Клиническое подразделение РНМОТ обращает ваше внимание на завершение проекта, выполнявшегося совместно с Европейским обществом по внутренним болезням EFIM, в котором Россия участвовала в числе прочих стран Европы.

Название проекта Alcohol Consumption among Hospitalised Internal Medicine patients In Europe ALCHIMIE study. Проект инициирован EFIM и был целиком ориентирован на молодых специалистов, согласно правилам проекта в качестве со-исследователей могли участвовать только молодые специалисты не достигшие 35 лет. Проект был посвящен изучению потребления алкоголя среди госпитализированных пациентов в терапевтические стационары. Проект выполнялся под контролем Клинического подразделения
РНМОТ.

Национальный координатор проекта Арутюнов А.Г.

Глубокоуважаемые коллеги огромное спасибо всем исследователям принявшим участие в клиническом исследовании ALCHIMIE, мы благодарим Вас за качественное выполнение большого объема работ Вы можете ознакомится с результатами первой фазы исследования которые представлены выше.

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Коллектив клинического подразделения

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ALCHIMIE STUDY

Results from phase I

BACKGROUND

Alcohol use is related to major health problems and people who misuses alcohol might be over-represented in health care settings

WHO 2009

- Alcohol use might be overlooked during hospitalization

- There is little information available regarding prevalence of at-risk and harmful drinking in hospital setting, adequacy of alcohol consumption history-taking in routine hospital practice.

- USA: 25% current problems. Record-documented diagnoses of alcohol-related problems 40% to 42% of current AUDs. Smothers BA et al. Arch Intern Med. 2003;163:713-9.Smothers BA et al. Arch Intern Med. 2004;164:749-56. - Germany: 9% current problems (5% AUDs and 4% hazardous-harmful drinking) Coder et at. Gen Hosp Psychiatry 2008; 30:147-154 - Spain: 12% current problems. Alcohol use recording 59% medical records. Roson et al. Eur J Intern Med 2010; 21:458-64

OBJECTIVES

- To determine the prevalence and spectrum of alcohol use disorders (including drinking above recommended levels) and other alcohol related disorders among general internal medicine inpatients across Europe.

- To evaluate the rate of identification and the methods used by medical staff.

- To describe possible differences among countries.

ALCHIMIE, participating countries

National coordinators - Austria: Rudolf Stauber - Czech Pepublik: Jan Vaclavik - Estonia: Margus Member - France: Pascal Perney - Latvia: Ieva Ruza - Portugal: Jose Barata - Spain: Beatriz Roson - Russia: Alexander Arutyunov

There were 8 participating countries representing south europe: portugal, spain and France; Central Europe: Austria and Czech Republic, and Northern and Eastern Europe, Estonia, Lavia and Russia

PATIENTS AND METHODS

- Point-prevalence, multicentre study performed in 8 European countries. - Setting: - 43 European Hospitals :20 community, 16 University, 7 referral - Population covered: Urban: 18 Rural:2 Both:23 - Type of medical records: paper:18 electronic:16 both:9 - Knowledge of local prevalence for alcohol use disorders:4 - Internal Medicine: 39, Other medical specialities 4

To address this issue we designed a:

There were 43 participating hospitals.

STUDY DEVELOPMENT

The ALCHIMIE STUDY was performed in two phases.

In first phase we colleted data on drinking patterns according to investigators screening and diagnoses and also data about actual detection during hospitalization by review of medical records for the current admission. These are the data we will present today.

The second phase collects data about past and current alcohol use related diagnoses

Lets see the screening procedure in more detail

There were two thousand ninety two eligible patients. 21% were excluded, mainly because of dementia.

All data was collected from direct patient interview. Therefore interviews performed to relatives or surrogates were not allowed.

There were two thousand twenty three interwied patients. First question asked if the patient ever drank. If the answer was no the interview was stopped and the patient classified as abstainer if the answer was yes there was further screening.

Systematic Inventory of Alcohol Consumption (SIAC)

Question 1: “If you ever drink alcoholic beverages (wine, beer, etc), how many drinks you have in a day? (written down in Standard Drinks)”

Question 2: “How often? (Number of days in a week)”

Question 3: “On weekends (or workdays) do your drinking habits change?”

