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Getting to the stable door before the horse has bolted
Alan Ogborne has given an accurate synopsis of the identification and treatment of patients with alcohol-related problems and has delineated what is currently thought of as best practice [Review].1 However, although he recognizes that much identifiable alcohol misuse is not clinically overt2 he nevertheless advocates the CAGE questionnaire3 for use in primary care; a more detailed alcohol history is only indicated if such questioning or a physical examination is positive. This approach identifies only the tip of the iceberg: it misses hazardous drinkers before they start to become dependent.4 A more proactive method is used in the Department of Emergency Medicine at St. Mary's Hospital, London, United Kingdom, where the Paddington Alcohol Test [PDF format] has been developed over the last 7 years.5,6,7,8 This test is easy (only 3 questions) and takes less than 1 minute to administer. It has been designed to identify misusers at an early stage, at which brief motivational interventions are more effective, and allows treatment to be started earlier. The test is given to all patients presenting with one or more of the "top 10" presenting complaints for which alcohol misuse may be considered a root cause. The test is given at the end of the consultation when the patient's initial agenda has been satisfied.In the modern context of rationing, evidence-based care and governance, we must move more effectively (that is, earlier) on alcohol misuse.
J.S. Huntley References
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