The Alcohol Use Disorders Identification Test (AUDIT-C) is a key three-question screening tool used by health care professionals to detect alcohol misuse. Although previous clinical research has validated the use of the AUDIT-C, its test-retest reliability (a measure of the consistency of test results over time) has not been evaluated under routine care settings with adult primary care patients.
Now, scientists supported by the National Institute on Alcohol Abuse and Alcoholism have conducted a study to examine the reliability of the AUDIT-C under real-world conditions. The team also set out to evaluate the screening tool in demographic subgroups (defined by age, sex, race and ethnicity) and the options for completing the AUDIT-C online or in a clinic setting.1
Dr. Claire B. Simon of the University of Washington in Seattle led the study, which used electronic health record (EHR) data from Kaiser Permanente Washington. More than 18,000 adult primary care patients completed two AUDIT-C tests 1 to 21 days apart as part of routine care in 2021.
Dr. Simon and colleagues reported that AUDIT-C testing performed in routine care and documented in electronic medical records demonstrated “excellent” test-retest reliability. Test-retest reliability assesses the consistency of results from the same measure or screening tool when it is administered at two different times to a group of people. Test-retest reliability is high when there are similar results across test administrations.
The authors also showed that the AUDIT-C demonstrated “good” to “excellent” test-retest reliability across multiple demographic groups, as well as when assessments were completed in the clinic or online through patient portals.
The study found that reliability was somewhat higher when patients completed the AUDIT-C both times using online patient portals, compared with completing the assessment in the clinic or when they combined the two assessment modes.
Results also indicated that reliability was slightly lower for American Indian/Alaska Native (AI/AN) and multiracial patients. Clinicians and researchers should be aware of this finding when working with patients who are members of AI/AN or multiracial groups and may consider seeking additional sources of information about these individuals' alcohol use beyond the AUDIT-C.
The results of this study support the utility of the AUDIT-C for identifying alcohol abuse among patients in routine care settings.
References:
1 Simon CB, McCabe CJ, Matson TE, Oliver M, Bradley KA, Hallgren KA. High test–retest reliability of the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) questionnaire completed by primary care patients in routine care. Alcohol Clin Exp Res (Hoboken). 2024 Feb;48(2):302–8. PubMed PMID: 38099421
2 Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT Alcohol Use Questions (AUDIT-C): a brief and effective screening test for problematic alcohol use. Arch Intern Med. Sep 14, 1998;158(16):1789–95. PubMed PMID: 9738608
This article first appeared in NIAAA Spectrum.
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