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Can routine information from electronic patient records predict a future diagnosis of alcohol use disorder?

View Article: PubMed Central - PubMed

ABSTRACT

Objective: To explore whether information regarding potentially alcohol-related health incidents recorded in electronic patient records might aid in earlier identification of alcohol use disorders.

Design: We extracted potentially alcohol-related information in electronic patient records and tested if alcohol-related diagnoses, prescriptions of codeine, tramadol, ethylmorphine, and benzodiazepines; elevated levels of gamma-glutamyl-transferase (GGT), and mean cell volume (MCV); and new sick leave certificates predicted specific alcohol use disorder.

Setting: Nine general practitioner surgeries with varying size and stability.

Subjects: Totally 20,764 patients with active electronic patient record until data gathering and with a history of at least four years without a specific alcohol use disorder after turning 18 years of age.

Methods: The Cox proportional hazard analysis with time-dependent covariates of potential accumulated risks over the previous four years.

Main outcome measures: Time from inclusion until the first specific alcohol use disorder, defined by either an alcohol specific diagnostic code or a text fragment documenting an alcohol problem.

Results: In the unadjusted and adjusted Cox-regression with time-dependent covariates all variables were highly significant with adjusted hazard ratios ranging from 1.25 to 3.50. Addictive drugs, sick leaves, GGT, MCV and International Classification for Primary Care version 2 (ICPC-2), and International Classification of Diseases version 10 (ICD-10) diagnoses were analyzed. Elevated GGT and MCV, ICD-10-diagnoses, and gender demonstrated the highest hazard ratios.

Conclusions: Many frequent health problems are potential predictors of an increased risk or vulnerability for alcohol use disorders. However, due to the modest hazard ratios, we were unable to establish a clinically useful tool.

Key points: Alcohol is potentially relevant for many health problems, but current strategies for identification and intervention in primary health care have not been successful.

Key points: Many frequent clinical problems recorded in electronic patient records may indicate an increased risk for alcohol related health problems.

Key points: The hazard ratios were modest and the resulting predictive model was unsatisfactory for diagnostic purposes. If we accepted a sensitivity as low as 0.50, the specificity slightly exceeded 0.75. With a low prevalent condition, it is obvious that the false positive problem will be vast.

Key points: In addition to responding to elevated blood levels of liver enzymes, general practitioners should be aware of alcohol as a potentially relevant factor for patients with repeated events of many mental and psychosocial diagnoses and new sick leaves and repeated prescriptions of addictive drugs.

Key points: In addition to responding to elevated blood levels of liver enzymes, general practitioners should be aware of alcohol as a potentially relevant factor for patients with repeated events of many mental and psychosocial diagnoses and new sick leaves and repeated prescriptions of addictive drugs.

No MeSH data available.


Related in: MedlinePlus

Receiver operator characteristics (ROC) curve for prognostic index (gender, elevated lab tests, class B-drugs, new sick leaves, and alcohol-related ICPC-2 and ICD-10 diagnoses), for n = 16,814 patients from the Stavanger area in Norway, for comprehensive alcohol use disorder. Abbreviations: ICD-10: International Classification of Diseases, version 10; ICPC-2: International Classification of Primary Care, version 2.
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Figure 0001: Receiver operator characteristics (ROC) curve for prognostic index (gender, elevated lab tests, class B-drugs, new sick leaves, and alcohol-related ICPC-2 and ICD-10 diagnoses), for n = 16,814 patients from the Stavanger area in Norway, for comprehensive alcohol use disorder. Abbreviations: ICD-10: International Classification of Diseases, version 10; ICPC-2: International Classification of Primary Care, version 2.

Mentions: We made a prognostic index from all significant regression coefficients in the adjusted model. ROC of this index compared to status four years later gave a fairly modest area under the curve (AUC) of 0.72 (Figure 1).[32,33] The curve reveals that with a sensitivity of 0.5, the corresponding specificity is slightly above 0.75.


