Emergency-room physicians': recognition of alcohol misuse.

Abstract

To determine the prevalence of alcoholism and alcohol misuse in emergency-room patients and to assess the effectiveness of physicians in recognizing, diagnosing and referring alcohol misusers, 2 studies were conducted at Kings County Hospital, Brooklyn, New York, USA. In both studies, patients were interviewed by medical students and rated on the Alcohol Abuse Scale (AAS) and a brief version of the Michigan Alcoholism Screening Test (MAST). Patient medical charts were examined for physican notations of alcohol-related problems, diagnoses and referrals. Of 346 patients interviewed in the 1st study, 50 were identified as alcoholics by the AAS and 31 by the AAS and the brief MAST. Of the 50 AAS-identified alcoholics, 21 had some notation of an alcohol-related problem on their medical charts, 6 were diagnosed as alcoholics and 5 were referred for treatment. Of the 31 AAS and MAST-identified alcoholics, 13 were recognized as having an alcohol-related problem, 5 were diagnosed as alcoholics and 6 were referred for treatment. In the 2nd study 1 yr later, 162 patients were interviewed; 41 were identified as alcoholics by the AAS, 28 by the brief MAST and 25 by the MAST and the AAS. Of the AAS-identified alcoholics, 19 had some notation of an alcohol-related problem on their charts, 16 were diagnosed as alcoholics, and 6 were referred for treatment. Of the 28 MAST-identified patients, 15 had medical charts indicating an alcohol-related problem, 13 were diagnosed as alcoholics and 6 were referred for treatment. The prevalence of alcoholism or alcohol misuse recognized in the 2 studies ranged 8.9-25.3%, depending on the method of assessment. Comparison of the rates of diagnosis in the 2 studies indicated a statistically significant increase perhaps attributable to a carry-over effect, the emergency room director''s role in the establishment of an alcoholism treatment network and an increase in undergraduate and graduate medical education in alcohol misuse. This significant increase may indicate that educational methods can improve physician knowledge of alcohol misuse and attitudes toward alcoholics.