News from the Field
Study Confirms Real-World Reliability of a Key Tool for Alcohol Screening
The Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) is a key, three-question tool used by health professionals to screen people for alcohol misuse. Although previous clinical research has validated use of the AUDIT-C, its test–retest reliability—a measure of the consistency of a test’s results over time—has not been evaluated in routine-care conditions with adult primary care patients.
AUDIT-C Questions2
Q1: How often did you have a drink containing alcohol in the past year?
Q2: How many drinks did you have on a typical day when you were drinking in the past year?
Q3: How often did you have six or more drinks on one occasion in the past year?
Now, scientists supported by the National Institute on Alcohol Abuse and Alcoholism have conducted a study to examine the AUDIT-C’s reliability in real-world conditions. The team also aimed to evaluate the screening tool across demographic subgroups (defined by age, sex, race, and ethnicity) and options to complete the AUDIT-C online or in a clinic setting.1
Claire B. Simon, M.D., of the University of Washington in Seattle, led the study, which used electronic health record (EHR) data from Kaiser Permanente Washington. More than 18,000 adult primary care patients completed two AUDIT-C screens at 1 to 21 days apart as part of routine care in 2021.
Dr. Simon and her colleagues reported that AUDIT-C screens completed in routine care and documented in EHRs demonstrated “excellent” test–retest reliability. Test–retest reliability evaluates the consistency of results from the same measure or screening tool when it is given at two different times to a group of individuals. Test–retest reliability is high when there are similar results across separate test administrations.
The authors also showed that the AUDIT-C demonstrated “good” to “excellent” test–retest reliability across various demographic groups, as well as when screens were completed in the clinic or online through patient portals.
The study found that reliability was somewhat higher when patients completed the AUDIT-C both times using online patient portals, as compared to completing the screen in-clinic or when mixing the two modes of screening.
The findings also indicated that reliability was slightly lower for American Indian/Alaska Native (AI/AN) patients and multiracial patients. Clinicians and researchers should keep this finding in mind when working with patients who are members of AI/AN or multiracial groups and may consider seeking additional sources of information about these individuals’ alcohol consumption beyond the AUDIT-C.
The results of this study support the utility of the AUDIT-C for identifying alcohol misuse among patients in routine-care settings.
References:
1 Simon CB, McCabe CJ, Matson TE, Oliver M, Bradley KA, Hallgren KA. High test–retest reliability of the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) questionnaire completed by primary care patients in routine care. Alcohol Clin Exp Res (Hoboken). 2024 Feb;48(2):302–8. PubMed PMID: 38099421
2 Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Arch Intern Med. 1998 Sep 14;158(16):1789–95. PubMed PMID: 9738608
