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Monday, 16 October 2006


Adam Perzynski, MA1, Stephanie Kanuch, MEd2, Noah Webster, MS1, Richard McCormick, PhD1, Eleanor P. Stoller, PhD1, Carol E. Blixen, PhD3, Joshua Terchek, BA1, and Neal Dawson, MD4. (1) Case Western Reserve University, Cleveland, OH, (2) Metrohealth Medical Center, Cleveland, OH, (3) Cleveland Clinic, Cleveland, OH, (4) Case Western Reserve University - MetroHealth Medical Center, Cleveland, OH

Purpose: Physicians caring for patients with Chronic Hepatitis C Virus (HCV) need to ascertain how much their patients are drinking. Patients with HCV may improve their prognosis by reducing or abstaining from alcohol use, even if they are not candidates for HCV drug treatments. A two phase investigation was employed to determine whether patient reports of quitting drinking are the same as total abstinence.

Methods: To be eligible for the study, patients had to be HCV positive, non-dependent drinkers. In Phase I, 42 subjects were recruited using a sampling grid to ensure a balance of race (White, African American, and Hispanic) and gender. Eligible patients who consented in Phase I were interviewed using a semi-structured format. Qualitative software was used to organize and analyze interview transcripts. In Phase II, 398 patients completed a telephone survey. Alcohol use was assessed using the Alcohol Use Disorders Identification Test (AUDIT) and the question “Have you quit drinking?” Both samples were drawn from the population of HCV patients at an urban teaching hospital.

Results: In Phase I, 20 patients said that they quit drinking or were a non-drinker. 12 of these 20 described in their interviews that they had continued to consume some alcohol. In Phase II, of those who reported quitting drinking 5% (95% CI, 2-7) had an AUDIT score greater than zero. A logistic regression of 64 covariates was used to compute the propensity score for the 398 Phase II subjects. The propensity score was used to create ten subclasses of patients matched by their propensity to have quit drinking. Mean scores on the AUDIT were compared within each of the ten subclasses. Patients who reported they quit drinking (N=272) had a weighted mean AUDIT score of .11 (95% CI, .05-.17) while patients who did not quit drinking (N=126) had a weighted mean AUDIT score of 2.97 (95% CI, 2.69-3.25).

Conclusions: Nearly all patients who reported having quit drinking abstained from alcohol completely in the past year. However for some HCV patients, quitting may imply a reduced pattern of drinking behavior rather than total abstinence. Doctors should discuss alcohol use with their patients using unambiguous questions that address the quantity and frequency of alcohol consumption, as well as the date of the last drink.

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See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)