Researchers from the Liver Unit at the Sheffield Teaching Hospitals in Sheffield, England, established the prevalence and detection rate of hazardous drinking in unselected hospital patients.
They then attempted to ascertain whether, in patients who presented with a first episode of decompensated alcoholic liver disease (ALD), opportunities to manage excessive drinking during previous admissions had been exploited.
On specific weekdays over a 9-month period, all patients aged 30-60 years, admitted to the admissions unit under the care of a general physician or surgeon, were considered for screening using the Alcohol Use Disorders Identification Test (AUDIT) questionnaire.
A total of 281 patients answered the questionnaire and 46 patients (16%) had an AUDIT score greater than 9.
BSG delegates were told that, within this group of 46 subjects, 40 had an alcohol history taken on admission, with excessive drinking being reported by 27.
Excessive drinking was classified as drinking more than 21 units of alcohol per week in the case of men, and more than 14 units of alcohol per week in women.
The research team found that, despite this level of excessive drinking, in only 15 of the 46 patients (33%), was it possible to reveal an awareness of hazardous drinking upon subsequent review of the continuity notes relating to the admission.
Furthermore, in only 12 of the 46 (26%), had action been taken about the drinking problem.
The researchers found that laboratory evidence of alcohol excess (raised MCV, gamma-GT or AST/ALT ratio, reduced platelets) was present in 30 of the 46 patients with an AUDIT score greater than 9.
However, in only 15 of the 30 had these markers been identified during admission of the patients, and in only 12 (40%) had action been taken as a result of these findings.
| In only 26% of hazardous drinkers had action been taken about the problem.
The researchers also reviewed the notes of 68 of 71 patients with first presentation of decompensated ALD, who had previously been admitted to local hospitals (237 episodes).
In 156 such admission episodes (60%), laboratory data or patient symptoms suggested excessive drinking.
Admission alcohol history had been recorded more than once in 63 patients (93%), but this only equated to 68% of previous admissions.
A total of 41 of these 63 patients reported drinking greater than 60 units of alcohol per week (men) or more than 40 units of alcohol per week (women).
Of these, awareness of excessive drinking was evident from the continuity notes of nearly 90% of subjects, yet action had only been taken in just over 63% of cases.
Researcher E. J. Williams said the group's findings showed that, "Hazardous drinking remains common, underdiagnosed, and undermanaged in hospital inpatients.
"Brief counseling for hazardous drinkers can lead to reduced alcohol consumption, hence detection is important."