VA-ALCOHOL AUDIT-C POSITIVE F/U EVAL (925)    REMINDER DEFINITION (811.9)

This reminder is due for patients who have a Positive Alcohol Use 
 
It resolves by documentation of direct alcohol related advice and 
education about alcohol related medical problems.  Options for further 
assessment and referral are also included.
 
It is intended for use by providers.
 
Update March 2009
1. Add SUD stop codes as an exclusion if the patient was seen during the 
90 days prior to the most recent positive AUDIT-C or is a current patient 
Screen.  It becomes due with an AUDIT-C score of 5 or more.
in an SUD clinic.
2. Make advice and feedback to the patient consistent and not forced.
3. Reverse the sequence of the feeback and the advice.
4. Update the reminder term for No Alcohol in the past year to represent 
include only the HF.  Remove the AUDC from this term to prevent an 
incorrect entry of AUDC=0 to override a positive AUDC entered for the 
same visit.
 
This setting of AUDIT-C of 5 or higher is for the national performance 
measure.  There are still patients who have lower scores who drink above 
the safe limit and these patients should also be counseled.
 
The dialog includes assessment tools and documentation of advice,
counseling and referral

• FUNCTION FINDING NUMBER:   1
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  FOUND TEXT:   

  The patient was seen in an SUD clinic during the 90 days prior to the 
  most recent positive AUDIT-C.
  \\
  

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  FUNCTION STRING:   FI(7)&(MRD(7)
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  FOUND TEXT:   

  The patient has recent SUD clinic visits.
  \\
  

  LOGIC:   FN(1)>FN(2)&(FN(3)>14)
  USE IN PATIENT COHORT LOGIC:   AND NOT
  FUNCTION STRING:   MRD(8)>MRD(1)&(DIFF_DATE(1,8)>14)
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Patients with no prior history of alcohol related problems or prior
Patients with prior alcohol problems and ANY positive AUDIT-C score should
be considered for referral to a Substance Abuse program.  These patients
are at high risk of dependence.
 
Standard drinks:   \\
     0.5 fluid ounces of absolute alcohol  \\
     12 ounces of beer                      \\
     5 ounces of wine                       \\
     1.5 ounces of 80-proof spirits         \\
treatment for alcohol abuse or dependence who have an AUDIT-C score of
4-7 (score of 3-7 for women) should be advised to stay within recommended
drinking limits.
 
RECOMMENDED LIMITS:
    Men:   <= 14 drinks/wk and maximum of 4 drinks/occasion
    Women: <=  7 drinks/wk and maximum of 3 drinks/occasion