Can routine information from electronic patient records predict a future diagnosis of alcohol use disorder?
Receiver operator characteristics (ROC) curve for prognostic index (gender, elevated lab tests, class B-drugs, new sick leaves, and alcohol-related ICPC-2 and ICD-10 diagnoses), for n = 16,814 patients from the Stavanger area in Norway, for comprehensive alcohol use disorder. Abbreviations: ICD-10: International Classification of Diseases, version 10; ICPC-2: International Classification of Primary Care, version 2.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5036010&req=5

Figure 0001: Receiver operator characteristics (ROC) curve for prognostic index (gender, elevated lab tests, class B-drugs, new sick leaves, and alcohol-related ICPC-2 and ICD-10 diagnoses), for n = 16,814 patients from the Stavanger area in Norway, for comprehensive alcohol use disorder. Abbreviations: ICD-10: International Classification of Diseases, version 10; ICPC-2: International Classification of Primary Care, version 2.
Mentions: We made a prognostic index from all significant regression coefficients in the adjusted model. ROC of this index compared to status four years later gave a fairly modest area under the curve (AUC) of 0.72 (Figure 1).[32,33] The curve reveals that with a sensitivity of 0.5, the corresponding specificity is slightly above 0.75.

View Article: PubMed Central - PubMed

ABSTRACT

Objective: To explore whether information regarding potentially alcohol-related health incidents recorded in electronic patient records might aid in earlier identification of alcohol use disorders.

Design: We extracted potentially alcohol-related information in electronic patient records and tested if alcohol-related diagnoses, prescriptions of codeine, tramadol, ethylmorphine, and benzodiazepines; elevated levels of gamma-glutamyl-transferase (GGT), and mean cell volume (MCV); and new sick leave certificates predicted specific alcohol use disorder.

Setting: Nine general practitioner surgeries with varying size and stability.

Subjects: Totally 20,764 patients with active electronic patient record until data gathering and with a history of at least four years without a specific alcohol use disorder after turning 18 years of age.

Methods: The Cox proportional hazard analysis with time-dependent covariates of potential accumulated risks over the previous four years.

Main outcome measures: Time from inclusion until the first specific alcohol use disorder, defined by either an alcohol specific diagnostic code or a text fragment documenting an alcohol problem.

Results: In the unadjusted and adjusted Cox-regression with time-dependent covariates all variables were highly significant with adjusted hazard ratios ranging from 1.25 to 3.50. Addictive drugs, sick leaves, GGT, MCV and International Classification for Primary Care version 2 (ICPC-2), and International Classification of Diseases version 10 (ICD-10) diagnoses were analyzed. Elevated GGT and MCV, ICD-10-diagnoses, and gender demonstrated the highest hazard ratios.

Conclusions: Many frequent health problems are potential predictors of an increased risk or vulnerability for alcohol use disorders. However, due to the modest hazard ratios, we were unable to establish a clinically useful tool.

Key points: Alcohol is potentially relevant for many health problems, but current strategies for identification and intervention in primary health care have not been successful.

Key points: Many frequent clinical problems recorded in electronic patient records may indicate an increased risk for alcohol related health problems.

Key points: The hazard ratios were modest and the resulting predictive model was unsatisfactory for diagnostic purposes. If we accepted a sensitivity as low as 0.50, the specificity slightly exceeded 0.75. With a low prevalent condition, it is obvious that the false positive problem will be vast.

Key points: In addition to responding to elevated blood levels of liver enzymes, general practitioners should be aware of alcohol as a potentially relevant factor for patients with repeated events of many mental and psychosocial diagnoses and new sick leaves and repeated prescriptions of addictive drugs.

Key points: In addition to responding to elevated blood levels of liver enzymes, general practitioners should be aware of alcohol as a potentially relevant factor for patients with repeated events of many mental and psychosocial diagnoses and new sick leaves and repeated prescriptions of addictive drugs.

No MeSH data available.


Related in: MedlinePlus