Evidence Based Care Models for Recognizingand Treating Alcohol Problems in Primary Care Settings.

摘要

Alcohol-related problems are a significant public health concern in the United States. Alcohol dependence, abuse, and problem drinking increase morbidity and mortality (McGinnis, 1993), and raise economic, social and health care costs (Institute for Health Policy, 1993; Rice, 1991; Manning, 1989; US department of Health and Human Services, 1993). A recent study estimated that the total economic cost of alcohol-related problems was $148 billion in 1992: $18.8 billion in health care costs, $67.7 billion in lost productivity and $19.7 billion in crime (Harwood, 1998). Effective treatments exist for the entire spectrum of alcohol-related problems (Fleming, 1997; CSAT TIP number 28; NIAAA, 1995), but fewer than half of those individuals who need treatment actually receive it (Institute of Medicine, 1990). One in 5 men and 1 in 10 women who visit their primary care providers meet the criteria for at-risk drinking, problem drinking or alcohol dependence (Manwell et al, 1998); (Flemming and Manwell, 1999). Primary care physicians (PCPs) are in an ideal position to screen for alcohol problems, begin treatment, and monitor progress. However, primary care systems are not set up to support PCPs in recognizing and treating alcohol use disorders. Since many of these patients do not consult alcohol treatment specialists on their own, important opportunities for identification and treatment are missed (Alcohol Research and Health, 2000). A recent national survey of primary care physicians and patients noted that more than nine in ten physicians fail to identify substance abuse in adults. The majority of patients with substance abuse say that their primary care physician did nothing to either assess or treat their substance abuse (CASA, 2000). A recent study of primary care physicians in Ohio in which 4454 patient visits were observed revealed that screening for alcohol problems took place during 8% of the visits, and only 1% of the patients received counseling on alcohol problems.