The edition · Family Medicine
Three ways of asking about alcohol found three different groups of patients
In nearly 9,000 Swedish primary care records, a questionnaire flagged 26.5% as hazardous drinkers, a blood biomarker 15–18%, and a simple weekly count 8.5% — and each found people the others missed. Meanwhile 677 practitioners describe exactly where their confidence in managing urinary tract infection runs out, and a structured medicines review in over-65s found problems usual care did not.
The edition in brief
Screening for hazardous alcohol use in primary care depends more on the instrument than most clinicians assume. A Swedish retrospective cohort linked regional primary care records to national registries and compared phosphatidylethanol, a direct alcohol biomarker, against two self-reported measures. In 3,679 patients with both a biomarker result and an Alcohol Use Disorders Identification Test score, and 8,934 with a biomarker result and a documented weekly intake, the proportions identified as hazardous were 26.5% by questionnaire, 14.6% to 18.3% by biomarker and 8.5% by weekly drinks. Correlation between biomarker and self-report was moderate and non-linear, and reporting varied by group: at similar biomarker levels, men and patients with higher education or income reported drinking more, while younger patients scored higher on the questionnaire. A qualitative evidence synthesis of 32 studies covering 677 primary care practitioners mapped how urinary tract infections are actually managed. Practitioners described confidence in the straightforward case that fell away for what the authors call patient X — children, men, older patients and those with recurrent infection — compounded by time pressure, staff shortages and patient expectation. A pragmatic cluster-randomised trial in six Welsh practices tested the Adverse Drug Reaction Profile in 60 patients aged 65 or over taking more than four long-term medicines. Intervention patients were more likely to have more than one clinical problem addressed, 82% versus 35%, with an adjusted odds ratio of 7.48. The trial is small and the confidence interval wide, and clinicians raised concerns about staff time.
A questionnaire, a blood test and a simple count identified three overlapping but different groups of drinkers
Use the biomarker to open a conversation, never to close one — and do not treat a normal result as clearance.
677 practitioners describe where their confidence in urinary tract infection stops: children, men, older patients, recurrence
Treat the moment you notice the patient is outside your usual case as the signal to culture and reassess, not to prescribe faster.
Your confidence is calibrated to the patient you see most often
When a consultation stops feeling routine, that feeling is data — use it to trigger a test, a review date, or explicit worsening advice.
A structured medicines review in over-65s addressed problems that usual care did not
For housebound or older patients on five or more long-term medicines, add a patient-completed symptom checklist to the repeat prescription review and route it through the pharmacist.
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