Practical assessment of DSM‐5 alcohol use disorder criteria in routine care: High test‐retest reliability of an Alcohol Symptom Checklist. (11th March 2022)

• Record Type: Journal Article
• Authors: Hallgren, Kevin A.; Matson, Theresa E.; Oliver, Malia; Caldeiro, Ryan M.; Kivlahan, Daniel R.; Bradley, Katharine A.
• Is Part Of: Alcoholism. Volume 46:Number 3(2022)
• Page Start: 458
• Page End: 467
• Publication Date: 2022-03-11
• Subjects: alcohol use disorder -- assessment -- measurement‐based care -- primary care -- symptom checklist; Alcoholism -- Periodicals; Alcoholism -- Periodicals; Alcoolisme; Electronic journals; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.861005
• DOI: 10.1111/acer.14778
• Languages: English
• ISSNs: 0145-6008

Abstract

Abstract: Background: Alcohol use disorder (AUD) is underdiagnosed and undertreated in medical settings, in part due to a lack of AUD assessment instruments that are reliable and practical for use in routine care. This study evaluates the test‐retest reliability of a patient‐report Alcohol Symptom Checklist questionnaire when it is used in routine care, including primary care and mental health specialty settings. Methods: We performed a pragmatic test‐retest reliability study using electronic health record (EHR) data from Kaiser Permanente Washington, an integrated health system in Washington state. The sample included 454 patients who reported high‐risk drinking on a behavioral health screen and completed two Alcohol Symptom Checklists 1 to 21 days apart. Subgroups of these patients who completed both checklists in primary care ( n = 271) or mental health settings ( n = 79) were also examined. The primary measure was an Alcohol Symptom Checklist on which patients self‐reported whether they experienced each of the 11 AUD criteria within the past year, as defined by the Diagnostic and Statistical Manual of Mental Disorders‐5 th edition (DSM‐5). Results: Alcohol Symptom Checklists completed in routine care and documented in EHRs had excellent test‐retest reliability for measuring AUD criterion counts (ICC = 0.79, 95% CI: 0.76 to 0.82). Test‐retest reliability estimates were also high and not significantly different for the subsamples of patients who completed both checklists in primary care (ICC = 0.82, 95% CI: 0.77 to 0.85) or mental health settings (ICC = 0.74, 95% CI: 0.62 to 0.83). Test‐retest reliability was not moderated by having a past two‐year AUD diagnosis, nor by the age or sex of the patient completing it. Conclusions: Alcohol Symptom Checklists can reliably and pragmatically assess AUD criteria in routine care among patients who screen positive for high‐risk drinking. The Alcohol Symptom Checklist may be a valuable tool in supporting AUD‐related care and monitoring AUD criteria longitudinally in routine primary care and mental health settings. Abstract : Alcohol use disorder (AUD) is underdiagnosed in healthcare settings, in part due to a lack of assessment measures that are reliable and practical to use in routine care. Alcohol Symptom Checklists were recently implemented in routine care at Kaiser Permanente Washington for patients who report high‐risk drinking on an annual behavioral health screen. We found that Alcohol Symptom Checklists completed by patients in routine care had high test‐retest reliability, suggesting the checklists can support AUD‐related care, including longitudinal clinical monitoring.