Alcohol Screening Scores and Medication Nonadherence

  1. Chris L. Bryson, MD, MS;
  2. David H. Au, MD, MS;
  3. Haili Sun, PhD;
  4. Emily C. Williams, MPH;
  5. Daniel R. Kivlahan, PhD; and
  6. Katharine A. Bradley, MD, MPH
  1. From the Health Services Research & Development Northwest Center of Excellence, Veterans Affairs Puget Sound Health Care System, and University of Washington, Seattle, Washington.

    Abstract

    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.

    Article and Author Information

    • 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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