Highlight : Alcohol Use by Washington Residents

Overview

The Washington Health Alliance was asked by the Governor’s Performance Measures Coordinating Committee to include questions related to alcohol use in this year’s patient experience survey. The U.S. Preventive Services Task Force recommends that providers screen adults (age 18 and older) for alcohol misuse, followed by brief counseling interventions for adults drinking at risky levels. Rigorous trials have shown that brief counseling interventions decrease drinking in patients drinking at unhealthy levels. As a result, such screening and brief interventions are considered an essential benefit under the Affordable Care Act.

Validated single item screening questions about so-called “binge drinking” are often used to identify patients who could benefit from brief alcohol interventions. Explicit advice to drink below recommended limits or to not drink at all is a key element of brief alcohol interventions with demonstrated efficacy in primary care. As a result, patient reports of alcohol-related advice on patient experience surveys has been recommended as a quality measure related to unhealthy alcohol use.

About the Report

Download the full report (PDF)

The Washington Health Alliance Patient Experience Survey is based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinician & Group Core Survey 3.0, also known as the CG-CAHPS Survey. The CG-CAHPS survey content is shaped by input from patients and other key stakeholders, including health care providers, health plans and purchasers of care.

This is the fourth time that the Alliance has administered this nationally developed and standardized patient experience survey. Between August and November 2017, surveys were sent to 250,000 people throughout Washington. We achieved a 26% response rate overall. We are very pleased that this response rate enables reporting of results for 114 medical groups and 351 clinics across the state.

Key Findings

The results of this survey indicate that male respondents have a drink containing alcohol four or more times a week about twice as often as women.

The frequency of having a drink containing alcohol changes with age. As people get older, they are increasingly likely to either not drink at all, or drink 4 or more times per week.

There was a survey question related to unhealthy alcohol use. This varies by gender and age. Approximately 35% of males and 21% of females respond that they have five or more drinks on one occasion, at least some of the time. Binge drinking is defined as 5 drinks for men or 4 drinks for women on one occasion in a relatively short amount of time (about 2 hours). 

Among those respondents who reported having five or more drinks on one occasion, we examined whether their primary care provider or other health care provider advised them about drinking (to drink less or not to drink at all). Results of the survey reveal that 37.1% of adults (29.4% of women and 44.4% of men) who screen positive for risky drinking report receipt of advice to drink less or not to drink at all. It is notable that women are less likely to be advised to drink less, and this may be due to a number of factors. For example, unhealthy alcohol use is more stigmatized in our society for women than men, which means providers might be less comfortable offering such advice to women than men. Another reason for lower rates of alcohol-related advice reported by women is lack of acceptance or understanding of the recommended limits. Some providers might not understand the basis of the recommended limits for women so might not think advice is appropriate for some women who are drinking at unhealthy levels.

The probability of reporting brief alcohol-related advice increased as the frequency of binge drinking increased. This likely reflects that alcohol-related advice is focused on the most severely affected patients. Still, over one quarter of all respondents (26.4%), including men and women, reporting that they have 5 or more drinks daily or almost daily also reported that they did not receive advice to drink less or not at all.