Prevalence of unhealthy alcohol use in hospital outpatients

Highlights

• There is little evidence on the prevalence of unhealthy alcohol use in hospital outpatients.

• Adult hospital outpatients completed the Alcohol Use Disorders Identification Test Consumption questions using an iPad.

• We found that one in three adult outpatients at a large Australian public hospital had unhealthy alcohol use.

• A large number of hospital outpatients who are not seeking treatment for their drinking could benefit from effective intervention in this setting.

Abstract

Background

Few studies have examined the prevalence of unhealthy alcohol use in the hospital outpatient setting. Our aim was to estimate the prevalence of unhealthy alcohol use among patients attending a broad range of outpatient clinics at a large public hospital in Australia.

Methods

Adult hospital outpatients were invited to complete the Alcohol Use Disorders Identification Test Consumption questions (AUDIT-C) using an iPad as part of a randomised trial testing the efficacy of alcohol electronic screening and brief intervention. Unhealthy alcohol use was defined as an AUDIT-C score ≥5 among men and ≥4 among women.

Results

Sixty percent (3616/6070) of invited hospital outpatients consented, of whom 89% (3206/3616) provided information on their alcohol consumption (either reported they had not consumed any alcohol in the last 12 months or completed the AUDIT-C). The prevalence of unhealthy alcohol use was 34.7% (95% confidence interval [CI]: 33.0–36.3%). The prevalence among men aged 18–24 years, 25–39 years, 40–59 years and 60 years and older, was 74.4% (95% CI: 68.4–80.4%), 54.3% (95% CI: 48.7–59.8%), 44.1% (95% CI: 39.9–48.3%), and 27.0% (95% CI: 23.6–30.4%), respectively (43.1% overall; 95% CI: 40.8–45.5%). The prevalence among women aged 18–24 years, 25–39 years, 40–59 years, and 60 years and older, was 48.6% (95% CI: 39.2–58.1%), 36.9% (95% CI: 31.2–42.6%), 25.2% (95% CI: 21.5–29.0%) and 14.5% (95% CI: 11.7–17.3%), respectively (24.9% overall; 95% CI: 22.7–27.1%).

Conclusion

A large number of hospital outpatients who are not currently seeking treatment for their drinking could benefit from effective intervention in this setting.

Introduction

Reducing unhealthy alcohol use, which covers the spectrum of use from that which risks health consequences through to dependence (Saitz, 2005), is a global health priority (World Health Organisation, 2010). Although alcohol screening and brief intervention (SBI) has been shown to reduce alcohol consumption in primary healthcare patients (Kaner et al., 2007), it is not implemented routinely in any country (Makela et al., 2011, Nilsen et al., 2011). In Australia, for example, general practitioners provided almost 129 million occasions of service in 2012–2013 (Australian Government Department of Health, 2012) but provided counselling and advice about alcohol at a rate of only 0.2 episodes per 100 general practice encounters even though the prevalence of unhealthy alcohol use was 24% (Britt et al., 2013b). Barriers include time constraints, insufficient training, and the risk of damaging rapport with patients (Johnson et al., 2011).

Electronic screening and brief intervention (e-SBI), which uses computers, tablets, and mobile phones to deliver SBI, circumvents many provider-level barriers. Although e-SBI has been shown to be efficacious in certain primary healthcare settings (Bendtsen et al., 2011, Kypri et al., 2008, Kypri et al., 2004), it would be unwieldy to set-up and maintain the infrastructure required to deliver it routinely in every general practice. Clinics in large public hospitals, which provide services to patients who have generally been referred from a primary care provider for additional specialty care in the hospital outpatient setting, could provide an additional or alternative point of contact for the routine delivery of e-SBI. In Australia, for example, specialist outpatient clinics in large public hospitals delivered 14.9 million individual outpatient care services in 2012–2013 (Australian Institute of Health and Welfare, 2014). Since a large number of patients are attending appointments in a smaller number of locations, this should reduce the cost and complexity associated with setting up and maintaining the infrastructure required to deliver e-SBI routinely.

Few studies have examined the prevalence of unhealthy alcohol use in the hospital outpatient setting. The prevalence of unhealthy alcohol use is very high in studies conducted in oral and maxillofacial clinics, with 78% (Smith et al., 2003) and 95% (Goodall et al., 2008) of patients screening positive for unhealthy alcohol use, and lower in studies conducted in general outpatient clinics (Chang et al., 2011, Emmen et al., 2005, Pengpid et al., 2011, Persson and Magnusson, 1987). Estimates range from 6% in a Dutch hospital (Emmen et al., 2005) to 38% in a South African hospital (Pengpid et al., 2011). Our study adds to this sparse literature by providing an estimate of the prevalence of unhealthy alcohol use among patients attending a broad range of outpatient clinics at a large public hospital in Australia.