men are alcoholics (Pilling et al, 2011). 1 in 6 primary care patients are either alcohol dependent or have an alcohol use disorder.
The study revealed that General practitioners (GPs) managed to identify 40% of problem drinkers, whilst hospital doctors identified 50% of problem drinkers and mental health specialists recognized 55% of patients with a drinking problem. However, according to the case notes, clinicians only correctly identified 1 in 3 people with an alcohol problem and only identified alcohol intoxication accurately. For instance, A&E clinicians correctly identified 9 out of 10 patients with alcohol intoxication. The study revealed that the same rates of under-detection occurred in cases where patients admitted to a drinking problem by self-report.
The UK Primary Care Service Framework and NICE assess alcohol problems in patients by using a short questionnaire, but this approach is not widely used by clinicians.
Dr Alex Mitchell concludes:
“This study highlights that clinical identification of alcohol problems is challenging in busy clinical environments. When clinicians try and spot alcohol problems they often miss patients who have serious alcohol problems but who are not currently intoxicated. Further they can misidentify about 5% of ‘normal drinkers’ as problem drinkers.
Clinicians are not always sure what questions to ask or what screening tests to apply. We did not find that patients refused to admit alcohol problems, in fact it was more common for patients to disclose problem drinking when asked to self-report than the number found by clinicians judgment alone.
There needs to be a greater awareness of the importance of carefully assessing alcohol problems for non-intoxicated patients. Patient responses to questioning about drinking habits should not be assumed to be misleading but questioning must be handled sensitively.”
Written by Petra Rattue