Addressing alcohol use among primary care patients: differences between family medicine and internal medicine residents

To determine whether rates of addressing alcohol use differed between family medicine and internal medicine residents, and to determine whether attitudes, confidence, and perceptions affected these relationships. Two university outpatient clinics, one staffed by family medicine and the other by primary care and categorical internal medicine residents. Cross-sectional study of consecutive patients who had been followed by second- and third-year residents for at least one year. Alcohol abuse was determined using the Michigan Alcoholism Screening Test (MAST), with a score > or = 5 considered positive. Rates of addressing alcohol use in the preceding year were determined by patient report and chart review. Attitudes were assessed using the Substance Abuse Attitude Survey (SAAS). 334 patients of 49 residents completed the MAST. Rates of alcoholism among the patient groups were: family medicine, 8.3%; primary care, 29.1%; and categorical medicine, 18.0% (p < 0.001). Screening behavior varied by type of residency: 47% of the family medicine, 71% of the primary care, and 65% of the categorical residents' patients reported being asked about alcohol use in the preceding year (p < 0.001); chart documentation was present for 15% of the family medicine, 38% of the primary care, and 24% of the categorical residents' patients (p < 0.001). Perceived prevalence of alcohol abuse, confidence in intervening, and several scales on the SAAS were related to residency type and to addressing alcohol use, but controlling for these variables did not affect the association between residency type and either patient report or chart documentation of screening. Rates of addressing alcohol use differed for internal medicine and family medicine residents, but were not due to differences in resident perceptions and attitudes.