Clinical Reminder for follow up of positive alcohol use screen (AUDIT-C)
Date: January 2008
Overview
These are screen captures of the VA's clinical reminder for alcohol counseling and assessment that was released nationally in January of 2008. This reminder is available with the installation of Patch 6 (PXRM*2*6).
In the AUDIT-C Needs Evaluation Clinical Reminder, the clinician is presented with two different screens, based on the AUDIT-C score. The content of these screens is similar, except that patients who score less than 8 are first evaluated to determine if they are drinking above recommended limits.
Figure 1 is the screen presented when the AUDIT-C score is between 4 and 7. This first screen presents the clinician with the score range, basic interpretation of the score and the recommended limits of alcohol consumption.
The clinician is then prompted to ask the patient whether they drink above or below these limits. The answer to this question takes them to the next screen (Figure 2-3).
Figure 1
In Figure 2, if the patient does not drink above recommended limits, the clinician is guided to counsel them to stay at or below their current drinking levels. Medical risks of alcohol are also reviewed. When the user clicks on the "Finish" button, then the reminder is completed.
Figure 2
Figure 3 shows the options presented to the clinician if the patient drinks above recommended limits. When the "Yes" button is clicked, dialog opens guiding the clinician through a brief intervention either counseling the patient to abstain or cut down. Medical problems associated with alcohol use are also reviewed. The required elements of the clinical reminder are completed after these two elements are addressed.
Figure 3
Figure 4 shows the advice options seen in Figure 3, but also the optional intervention a clinician may elect to use. The expanded dialog below allows the clinician to document the patient's response to the counseling documented in the first part of the reminder.
Figure 4
Figure 5 further expands the optional interventions a clinician may elect to use to assess their patient's alcohol use. The Assessment section allows for viewing of current blood pressure, and labs. Figure 6 will show an expansion of the AUDIT 0 and Readiness to Change options.
Figure 5
Figure 6 shows expansion of the AUDIT 10 option and assessment of readiness to change. If the user clicks on the box that says "Perform AUDIT", it will bring up the 10 item AUDIT, which, when completed will give a score and interpretation of the score.
Figure 6
Figure 7 shows the compressed view of the options presented when a clinician clicks "Yes" to the question "Does the patient drink above recommended limits?"
The options clicked highlight the clinician option to refer to a specialty program or to document the patient's refusal of referral. When the Refer option is clicked, it will bring up a mental health or specialty care consult dialog so the order for referral can be entered directly from the clinical reminder.
Figure 7
Figure 8 shows the content presented to the clinician if the patient's AUDIT-C score is 8 or more. This content does not ask the clinician to evaluate whether the patient is drinking above recommended limits, as the AUDIT-C score indicates that the patient is.
The content displayed educates the clinician that the patient is at high risk of dependence and to advise the patient and offer referral as appropriate. The optional interventions are the same as what is reviewed in Figures 4 to 7.
Figure 8
