Primary Care Residents Ill-Equiped To Screen For Binge Alcohol

Dr. Kristy Barnes Le MD Department of Internal Medicine Wake Forest School of Medicine Winston-Salem, Interview with:
Dr. Kristy Barnes Le MD
Department of Internal Medicine
Wake Forest School of Medicine
Winston-Salem, NC

Medical Research: What is the background for this study? What are the main findings?
Response: Because about 1 in 6 Americans binge drink, it is important that physicians know how to screen for at-risk drinking and be able to effectively address alcohol use with their patients.   Alcohol screening and brief intervention (SBI) has been shown to be an effective tool to detect and reduce hazardous alcohol use, but it has not yet gained wide acceptance in practice or in medical education.  We know that lack of confidence contributes to practicing physicians’ hesitancy to screen and intervene with at-risk drinkers, but this had not been studied in resident physicians.

We set out to determine how primary care resident physicians screen and intervene with their patients who drink, how they feel about discussing at-risk drinking, and what barriers they have to performing  Alcohol screening and brief intervention.

Our main findings are:

1.)  Resident physicians are using the wrong screening instruments at the wrong times, and are not adequately performing the brief intervention when they do detect hazardous drinking.

Less than 20% of residents in this study used screening instruments that are capable of detecting at-risk or binge drinking, while the remainder used instruments designed to detect alcohol use disorders.  And, only 17% screened for at-risk drinking at acute-care visits, where the consequences of binge drinking (such as injuries) are most likely to appear.  Additionally, when a brief intervention was performed, only a quarter of residents usually or always included the three recommended elements of feedback, advice, and goal-setting.

2.)  Resident physicians do not feel confident addressing at-risk drinking with their patients.

Only 21% felt they could help their patient with hazardous drinking cut down or stop using alcohol and only 17% felt they had been successful in doing so in the past.  Interestingly, U.S.-born residents and those reporting no religious affiliation were even more likely to express lack of confidence.

3.)  Lastly, residents report barriers that include lack of adequate training (53 %), the belief that talking with patients is unlikely to make a difference (44 %), and just being too busy (39%).  The hours of reported  Alcohol screening training did not vary with residency year, perhaps indicating that most of it was done prior to residency.

Clearly, the several hours they report getting (mean of 9.8 hours) is either not covering the right topics, or not teaching them in a way that leads to changes in practice.

Medical Research: What should clinicians and patients take away from your report?

Response: Perhaps the most important message is that resident physicians are not adequately performing  Alcohol screening despite its known effectiveness.  Additionally, the most frequently reported barriers to alcohol SBI can potentially be overcome.  As educators, we need to learn how to train residents in these skills – in a way that not only increases knowledge but also increases competence and confidence.  In summary, to address the high prevalence of hazardous drinking among U.S. adults, residency programs should incorporate Alcohol screening curricula that focus on both comprehensive resident training and the development of appropriate clinic systems to support screening and brief intervention.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: Since our study was conducted in the southeast, a larger, nationwide survey might further reveal regional patterns in resident confidence and barriers to alcohol  screening and brief intervention.

And, since there is an obvious and pressing need to teach residents how to appropriately do SBIRT, it would be beneficial to investigate exactly which types of training modalities (video examples, case studies, role-play, simulation) make the most impact in practice improvement.


J Gen Intern Med. 2015 Feb 10. [Epub ahead of print]

Primary Care Residents Lack Comfort and Experience with Alcohol Screening and Brief Intervention: A Multi-Site Survey.

Le KB1, Johnson JA, Seale JP, Woodall H, Clark DC, Parish DC, Miller DP. Interview with:Dr. Kristy Barnes Le MD (2015). Primary Care Residents Ill-Equiped To Screen For Binge Alcohol

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Last Updated on February 27, 2015 by Marie Benz MD FAAD