Study suggests documentation of alcohol use needs to improve in disadvantaged areas
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Key takeaways:
- Practices in areas with greater social deprivation were less likely to document alcohol-related problems in the EHR.
- Researchers said these practices need support to improve their documentation.
Primary care practices in counties with higher social deprivation had decreased odds of documenting alcohol-related problems in the electronic health record, according to a recent study.
Elizabeth Needham Waddell, PhD, an associate professor at the Oregon Health & Science University-Portland State University School of Public Health, and colleagues studied the association between the socioeconomic status of counties in which primary care practices serve and the likelihood of documentation of alcohol-related problems.
“Previous studies examining documentation of [alcohol use disorder] in primary care suggest substantial gaps in screening, diagnosis and treatment of alcohol-related problems, even in systems with population-based screening,” they wrote in JAMA Network Open. “A county’s socioeconomic status may directly impact a practice’s capacity for comprehensive patient care.”
The cross-sectional analysis evaluated 44 primary care practices and 3,105 patients, who had at least one chronic condition and one behavioral health condition, or three chronic conditions.
Meanwhile, counties’ social deprivation was measured using practice-level Social Deprivation Index (SDI) scores.
Overall, 9.1% of patients reported higher risk alcohol use, 4% screened positive for substance use disorder and 6% had a documented alcohol-related problem in the EHR.
The researchers found that after adjusting for alcohol use, demographic characteristics and health status, each 10-unit increase in practice-level SDI was linked to 11% decreased odds of documentation (OR = 0.89; 95% CI, 0.8-0.99).
Meanwhile, increased odds of documentation were associated with:
- higher risk alcohol use vs. lower risk use (OR = 3.28; 95% CI, 1.89-5.65);
- a positive Global Assessment of Individual Needs-Short Screener (GAIN-SS) screen (OR = 2.11; 95% CI, 1.14-3.9);
- participants who were men (OR = 2.04; 95% CI, 1.44-2.99);
- household income lower than $30,000 (OR = 1.84, 95% CI, 1.22-2.78); and
- higher numbers of chronic conditions (OR = 1.68, 95% CI, 1.52-1.87).
Waddel and colleagues noted that their research “supports previous work citing clinical barriers, including training in and confidence using evidence-based tools, availability of appropriate screening tools, time, and staffing.”
Additionally, “low levels of documentation among participants who self-reported higher risk drinking and scored positively on the GAIN-SS indicate a need for increased substance use screening, brief intervention, and access to specialty addiction treatment,” they wrote.
The researchers called for “specialized training, resources and practical evidence-based tools to improve documentation of alcohol-related problems.”