PREDICTORS FOR HIDDEN PROBLEM DRINKERS IN GENERAL PRACTICE

In The Netherlands general practice attenders are not usuallyquestioned about their drinking habits. The objective of thisstudy was to determine to what extent easily available data(e.g. age, gender) can be used to identify categories of patientswho are at risk of problem drinking as a preliminary to moreintensive screening. Sixteen practices with a total populationof 32,000 patients were involved in the study. All problem drinkersknown by their GPs and a random sample of one in ten patientsnot thought to be problem drinkers were admitted to the studyat their first surgery visit during a 1-year period. A screeningquestionnaire was used to find hidden problem drinkers amongstthe individuals thought to be non-problem drinkers. The overallresponse rate was 91% (n=1405). Problem drinking was detectedin 6% (n=82) of the group regarded by the GPs as non-problemdrinkers (n=1283). Male gender, smoking, life events and chronicsocial problems were the strongest non-alcohol-related predictorsof hidden problem drinking. We conclude that a pre-selectionof patients with a greater risk of problem drinking can be madewithout information related directly to alcohol. Case-findingin this category is much more effective and probably much moreacceptable both to the GP and the patients, than the screeningof all patients.     

Detection of left coronary artery stenosis by transoesophageal echocardiography

The ability of transoesophageal echocardiography to visualizethe left coronary artery was retrospectively analysed in 60consecutive patients without clinical evidence of coronary arterydisease. The left main coronary artery was visualized in 56patients, the proximal circumflex in 34 patients and the proximalanterior descending artery in nine patients. Patency of thesearteries was established in all these patients. Subsequently,a prospective study was undertaken in 23 patients with angiographicallyproven left coronary artery disease. Both the left main coronaryartery and the circumflex artery were adequately visualizedwith transoesophageal echocardiography in all 23 patients, whereasthe anterior descending artery was identified inthree patients.The extent of stenosis in the left main coronary artery andthe circumflex arterywas correctly diagnosed in 18 patients.In five patients the degree of stenosis was overestimated. Thesefindings indicate the potential of transoesophageal echocardiographyto detect or exclude stenosis of both the left main coronaryartery and circumflex artery.     

THE MEDICAL PROFILE OF UNIDENTIFIED PROBLEM DRINKERS IN GENERAL PRACTICE: TEST OF AN HYPOTHESIS

In order to facilitate general practitioner (GP) detection ofproblem drinkers the Dutch College of General Practitionersdeveloped a standard specifying the differences in medical profilebetween problem drinker and non-problem drinkers. The standardmentions 35 Reasons for Encounter (RFEs) and OP Evaluations(Es) that are thought to be specific for problem drinkers. Thestudies referred to in the standard base their conclusions aboutdifferences in medical profile upon a comparison of problemdrinkers already identified by the GP with other patients. Thisstudy tests the hypothesis that the medical profile specifiedby the standard also applies to unidentified problem drinkers.All known problem drinkers in the practices of 16 GPs, as wellas a one in 10 random sample of patients considered to be non-drinkerswere admitted to the study at their first surgery visit duringa 1-year period. Hidden problem drinkers were detected by meansof a screening questionnaire, although the results were notconveyed to the GP until the study was completed. Over the 1-yearstudy period the GPs then registered all RFEs and Es of thestudy population. RFE and E sum scores were then constructedbased on the Alcohol Standard. The estimated population prevalenceof problem drinking, corrected for the one in 10 sample fractionwas 7%. We found 6% problem drinkers (n = 78) in the categoryregarded by the GPs as non-problem drinkers (n = 1254). Differencesin RFEs and Es between hidden problem drinkers and those regardedas non-problem drinkers were significant for irregular heartbeatand psychological problems. Sexual problems were significantat the RFE level, social problems at the E level. When identifiedproblem drinkers are compared with non-problem drinkers moredifferences in the medical profile are found (four times bothRFE and E; twice RFE and once E). We conclude that most of thepublished differences in the medical profile between problemdrinkers and other GP patients are not found for unidentifiedproblem drinkers. The observed differences between unidentifiedproblem drinkers and non-problem drinkers are too small to behelpful to the GP to detect problem drinkers.