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Annual Rescreening for Alcohol Misuse: Diminishing Returns for Some Patient Subgroups

Lapham, Gwen T. PhD, MPH, MSW*,†,‡; Rubinsky, Anna D. PhD, MS*,†; Heagerty, Patrick J. PhD†,§; Williams, Emily C. PhD, MPH*,†; Hawkins, Eric J. PhD*,∥,¶; Maynard, Charles PhD*,†; Kivlahan, Daniel R. PhD*,∥,¶; Bradley, Katharine A. MD, MPH*,†,‡,∥,#

doi: 10.1097/MLR.0b013e3182a3e549
Original Articles

Background: Routine alcohol screening is widely recommended, and Medicare now reimburses for annual alcohol screening. Although up to 18% of patients will screen positive for alcohol misuse, the value of annual rescreening for patients who repeatedly screen negative is unknown.

Objective: To evaluate the probability of converting to a positive alcohol screen at annual rescreening among VA outpatients who previously screened negative 2–4 times.

Research Design: Retrospective cohort study.

Subjects: A total of 179,035 VA outpatients (10,588 women) who previously screened negative on 2 and up to 4 consecutive annual alcohol screens and were rescreened the next year.

Measures: AUDIT-C alcohol screening scores (range, 0–12) were obtained from electronic medical record data. The probability of converting to a positive screen (scores: men ≥4; women, ≥3) at rescreening after 2–4 prior negative screens was evaluated overall and across subgroups based on age, sex, and prior negative screen scores (scores: men, 0–3; women, 0–2).

Results: The overall probability of converting to a positive subsequent screen decreased modestly from 3.5% to 1.9% as the number of prior consecutive negative screens increased from 2 to 4, yet varied widely across subgroups based on age, sex, and prior negative screen scores (0.6%–38.7%).

Conclusions: The likelihood of converting to a positive screen at annual rescreening is strongly influenced by age, sex, and scaled screening scores on prior negative alcohol screens. Algorithms for the frequency of repeat alcohol screening for patients who repeatedly screen negative should be based on these factors. These results may have implications for other routine behavioral health screenings.

Supplemental Digital Content is available in the text.

*Health Services Research & Development (HSR&D) Northwest Center of Excellence

Department of Health Services, University of Washington

Group Health Research Institute

§Department of Biostatistics, University of Washington

Center of Excellence in Substance Abuse Treatment and Education (CESATE)

Departments of Psychiatry and Behavioral Sciences

#Medicine, University of Washington, Seattle, WA

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Supported by VA HSR&D Substance Use Disorders Quality Enhancement Research Initiative (QUERI) RRP 11-021.

Presented as an oral presentation at the 2012 Addiction Health Services Research Conference, October 17–19, New York, NY.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs, the United States Government, or any of the authors’ institutions.

The authors declare no conflict of interest.

Reprints: Gwen T. Lapham, PhD, MPH, MSW, Health Services Research & Development, VA Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101. E-mail:

© 2013 by Lippincott Williams & Wilkins.