Predictors of Treatment Referral after AUDIT-C Screening for Heavy Drinking

Objectives:The Veterans Health Administration has implemented annual screening for heavy drinking during primary care encounters using the 3-item Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire and made specialized services available to patients with alcohol use disorders (AUDs). We sought to identify the factors that influence whether a patient who has an elevated AUDIT-C score receives appropriate care in the context of an integrated mental health services program. We focused on higher AUDIT-C scores, as these are seen in individuals who are most likely to have a moderate-to-severe AUD and more severe alcohol-related consequences. Methods:Utilizing electronic health record data, we conducted a 4-year retrospective study of veterans at high-risk for an AUD, based upon an AUDIT-C score ≥8 recorded during a primary care encounter at a Veterans Affairs Medical Center and its community-based outpatient clinics. Results:In multivariate analysis, the predictors of treatment referral were younger age, being nonwhite, higher AUDIT-C score, and main campus location. Among patients referred for treatment, younger age and being white were associated with an increased likelihood of completing a pretreatment assessment. Conclusions:Efforts to increase the consistency of treatment referrals, according to established clinical guidelines, could enhance the effectiveness of AUDIT-C screening during primary care visits. Subgroups of patients who may benefit from such efforts include individuals with high-risk but submaximal AUDIT-C scores, older patients, and patients who are seen at community-based outpatient clinics.