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D G Buchsbaum

Publications and source records attributed to D G Buchsbaum.

12 recordsLinked to original sources
PubMed1995

Screening for drinking problems by patient self-report. Even 'safe' levels may indicate a problem.

BACKGROUND: Physicians often screen their ambulatory patients for serious drinking problems by asking questions related to the quantity of alcohol that they consume. Never previously reported is whether this "quantitative" approach to screening can be used to effectively screen ambulatory patients for the presence of a serious drinking problem. METHODS: The project interviewed 510 patients attending an inner city general medicine practice with the alcohol module of the Diagnostic Interview Schedule, revised for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Collected data also included reported quantity, frequency, and recency of drinking. We then calculated the sensitivity, specificity, positive predictive values, and receiver operating characteristic curve for zero to two, three to five, six to 11, 12 to 23, and 24 or more standard drinks as reported by 155 patients who reported drinking within 30 days of their visit. RESULTS: Forty-eight of 155 active drinkers met the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for alcohol dependence or abuse. Only five patients with an active diagnosis failed to report drinking within 30 days of their visit. The calculated area under the receiver operating characteristic curve for reported quantity was 0.81. The sensitivities of reported consumption decline with increasing drinking, while the specificities and positive predictive values rise. The report of drinking between six and 12 drinks per week was associated with a positive predictive value of 0.54 for an active Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, diagnosis. CONCLUSIONS: Patient self-report of drinking can be used to screen actively drinking outpatients on the general medicine service for serious drinking problems. Further, in an urban general medicine outpatient population, even federally recommended levels of drinking may indicate a problem. Our data suggest that physicians' recommendations be adjusted for the setting in which they practice.

Alcoholism↗
PubMed1993

A program of screening and prompting improves short-term physician counseling of dependent and nondependent harmful drinkers.

BACKGROUND: Physicians in the general medical setting commonly encounter but rarely counsel patients with dependent or harmful drinking behaviors. We tested whether providing physicians with their patients' results on the alcohol module of the Diagnostic Interview Schedule and counseling directives would prompt them to counsel these patients. METHODS: We randomly assigned 83 first-, second-, and third-year medical residents to receive or not to receive diagnostic information and counseling directives on 214 patients who reported at least one symptom of alcohol impairment as defined in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition. Using binary logistic regression, we examined the effect of specific covariables on rates of physician counseling. These variables included physician information status, patient gender, and drinking disorder severity and recency. We also examined the effect of physician prompting on counseling of female patients, patients with inactive disorders, and nondependent but harmful drinkers. We determined counseling by post-visit patient interviews. RESULTS: Physician prompting, dependent drinking, and recent disorder activity were significant correlates of physician counseling (P < .05), while male gender was a marginally significant correlate (P = .08). Informed physicians counseled female patients, harmful but nondependent drinkers, and patients with inactive disorders more often than their uninformed colleagues, although only the last variable achieved statistical significance. CONCLUSIONS: Providing physicians with the results of the Diagnostic Interview Schedule and counseling directives resulted in short-term improvement in their rates of counseling patients with a history of dependent or nondependent but harmful drinking. Further research is necessary to determine long-term gains in rates of physician counseling and improvements in the course of these patients.

Alcoholism↗
PubMed1993

Quality of life of alcoholics and non-alcoholics: does excessive drinking make a difference in the urban setting?

The current study assessed whether perceived quality of life differed between alcoholics and non-alcoholics. Patients attending an urban-based hospital were screened for alcoholism using the CAGE questionnaire. Patients were recruited from an out-patient clinic setting as well as from an in-patient substance abuse unit. Quality of life scores were based on Chubon's (1987) Life Situation Survey. Results indicated that alcoholics experience a lower quality of life than their non-alcoholic counterparts regardless of setting; however, all patients reported experiencing poor life quality. The impact of alcoholism treatment programmes on patients already experiencing low quality of life is questioned.

Adult↗
PubMed1992

Screening for drinking disorders in the elderly using the CAGE questionnaire.

OBJECTIVE: To assess the performance of the CAGE questionnaire in identifying elderly medicine outpatients with drinking problems. DESIGN: Cross-sectional design, with the alcohol module of the Diagnostic Interview Schedule as the criterion standard. SETTING: The outpatient medical practice of an urban university teaching hospital. PATIENTS: Consecutive patients 18 years or older who signed a consent form approved by the university's institutional review board. For this study, 323 patients greater than or equal to 60 years old. MAIN OUTCOME MEASURES: Sensitivity, specificity, receiver operating characteristics (ROC) curve and positive predictive value for CAGE scores of 0-4 for patients 60 years or older. RESULTS: Thirty-three percent of the sample group met study criteria for a history of drinking problems, including 63% of the male patients and 22% of the female patients. The sensitivity and specificity for a cut-off score of one for all patients was 86% and 78%, respectively, and 70% and 91% for a cut-off of two. The calculation of the area under the ROC curve was .86, and the positive predictive value of CAGE scores of 0-4 were 33%, 66%, 79%, 82%, and 94%, respectively. The predictive value for any score was higher in males than females, reflecting the higher prevalence of problems in the male population. CONCLUSIONS: The CAGE can effectively discriminate elderly patients with a history of drinking problems from those without such a history. The chosen cut-off score should consider the prevalence of drinking problems in the population being tested.

