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Screening for Unhealthy Alcohol Use among Patients with Multiple Chronic Conditions in Primary Care �

Michelle Rockwell PhD, RD

Senior Research Associate/ Assistant Professor

Family & Community Medicine

Carilion Clinic/ Virginia Tech Carilion School of Medicine

M. Rockwell, A. Funk, A. Huffstetler, R. Sabo, J. Britz, J. Epling, A. Krist

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Unhealthy Alcohol Use (UAU)

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Background

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Up to 33% of US adults.

3rd leading cause of preventable death, increases risk and progression of many chronic conditions.

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Multiple Chronic Conditions (MCC)

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Background

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>2 long-term physical or mental health conditions

Prevalent, costly, complex, inequitably distributed across population

Delivery of preventive services to patients with MCC?

- 10 years ago, a national PBRN study observed

higher rates of preventive services delivery to

patients with MCC

Ornstein et al., Annals Fam Med, 2013

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  1. To assess the rate of screening for unhealthy alcohol use among patients with physical, mental, and both physical & mental health MCC in primary care.

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  • To assess the rate of unhealthy alcohol use among primary care patients with MCC.

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Study Objectives

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  • Secondary, cross-sectional analysis of baseline data from statewide alcohol screening study (AHRQ) involving 18 to 75 year-old primary care patients in Virginia (n=3537).

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  • Using EMR chart review data, we categorized multi-morbidity status:

CMS Chronic Conditions algorithm- no MCC ● physical MCC ● mental MCC ● physical & mental MCC

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  • and evaluated:
    1. occurrence of screening- screened vs. not screened
    2. screening instrument used- USPSTF-recommended vs. not USPSTF-recommended
    3. result of screening- positive vs. negative

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Methods

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We performed multiple logistic regression, adjusting for age, sex, race, ethnicity, insurer, and rurality.

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multi-morbidity status screening for unhealthy alcohol use

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Methods

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Results

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Age

48.6 + 16.1 years

Sex

61.6% female

Race

3.6% Asian

19.6% Black

63.2% White

4.9% American Indian/Alaska Native

3.8% Native Hawaiin/Pacific Islander

4.2% Other

Ethnicity

90.0% Non-Hispanic

Insurer

56.9% commercial

13.8% Medicaid

21.1% Medicare

0.5% other

Practice Rurality

52.4% Rural

Practice Ownership

17.6% Clinician-owned

9.8% FQHC

70.9% Health system

1.7% University

Table 1. COHORT DEMOGRAPHICS (n=3537)

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# of Diagnoses

10.1 + 4.7

Overall Screening Rate

69.4%

USPSTF Tool Screening Rate

9.8%

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Results

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Age

48.6 + 16.1 years

Sex

61.6% female

Race

3.6% Asian

19.6% Black

63.2% White

4.9% American Indian/Alaska Native

3.8% Native Hawaiin/Pacific Islander

4.2% Other

Ethnicity

90.0% Non-Hispanic

Insurer

56.9% commercial

13.8% Medicaid

21.1% Medicare

0.5% other

Practice Rurality

52.4% Rural

Practice Ownership

17.6% Clinician-owned

9.8% FQHC

70.9% Health system

1.7% University

Table 1. COHORT DEMOGRAPHICS (n=3537)

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# of Diagnoses

10.1 + 4.7

Overall Screening Rate

69.4%

Validated Tool Screening Rate

9.8%

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Results

Variable

Screening

USPSTF Instrument

Risky Use

MCC Group

ORs compared to no MCC (95% CI) p value

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Physical MCC

Mental MCC

Physical & Mental MCC

 

1.104 (0.905, 1.347) 0.3280

1.339 (0.996, 1.799) 0.0528

1.948 (1.386, 2.738) 0.0001*

 

1.179 (0.839, 1.657) 0.3418

0.988 (0.600, 1.626) 0.9609

1.410 (0.908, 2.189) 0.1255

 

0.567 (0.358, 0.900) 0.0160*

2.693 (1.691, 4.289) <0.0001*

2.083 (1.254, 3.458) 0.0046*

Table 2.

REGRESSION RESULTS: MCC STATUS & SCREENING FOR UNHEALTHY ALCOHOL USE

  • Screening with validated instrument
    • there was no difference in alcohol screening with a validated instrument based on MCC.

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  • Screening results
    • patients with physical MCC were less likely to screen positive than all other groups.
    • patients with mental MCC and physical & mental MCC were more likely to screen positive than all other groups.

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  • We were unable to evaluate the impact of visit frequency on screening outcomes
  • Our knowledge of diagnoses is limited to those documented in patients’ charts.
  • We documented a maximum of 15 problem list diagnoses and 8 visit diagnoses.

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Limitations

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  • Among 58 primary care practices in Virginia, 55% of patients had either physical MCC, mental MCC, or both physical & mental MCC.
  • Patients with mental MCC and physical & mental MCC were more likely to engage in unhealthy alcohol use, but were screened at the same low to moderate rates as patients without MCCs.
      • Innovative approaches to the incorporation of regular alcohol screening for patients with MCC in primary care are needed.

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Summary/ Conclusions

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