Funding: This study was funded by the National Health and Medical Research Council of Australia, The Queensland Government's Smart State Health and Medical Research Fund, The Princess Alexandra Hospital Research and Development Foundation and the Australian Liver Foundation.
Assessment of alcohol histories obtained from patients with liver disease: opportunities to improve early intervention
Article first published online: 18 OCT 2013
© 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians
Internal Medicine Journal
Volume 43, Issue 10, pages 1096–1102, October 2013
How to Cite
Fagan, K. J., Irvine, K. M., Kumar, S., Bates, A., Horsfall, L. U., Feeney, G. F. and Powell, E. E. (2013), Assessment of alcohol histories obtained from patients with liver disease: opportunities to improve early intervention. Internal Medicine Journal, 43: 1096–1102. doi: 10.1111/imj.12229
Conflict of interest: None.
- Issue published online: 18 OCT 2013
- Article first published online: 18 OCT 2013
- Accepted manuscript online: 9 JUL 2013 02:25AM EST
- Manuscript Accepted: 19 JUN 2013
- Manuscript Received: 16 APR 2013
- National Health and Medical Research Council of Australia
- The Queensland Government's Smart State Health and Medical Research Fund
- The Princess Alexandra Hospital Research and Development Foundation and the Australian Liver Foundation
- hepatology outpatient clinic;
Alcohol is an important primary and comorbid cause of liver injury in patients referred for investigation and management of liver disease. Early assessment and documentation of alcohol consumption is therefore essential, and recommended in both general practice and hospital settings.
To determine the extent and accuracy of documentation of alcohol consumption in patients referred for evaluation of liver disease.
Patients were interviewed using a structured questionnaire. The medical records of all patients interviewed were reviewed to obtain information from the referral letter and the hepatology consultations.
Eighty-three patients were surveyed. Only 14 referrals had an informative alcohol history, despite 27 patients admitting risky alcohol consumption at the initial hepatology consultation. Ninety per cent of initial consultations had an informative alcohol history documented, whereas only 56% of patients attending a follow-up appointment had informative documentation. Assessment of alcohol consumption was comparable between the hepatology consultation and the structured questionnaire, but four subjects had substantially different alcohol histories. Alcohol Use Disorders Identification Test identified all patients reporting harmful alcohol consumption on the questionnaire.
Hazardous alcohol use is prevalent in subjects attending hepatology clinics, but informative alcohol histories, which are crucial to patient management, are rarely documented in referrals. Screening tools improve documentation and accuracy of alcohol histories, and their use by general practitioners and hospital clinicians would improve detection rates of hazardous drinking and allow earlier intervention. Systematic use of screening tools in hepatology clinics will provide opportunities for education and reinforce recommendations to reduce hazardous or harmful alcohol consumption.