Abstract
Objectives:1) to determine the rate of alcoholism among general internal medicine inpatients, 2) to assess the recognition and referral rates of these patients by their physicians, 3) to determine the effect of patient gender on physician recognition of alcoholism, and 4) to compare the observed alcoholism rates with rates reported in frequently cited studies, controlling for gender distribution.
Design:Cross-sectional study, face-to-face interviews.
Setting:A large, county-owned metropolitan teaching hospital.
Patients/participants:Adult patients admitted to an inpatient general medical firm. From among 95 consecutive admissions, 78 patients (81%) entered the study.
Intervention:The Michigan Alcoholism Screening Test (MAST) was administered to all study subjects. Chart reviews provided evidence of physician recognition and referral of patients with alcoholism. The observed rate of alcoholism was compared with rates reported in frequently cited studies after stratifying by type of service sampled and alcoholism assessment method used. Rates were then standardized for gender using the direct method.
Measurements and main results:Twenty-two patients (28%) were found to be alcoholic by MAST criteria (scores of 5 or higher). Scores in the range indicative of alcoholism were observed more frequently among the 36 men than among the 42 women (p=0.002) and varied by age group. Only the interaction between gender and age group was significant (p=0.023). Sixteen of the 22 patients (73%) with alcoholism by MAST criteria were identified as alcoholic by physician evaluation. Physicians were significantly more likely to identify as alcoholic those patients with MAST scores higher than 29 and tended to more readily identify men who had alcoholism than women. Among physician-identified patients, only about one in five was referred for rehabilitation. The standardized alcoholism rate found (291/1,000) ranked about halfway between the highest and the lowest standardized rates from nine other studies of medicine inpatient services (465/1,000 and 112/1,000).
Conclusions:Patient gender affected the prevalence of alcoholism and influenced its recognition by physicians. Alcoholism by MAST criteria was found in one in eight female and nearly one in two male inpatients. Physician recognition was higher for men and for more severely affected patients. An understanding of gender effects is essential to the appropriate interpretation of the results of screening tests for alcoholism and to understanding differences in reported crude rates of alcoholism among studies. Supplementing clinical impressions with the routine use of standardized methods for detecting alcoholism is recommended.
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References
Nace EP. Epidemiology of alcoholism and prospects for treatment. Ann Rev Med. 1984;35:293–309.
Moore RD, Bone LR, Geller G, Mamon JA, Stokes EJ, Levine DM. Prevalence, detection and treatment of alcoholism in hospitalized patients. JAMA. 1989;261:403–7.
West LJ, Maxwell DS, Noble EP, Solomon DH. Alcoholism (UCLA Conference). Ann Intern Med. 1984;100:405–16.
Aronow L, Nightingale EO, Filner B. Special report: Research opportunities in alcoholism. N Engl J Med. 1980;303:595–6.
Niven RG. Alcoholism — a problem in perspective. JAMA. 1984;252:1912–4.
Holden C. Alcoholism and the medical cost crunch. Science. 1987;235:1132–3.
Lewis DC, Gordon AJ. Alcoholism and the general hospital. Bull N Y Acad Med. 1983;59:181–97.
Kearney TR, Bonime HB, Cassimatis G. The impact of alcoholism on a community general hospital. Community Ment Health J. 1967;3:373–6.
Lefkowitz P, Suljoga-Petchel K. The prevalence of alcoholism in acute care general hospital patients. Mt Sinai J Med. 1986;52:291–6.
Gomberg ES. Prevalence of alcoholism among ward patients in a VA hospital. J Stud Alcohol. 1975;36:1458–67.
Funkhouser MJ. Identifying alcohol problems among elderly hospital patients. Alcohol Health Res World. 1977;2:27–34.
Pearson WS. The “hidden” alcoholic in the general hospital. N C Med J. 1962;23:6–10.
McCusker J, Cherubin CE, Zimberg S. Prevalence of alcoholism in general municipal hospital population. N Y State J Med. 1971;71:751–4.
Decker N, Fann WE, Girardin P, Miller DH, Kanas T. Alcoholism in a general hospital population. Alcoholism. 1979;6:33–9.
Page JB. Identifying drinking problems in VA hospital patients. J Stud Alcohol. 1979;40:447–56.
Sherin KM, Piotrowski ZH, Panek SM, Doot MC. Screening for alcoholism in a community hospital. J Fam Pract. 1982;15:1091–5.
Cohen M, Kern JC, Hassett C. Identifying alcoholism in medical patients. Hosp Community Psychiatry. 1986;37:398–400.
Bush E, Shaw S, Cleary P, Delbanco TL, Aronson MP. Screening for alcohol abuse using the CAGE questionnaire. Am J Med. 1987;82:231–5.
Abbott JA, Goldberg GA, Becker CE. The role of medical audit in assessing management of alcoholics with acute pancreatitis. J Stud Alcohol. 1974;34:272–6.
Tamayo MB, Feldman DJ. Incidence of alcoholism in hospitalized patients. Soc Work. 1975;20:89–91.
Whitfield CL. Advances in alcoholism and chemical dependence. Am J Med. 1988;85:465.
Nielsen AC III, Eaton JS Jr. Medical student student attitudes about psychiatry. Arch Gen Psychiatry. 1981;38:1144–54.
Nolan JP. Alcohol as a factor in the illness of university service patients. Am J Med Sci. 1965;249:135–42.
Barchha, R, Stewart MA, Guze SB. The prevalence of alcoholism among general hospital ward patients. Am J Psychiatry. 1968;125:681–4.