MEN	WOMEN AND >65 YEARS
>28 SDs per week > 6 SDs per ocasion	>17 SDs per week > 4 SDs per ocasion

AUDIT-C

Question 1: How often did you have a drink containing alcohol in the past year?

Question 2: How many drinks did you have on a typical day when you were drinking in the past year?

Question 3: How often did you have six or more drinks on one occasion in the past year?

The AUDIT-C is scored on a scale of 0-12 (scores of 0 reflect no alcohol use). In men, a score of 5 or more is considered positive; in women, a score of 4 or more is considered positive.

In all cases, the SYSTEMATIC INTERVIEW OF ALCOHOL COSUMPTION (SIAC) and the AUDIT-C were performed

You can see in the slide the cut off for both test.

SIAC limits were 28 drinks per week or 6 per occasion for men and 17 drinks per week or 4 per occasion for women.

AUDIT C cutoff values were 5 for men and 4 for women

AUDIT

The test contains 10 multiple choice questions on quantity and frequency of alcohol consumption (questions 1 to 3), drinking behaviour and dependence (questions 4 to 7) and alcohol-related problems or reactions (questions 8 to 10). cut-off points were 8 for men and 6 for women.

ICD-10 DIAGNOSTIC CRITERIA

ABSTAINERS LOW RISK DRINKERS HAZARDOUS DRINKING HARMFUL DRINKING DEPENDENCE

STATISTICAL ANALYSIS

CHI-SQUARE T-TEST p<0.05

POSITIVE SCREENING PATITENS underwent full audit

A clinical evaluation of the drinking pattern was performed in all drinkers.

We used ICD-10 criteria for the clinical diagnoses

STATISTICAL ANALYSIS WAS PERFORMED BY STANDARD TEST. Level of significance P<0.05

RESULTS

- There were 1114 (52%) men; mean age (SD) 67.9±17.3 years.

- Reasons for admission were not alcohol-related in 2031 (95%) patients.

Detected Drinking Patterns in 2123 Inpatients in IM Wards

Of the 2123 interviewed patients there were 52% men  with mean age 68 years.

Most patients had been admitted due to non alcohol related diseases.

Overall 14% had current AUDS and 2% were classified as former dependent patients.

Drinking patterns were as follows:

DRINKING HABITS IN HOSPITALIZED PATIENTS

The plot shows percentage of patients who ever drank alcohol in green, current drinkers in light blue and AUDs in dark blue.

There were signicant differences in percentage of AUDs among countries, ranging from 8% in Estonia to 22% in France.

The % of current drinkers was higher in central and northern countries than in the south, however it didn’t correlate with the % of AUDs. As you can see in the plot there is certain homogeinity of drinkers and current drinkers by region.

Methods of Recording Alcohol Consumption

- We reviewed 2100 (98%) medical records.

- Alcohol consumption was recorded in 920 (44%) patients.

- Recording was more frequently performed in patients with AUDs than in the other patients (58% vs 41%).

Let’s see how attending physicians documented alcohol use in medical records.

Overall alcohol consumption was recorded in 920 (44%) patients. It was more frequently performed in patients with AUDs than in the other patients (58% vs 41%).

Rate of quantification in medical records in wich there was alcohol use documentation was 13%.

Alcohol use documentation in medical records

Again this graphic shows the alcohol use documentation in medical records by country also ordered by region.

As yo can see ther were significant differences in the rate of documentation ranin from 76% in Czech Republic to &% in Latvia and Russia.

Also the rate of adequate quantification of alcohol use differed among countries.

In the plot yoy can see how these rates did not correlate with % of current drinkers in this hospitalized population

Conclusions

- Alcohol use disorders are frequent among European patients hospitalized for reasons not alcohol-related.

- They are frequently undetected during hospitalization.

- Adequate quantification of alcohol intake is rarely performed.

- We stress the need to implement measures to increase and improve the detection and recording of alcohol use among hospitalized patients.