Simon Coulton1, Veronica Dale2, Paolo Deluca3, Eilish Gilvarry4, Christine Godfrey2, Eileen Kaner5, Ruth McGovern5, Dorothy Newbury-Birch6, Robert Patton7, Steve Parrott2, Katherine Perryman8, Thomas Phillips3,9, Jonathan Shepherd10, Colin Drummond3. 1. Centre for Health Services Studies, University of Kent, Canterbury CT2 7NZ, Kent, UK. 2. Department of Health Sciences, University of York, York YO10 5DD, UK. 3. Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8BB, UK. 4. Plummer Court - Northumberland Tyne and Wear NHS Foundation Trust, Newcastle NE1 6UR, UK. 5. Institute of Health and Society, Newcastle University, Newcastle NE2 4AX, UK. 6. School of Health and Social Care, Teesside University, Middlesbrough TS1 3BX, UK. 7. School of Psychology, University of Surrey, Guildford GU2 7XH, UK. 8. Division of Population Health, Health Service Research and Primary Care, University of Manchester, Manchester M13 9PL, UK. 9. Humber NHS Foundation Trust, Willerby HU10 6ED, UK. 10. Crime and Security Research Group, Cardiff University, Cardiff CF10 3DB, Wales, UK.
Abstract
AIMS: The aim of the study was to explore the relative efficiency and effectiveness of targeted versus universal screening for at-risk alcohol use in a primary care population in the UK. METHODS: The study was a randomized evaluation of screening approach (targeted versus universal) for consecutive attendees at primary care aged 18 years or more. Targeted screening involved screening any patient attending with one of the targeted presentations, conditions associated with excessive alcohol consumption: mental health, gastrointestinal, hypertension, minor injuries or a new patient registration. In the universal arm of the study all presentations in the recruitment period were included. Universal screening included all patients presenting to allocated practices. RESULTS: A total of 3562 potential participants were approached. The odds ratio of being screen positive was higher for the targeted group versus the universal group. Yet the vast majority of those screening positive in the universal group of the study would have been missed by a targeted approach. A combination of age and gender was a more efficient approach than targeting by clinical condition or context. CONCLUSIONS: While screening targeted by age and gender is more efficient than universal screening, targeting by clinical condition or presentation is not. Further universal screening is more effective in identifying the full range of patients who could benefit from brief alcohol interventions, and would therefore have greater public health impact. TRIAL REGISTRATION: Current Controlled Trials ISRCTN06145674.
AIMS: The aim of the study was to explore the relative efficiency and effectiveness of targeted versus universal screening for at-risk alcohol use in a primary care population in the UK. METHODS: The study was a randomized evaluation of screening approach (targeted versus universal) for consecutive attendees at primary care aged 18 years or more. Targeted screening involved screening any patient attending with one of the targeted presentations, conditions associated with excessive alcohol consumption: mental health, gastrointestinal, hypertension, minor injuries or a new patient registration. In the universal arm of the study all presentations in the recruitment period were included. Universal screening included all patients presenting to allocated practices. RESULTS: A total of 3562 potential participants were approached. The odds ratio of being screen positive was higher for the targeted group versus the universal group. Yet the vast majority of those screening positive in the universal group of the study would have been missed by a targeted approach. A combination of age and gender was a more efficient approach than targeting by clinical condition or context. CONCLUSIONS: While screening targeted by age and gender is more efficient than universal screening, targeting by clinical condition or presentation is not. Further universal screening is more effective in identifying the full range of patients who could benefit from brief alcohol interventions, and would therefore have greater public health impact. TRIAL REGISTRATION: Current Controlled Trials ISRCTN06145674.