While making sure no segment of the population is overlooked in alcohol screening is crucial, how that screening is administered also appears to be important, according to Katharine Bradley, MD, MPH. She said at the webinar that, since 2006, the VA has required use of the Audit C questionnaire, which asks three questions:

• How often did you have a drink containing alcohol in the past year?

• How many drinks did you have on a typical day when you were drinking in the past year?

• How often did you have six or more drinks on one occasion in the past year?

Bradley said a national study at the VA comparing Audit C screening by providers, versus on the VA’s patient satisfaction survey, found that 61% of patients who screened positive on the alcohol screening through the survey were negative when screened as part of clinical care in the VA.

That led to a further study examining how the Audit C was being used by clinicians in VA at nine sites. What the researchers found was that “screening was happening in all kinds of ways,” she said.

The researchers found that there appears to be discomfort on the part of clinicians to “not own” the questions, Bradley said.

“For instance, rather than asking them straightforward, they would say, ‘VA has some questions for you,’ or ‘This is a reminder we have to ask,’ or ‘They want to know about your alcohol use.’ So one of the things was this disowning the process of alcohol screening,” she said.

Bradley also noted that responses were sometimes presumed by interviewers, if the patients’ response did not fit the written options, or the questions were not asked verbatim. “These were all clinicians trying to do the right thing, but they didn’t understand. … So, it is very essential to not just train primary-care providers in screening and brief intervention, but, if their medical assistants or health techs or nurses are doing screening, it is essential that everybody understands the rationale behind it,” she said.

Best practices also were observed during screening, the study showed.

“We concluded that the best is if you can give the patient a private way to answer the questions themselves,” she said. “We observed clinics that were using paper-based screening. It can be mailed prior to the appointment; it can be self-administered in the waiting room. Another is a laminated questionnaire that, during intake and blood-pressure intake, can be handed to the patient. The patient can tell [the clinician] the number of the response for [the questions].”