Alcohol Screening Scores and Medication Nonadherence

2 December 2008 | Volume 149 Issue 11 | Pages 795-803

Background: Medication nonadherence is common and is associated with adverse outcomes. Alcohol misuse may be a risk factor for nonadherence; however, evidence is limited.

Objective: To identify whether alcohol misuse, as identified by a simple screening tool, is associated in a dose–response manner with increased risk for medication nonadherence in veterans attending primary care clinics.

Design: Secondary analysis of cohort data collected prospectively from 1997 to 2000 as part of a randomized, controlled trial.

Setting: 7 Veterans Affairs primary care clinics.

Participants: 5473 patients taking a statin, 3468 patients taking oral hypoglycemic agents, and 13 729 patients taking antihypertensive medications.

Measurements: Patients completed the Alcohol Use Disorder Identification Test–Consumption (AUDIT-C) questionnaire, a validated 3-question alcohol misuse screening test. Their scores were categorized into nondrinkers; low-level alcohol use; and mild, moderate, and severe alcohol misuse. Medication adherence, defined as having medications available for at least 80% of the observation days, was measured from pharmacy records for either 90 days or 1 year after the alcohol screening date. Logistic regression was used to estimate the predicted proportions of adherent patients in each AUDIT-C group and adjusted for demographic and clinical covariates.

Results: The proportion of patients treated for hypertension and hyperlipidemia who were nonadherent increased with higher AUDIT-C scores. For 1-year adherence to statins, the percentage of adherent patients was lower in the 2 highest alcohol misuse groups (adjusted percentage of adherent patients, 58% [95% CI, 52% to 65%] and 55% [CI, 47% to 63%]) than in the nondrinker group (66% [CI, 64% to 68%]). For 1-year adherence to antihypertensive regimens, the percentage of adherent patients was lower in the 3 highest alcohol misuse groups (adjusted percentage of adherent patients, 61% [CI, 58% to 64%]; 60% [CI, 56% to 63%]; and 56% [CI, 52% to 60%]) than in the nondrinker group (64% [CI, 63% to 65%]). No statistically significant differences were observed for oral hypoglycemics in adjusted analyses.

Limitation: This observational study cannot address whether changes in drinking lead to changes in adherence and may not be generalizable to other populations.

Conclusion: Alcohol misuse, as measured by a brief screening questionnaire, was associated with increased risk for medication nonadherence.

Editors' Notes Context Is alcohol misuse associated with medication nonadherence? Contribution This study of primary care patients attending 7 Veterans Affairs clinics found a graded, linear decrease in adherence to statins and hypertension medications with increasing levels of alcohol misuse. Caution Alcohol misuse was measured with a brief screening questionnaire that was mailed to patients. Adherence was measured by pharmacy refills. Implication Alcohol misuse may be associated with increased risk for medication nonadherence. —The Editors

 

Author and Article Information

From the Health Services Research & Development Northwest Center of Excellence, Veterans Affairs Puget Sound Health Care System, and University of Washington, Seattle, Washington.

Grant Support: By the Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service (AUDIT-C as a Scaled Marker for Health Risks in VA Medical Outpatients; IAC 05-206). The ACQUIP was funded by Department of Veterans Affairs grants SDR 96-002 and IIR 99-376. Drs. Bryson and Au were supported by Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service Career Development Awards (RCD 03-177 and RCD 00-018).

Potential Financial Conflicts of Interest: None disclosed.

Reproducible Research Statement: Study protocol: Available from Dr. Bryson (e-mail, christopher.bryson{at}va.gov). Statistical code: Available from Dr. Sun (e-mail, haili.sun{at}va.gov). Data set: Not available.

Requests for Single Reprints: Chris L. Bryson, MD, MS, Veterans Affairs Puget Sound Healthcare System, Health Services Research & Development Service, 1100 Olive Way, Suite 1400, Seattle, WA 98101; e-mail, christopher.bryson{at}va.gov.

Current Author Addresses: Drs. Bryson, Sun, Au, and Bradley and Ms. Williams: Veterans Affairs Puget Sound Healthcare System, Health Services Research & Development Service, 1100 Olive Way, Suite 1400, Seattle, WA 98101.

Dr. Kivlahan: Veterans Affairs Puget Sound Healthcare System, 1660 South Columbian Way, Seattle, WA 98108.

Author Contributions: Conception and design: C.L. Bryson, D.R. Kivlahan, K.A. Bradley.

Analysis and interpretation of the data: C.L. Bryson, D.H. Au, H. Sun, E.C. Williams, D.R. Kivlahan, K.A. Bradley.

Drafting of the article: C.L. Bryson, D.H. Au, H. Sun, E.C. Williams, K.A. Bradley.

Critical revision of the article for important intellectual content: C.L. Bryson, D.H. Au, H. Sun, E.C. Williams, D.R. Kivlahan, K.A. Bradley.

Final approval of the article: C.L. Bryson, D.H. Au, H. Sun, E.C. Williams, D.R. Kivlahan, K.A. Bradley.

Statistical expertise: C.L. Bryson, H. Sun, E.C. Williams, K.A. Bradley.

Obtaining of funding: C.L. Bryson, D.R. Kivlahan, K.A. Bradley.

Administrative, technical, or logistic support: E.C. Williams.

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