Aged↗
PubMed1991

Screening for alcohol abuse using CAGE scores and likelihood ratios.

OBJECTIVE: To assess the performance of the CAGE (acronym referring to four questions, see below) questionnaire in discriminating between medicine outpatients with and without an alcohol abuse or dependence disorder. DESIGN: A cross-sectional design of a sample of consecutive patients who received both the alcohol module of the diagnostic interview schedule and the CAGE (Cut down, Annoyed, Guilty, Eye-opener) screening questionnaire. SETTING: The outpatient medical practice of an urban university teaching hospital. PATIENTS: All patients 18 years or older who signed a consent form approved by the university's institutional review board. MEASUREMENT: Calculation of the sensitivity, specificity, receiver operating characteristic (ROC) curve, and likelihood ratio for CAGE scores of 0 to 4. RESULTS: Thirty-six percent of the sample group met criteria for a history of alcohol abuse or dependence. A CAGE score of 2 or more was associated with a sensitivity and specificity of 74% and 91%. The calculated area under the ROC curve was 0.89, whereas the likelihood ratios for CAGE scores of 0 to 4 were 0.14, 1.5, 4.5, 13, and 100, respectively. These ratios were associated with posterior probabilities for an abuse or dependence disorder of 7%, 46%, 72%, 88%, and 98%, respectively. CONCLUSION: Clinicians can improve their ability to estimate a patient's risk for an alcohol abuse or dependence disorder using likelihood ratios for CAGE scores.

Adult↗
PubMed1991

Alcohol consumption patterns in a primary care population.

Over a one-year period the authors administered the Diagnostic Interview Schedule to 459 randomly selected patients attending an urban general medicine practice. Alcohol abuse and alcohol dependence disorders were diagnosed as current in 12% of the patients, while 19% of the patients met criteria for a past disorder. In addition, 11% and 3%, respectively, reported a history of previous or current heavy consumption. The lifetime prevalence of alcohol consumption disorders is significantly higher in males than females, while current disorders are significantly more common in younger than older individuals. Based upon the number of reported symptoms, patients reporting current disorders appear to have a more serious form of disease than patients reporting a past disorder. We conclude that disorders of alcohol consumption are common in our medical practice. Moreover, our findings suggest that many patients do recover from alcohol consumption disorders (i.e. are currently symptom-free by self-report) and disease severity may be an important factor in this process.

Adult↗
PubMed1986

Reassurance reconsidered.

Reassurance is a therapeutic intervention that is commonly employed by physicians in their practice of medicine. Although physicians most often save reassurance for the patient with benign and transient disease, it is an appropriate therapeutic intervention in patients with chronic and progressive conditions as well. The goals of reassurance include relieving the patient's anxiety and restoring his sense of autonomy. This requires that the physician clarify the meaning that the perceived illness has for the patient, characterize the patient's information needs and convey a message that addresses these needs in an empathic and unambiguous way. Ultimately, the success of reassurance relies as much upon the physician's ability to effectively communicate with the patient and his commitment to the doctor-patient relationship as it does to his understanding of human pathology.

Adult↗
PubMedDate not supplied

Underdocumentation of benzodiazepine prescriptions in a general medicine clinic.

During a three-month period the authors reviewed the charts of patients prescribed benzodiazepine and non-benzodiazepine medications by 73 housestaff practicing in an ambulatory medical clinic. Compared with non-benzodiazepine prescriptions, benzodiazepine name (p less than 0.001), instructions (p less than 0.001), and targeted problems (p less than 0.0001) were significantly underrecorded. In 11% of the records reviewed there was no indication that a mood disorder had been identified or a benzodiazepine prescribed (p less than 0.0001). Problems targeted for benzodiazepine management were found less frequently in the records of elderly patients than in those of patients less than 65 years of age (p less than 0.05). The authors conclude that many houseofficers significantly underdocument the prescriptions they write for benzodiazepine medications and that this may be a marker of their regard for managing mood disorders with benzodiazepines.

Ambulatory Care Facilities↗
PubMedDate not supplied

Physician detection of drinking problems in patients attending a general medicine practice.

OBJECTIVE: To assess the patient and physician characteristics that influence physicians' detection of problem drinking in their medical patients. SETTING: The outpatient medical clinic at an urban university teaching hospital staffed by interns and residents. DESIGN: Cross-sectional study of a randomly chosen subsample of consecutive patients. MEASUREMENT: Univariate and multivariate analysis with calculated adjusted odds ratios of factors associated with physician detection of drinking problems. A problem was diagnosed according to the patient's results on the alcohol module of the Diagnostic Interview Schedule (DIS). RESULTS: Physicians detected 22% of 189 presumably inactive problems and 49% of 92 current problems, i.e., those that have occurred within the preceding year. Multivariate correlates of detection of active problems included male patient gender, presence of gastrointestinal complications of excessive drinking, number of concurrent medical disorders, and previous medical record reference to alcohol (p less than 0.05). Physician gender and year of training were not associated with detection. CONCLUSION: Our physicians appear to rely on specific patient characteristics as well as the patient's medical record to detect drinking problems in their ambulatory patients. Their reliance upon these factors may hinder their detection of drinking problems in women patients and less seriously impaired individuals.

Alcoholism↗