Jarman MB, Kellett JM. Alcoholism in the general hospital. Br Med J. 1979;290:469–72.
Panepinto WC, Kohut SA. Alcoholism: treatment through understanding. Hospitals. 1971;45:56–8.
Maletzky BM, Klotter J. The prevalence of alcoholism in a military hospital. Milit Med. 1975;140:273–5.
Waggoner DM, Frengley JD, Griggs RC, Rammelkamp CH. A “firm” system for graduate training in internal medicine. J Med Educ. 1979;54:556–61.
Dawson NV. The Metro Firm System: meeting the challenges of a changing health care environment. Health Matrix. 1988;5:27–33.
Cohen DI, Breslau D, Porter DK, et al. The cost implications of academic group practice. N Engl J Med. 1986;314:1553–7.
Cebul RD. Randomized controlled trials using the Metro Firm System. Med Care. 1991;29(suppl):JS9-JS18.
Dawson NV. Organizing the Metro Firms for research. Med Care. 1991;29(suppl):JS19-JS25.
Seltzer ML. The Michigan Alcoholism Screening Test: the quest for a new diagnostic instrument. Am J Psychiatry. 1971;127:1653–8.
Feinstein AR. Clinical epidemiology: the architecture of clinical research. Philadelphia: W. B. Saunders, 1985;443–4.
Diem K, Lentner C (eds). Documenta Geigy: scientific tables. Basel, Switzerland: Ciba-Geigy, 1970;85–98.
Bariety MX, Choubrac P, Acar J. Influence of alcoholism on morbidity and mortality in general medical practice. Bull Acad Nat Med. 1957;141:334–8.
Green JR. The incidence of alcoholism in patients admitted to medical wards. Med J Aust. 1965;1:465–6.
Lloyd G, Chick J, Crambie E. Screening for problem drinkers among medical inpatients. Drug Alcohol Depend. 1982;10:355–9.
Mayfield DG, Johnston RGM. Screening techniques and prevalence estimation in alcoholism. In: Famm WE, Karacan I, Pokorny AD, Williams RL (eds). Phenomenology and treatment of alcoholism. New York: Spectrum Publications, 1980.
Cleary PD, Miller M, Bush BT, Warburg MM, Delbanco TL, Aronson MD. Prevalence and recognition of alcohol abuse in a primary care population. Am J Med. 1988;85:466–71.
Briggs TG, Heuttner J, Malerich JA, et al. Detection of the alcoholic patient in the acute care setting. Minn Med. 1983;66:245–8.
Klerman GL. Treatment of alcoholism. N Engl J Med. 1989;320:394–5.
Mayfield D, McCleod G, Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry. 1974;131:1121–3.
Cyr MG, Wartman SA. The effectiveness of routine screening questions in the detection of alcoholism. JAMA. 1988;259:51–4.
Moran MB, Naughton BJ, Hughes SL. Screening elderly veterans for alcoholism. J Gen Intern Med. 1990;5:361–4.
Cyr MG, Wartman SA. Screening for alcholism (editorial). J Gen Intern Med. 1990;5:379–80.
Mitchell WD, Thompson TL, Craig SR. Underconsultation and lack of follow-up for alcohol abusers in a university hospital. Psychosomatics. 1986;27:431–7.
Emrick CD. A review of psychologically oriented treatment of alcoholism: II. The relative effectiveness of different treatment approaches and relative effectiveness of treatment versus no treatment. J Stud Alcohol. 1975;36:88–108.
Costello RM, Biever P, Baillargeon JG. Alcoholism treatment programming: historical trends and modern approaches. Alcohol Clin Exp Res. 1977;1:311–8.
Holder HD. Alcoholism treatment and potential health care cost savings. Med Care. 1987;25:52–71.
Ransohoff DF, Feinstein AR. Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med. 1978;299:926–30.
Begg CB. Biases in the assessment of diagnostic tests. Stat Med. 1987;6:411–23.
Morse RM, Hurt RD. Screening for alcoholism. JAMA. 1979;242:2688–90.
McIntosh ID. Alcohol-related disabilities in general hospital patients: a critical assessment of the evidence. Int J Addict. 1982;17:609–39.
Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA. 1984;252:1905–7.
Beresford TP, Blow FC, Brower KJ, Singer K. Screening for alcoholism. Prev Med. 1988;17:653–63.
Cleary PD, Bush BT, Kessler LG. Evaluating the use of mental health screening scales in primary care settings using receiver operating characteristics curves. Med Care. 1987;25:590–8.
Lange DE, Schacter B. Prevalance of alcohol related admissions to general medical units. Int J Psychiatry Med. 1989;19:371–84.
Goldberg HI, Mullen M, Ries RK, Psaty BM, Ruch BP. Alcohol counseling in a general medicine clinic: a randomized controlled trial of strategies to improve referral and show rates. Med Care. 1991;29(suppl):JS49-JS56.
Puddey IB, Beilin LJ, Vandongen R. Regular alcohol use raises blood pressure in treated hypertensive subjects. A randomized controlled trial. Lancet. 1987;1:647–51.
Van Thiel DH, Gaveler JS, Sanghvi A. Recovery of sexual function in abstinent alcoholic men. Gastroenterology. 1982;84:677–82.
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Dawson, N.V., Dadheech, G., Speroff, T. et al. The effect of patient gender on the prevalence and recognition of alcoholism on a general medicine inpatient service. J Gen Intern Med 7, 38–45 (1992). https://doi.org/10.1007/BF02599100
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DOI: https://doi.org/10.1007/BF02599100