John M. Spandorfer, MD Yedy Israel, PhD Barbara J. Turner, MD, MSEd Philadelphia, Pennsylvania Submitted, revised, June 9, 1999. From the Division of General Internal Medicine (J.M.S., B.J.T.), the Center for Research in Medical Education and Health Care (B.J.T.), and the Division of Pathology (Y.I.), Jefferson Medical College of Thomas Jefferson University, Philadelphia. Reprint requests should be addressed to Barbara J. Turner, MD, Thomas Jefferson University, College Building Room 132, 1025 Walnut St, Philadelphia, PA 19107-5083. E-mail: barbara.turner@mail.tju.edu.
References
Limitations
Our response rate of 68% in this study was substantially higher than the response rates (30% to 50%) in other surveys of physician practices concerning diagnosis and treatment of alcohol disorders.4,19 We conducted a questionnaire survey rather than a chart audit because audits are intrusive and may require patient consent. Additionally, physicians may not document in the chart questions about alcohol use, since this is not a billable service. Therefore, a recognized limitation of our study was that we used only self-reported data. In research on cancer screening practices, physician self-reported performance of recommended primary care interventions was generally higher than documented by chart review.27 If this were the case, the actual alcohol screening rates for our respondents might have been worse than reported.
Our study offers evidence that NIAAA guidelines are not being followed by clinicans in one large health system and lends support to the development of interventions to address this deficiency.
Acknowledgments
The authors thank Sondra G. Druker, clinical research coordinator, for her technical and editorial assistance, and Susan Marcus, PhD, for her statistical assistance.
