Test screens for problem drinking in primary care.
Alcohol abuse accounts for about 100,000 excess deaths per year, not to mention trauma, job loss, and family issues, Jim Harasymiw, Psy.D., said in an interview about his poster presentation. "One of the big issues is: Is the person drinking heavily or not?"
The new test determines the likelihood of heavy drinking in the previous 4-6 weeks, based on standard blood laboratory values. The Early Detection of Alcohol Consumption (EDAC) test uses on an algorithm that includes 27 blood chemistry levels, including monocytes, high-density lipoprotein, albumin, bilirubin, hematocrit, and liver enzymes. The cutoff values for heavy drinking, compared with light drinking, are expressed as a percentage match with values from more than 1,700 individuals in a database. Heavy drinkers in the database reported more than five drinks (over 2.5 ounces of alcohol total) per day for men and more than four drinks (over 2 ounces of alcohol total) per day for women.
"This holds a lot of promise for reducing problem drinking, in a primary care practice, in a nonjudgmental way," said Dr. Harasymiw, director of research, Alcohol Detection Services, Big Bend, Wis. "This can be part of an early intervention and prevention model to handle these issues in a primary care practice setting."
Dr. Harasymiw and his associates used the EDAC and the well-established gamma-glutamyl-transferase (GGT) liver enzyme test to assess 1,022 men (618 heavy drinkers and 404 light drinkers) and 583 women (228 heavy drinkers and 355 light drinkers). The mean age was 38 years. The participants were recruited from detoxification centers, hospitals, outpatient clinics, recovering alcoholic groups, Mormon churches, colleges, and professional associations.
"The guidelines say physicians should be screening for alcohol problems in their practices," Dr. Harasymiw said. "We have tried to get physicians to use questionnaires for many years, but it doesn't fit into their office practice, and some answers are subjective." Because the EDAC is based on routine blood values, it is more objective and "gives a physician something they are comfortable talking about." With the results of the EDAC test, you can tell a patient, "You are drinking to a point that is causing biologic changes in your body," he added.
In specific populations, such as drunk drivers convicted for the third time, it becomes a diagnostic test, he said. "We tested this [EDAC test] in a number of different settings, and it worked as well or better than anything else out there."
The sensitivity of the EDAC among men was 65%, compared with 30% for the GGT. Sensitivity among women was 34% for the EDAC and 23% for the GGT. Specificity was 89% among men for the EDAC and 92% with the GGT. Among women, the specificity of the EDAC was 98%, compared with 94% for the GGT.
Assuming a prevalence of 15% in the general population, for example, the EDAC has a 51% positive predictive value, compared with 40% for the GGT, among men. The difference is even greater among women--a positive predictive value of 75% for the EDAC, compared with 41% for the GGT.
Test interpretation is done at a central site. Dr. Harasymiw and his colleagues plan to launch a Web site that features the algorithm software. For a fee, physicians can enter the blood values for a particular patient and get results online.
Changes in CPT codes increase the likelihood of reimbursement for the EDAC test, Dr. Harasymiw said. "As of January 2007, there is a CPT code for brief screening and office intervention. We did not have this before." This also is a CPT code for a brief pathology consult that might be applicable, he added. Dr. Harasymiw developed and is part owner of the EDAC test.
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|Publication:||Family Practice News|
|Date:||Jul 15, 2007|
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