From Clinicaltools.com

Alcohol Use and Misuse and Patient Care

*New title as of 2/09

Description

(Steve draft) This course is to set the stage for the physicians by making them aware as to the extent the misuse of alcohol can make in their patient's overall health and well being.

Alcohol use and misuse can negatively affect patient health. This course defines alcohol use disorders, provides epidemiological data on recent trends and demographics, as well as the health impact of excessive alcohol use.

URL

Alcohol Use and Misuse and Patient Care (Draft)

Need

Regular alcohol consumption is prevalent, resulting in a significant number of deaths and leading to alcohol abuse or dependence. Coverage of alcohol misuse in medical schools is superficial and not universal.

Needs Analysis

(In the spring of 2008, we conducted a focus group with 13 medical school faculty and addiction consultants. The results of the focus group shaped our module outline and content.)

Brief Summary: This module was as important by 12/13 faculty (mean 4.17). Six faculty thought a one hour course was appropriate for the subject matter. With a rating scale of 1-5, the importance of as a topic are to be covered was rated 4.17, the implication that the average medical student would benefit from additional instruction in this topic was rated 4.08, and the willingness of faculty to encourage students to learn more about the topic was rated 4.38. The willingness to include this module in current teaching was rate 4.08 and the ease of fitting the module into the institution's current curriculum was rated 4.00. The topic was deemed to align with recommended physician competencies in the area of substance abuse with a rating of 4.31. A number of aspects of the topic were requested for emphasis and these areas were taken under consideration when devising the course.

Vision

Physicians-in-training understand that alcohol use problems are prevalent and can negatively impact patient health if not detected and treated.

Mission

(The CTI Solution)

Proper preparation during medical school can increase the number of alcohol use interventions and effectively lower the number of alcohol-related deaths.

Goal

After taking this course, medical students will be able to recognize and categorize alcohol use disorders, as well as the negative health impacts alcohol has on the body.

Learning Objectives

Describe the continuum of alcohol abuse or dependence as a disease.
Recognize that alcohol misuse is prevalent in a variety of settings and should be assessed in all patients.
Identify common diseases that often manifest or are comorbid with alcohol misuse.

Case Study 1: Amanda

Case Focus: Amanda is presented in two different, non consecutive pages. The first time we encounter Amanda is in a "Clinical Choice" question immediately following a discussion of the continuum of alcohol use problems. The second time we meet Amanda is immediately following a page about alcohol consumption in older adults. Again, Amanda's discussion is presented as a "Clinical Choice" question for physicians-in-training.

Case Goal: Physicians-in-training will apply their understanding of alcohol use disorders and determine what is best clinically for an older adult who drinks more than the recommended guidelines.

Course Objectives Met: 2 and 3

Patient: Amanda - 67 YOWF

Chief Complaint: Difficulty sleeping that hasn't resolved despite past office visits
Narrative: Amanda is a 67 year old woman who has a complaint of difficulty sleeping. She has tried OTC and Ambien.
Alcohol Use: Two glasses of wine/night
AUD Diagnosis: At risk for abuse; drinking above recommended guidelines for her age
Relevant Past Medical, Psychosocial, Family History: Difficulty sleeping, not remedied by OTC or Ambien. Revealed that a friend passed away one year ago. Amanda's alcohol use increased at this time; she now is drinking 2 glasses wine/night
Take Home Message: In older adults, increased use of alcohol can cause increased health concerns. In this case, Amanda's daily use of alcohol is causing her sleep difficulties.
Practice Tip: Physicians-in-training should be aware that alcohol misuse can manifest differently in older adults than in younger persons.
URL's: Meet Amanda; Amanda's Alcohol History

Case Study 2: Phoebe

Case Focus: Phoebe is presented in two different, consecutive pages. The first time we encounter Phoebe is in a "Clinical Choice" question in the last section of the course. We once again deal with Phoebe in the same office visit. Again, Phoebe's discussion is presented as a "Clinical Choice" question for physicians-in-training.

Case Goal: Physicians-in-training will apply their understanding of alcohol use disorders among adolescents, as well as their understanding of consent.

Course Objectives Met: 3

Patient: Phoebe - 15YOWF

Chief Complaint: Suspected depression, coupled with other contributing factors
Narrative: Her mother brings her in and describes the difficulties of the past year. Among these troubles, the mother recounts conflicts about piercings, tattoos, musical taste, clothing selection, and alcohol use. Phoebe is being brought to your attention due to mother's concern about whether her daughter has depression.
Alcohol Use: 2 beers at a sitting, very infrequently (at parties with friends)
AUD Diagnosis: At risk for alcohol use disorder. Though her use is illegal as she is underage, her use has not had any significant medical repercussions.
Relevant Past Medical, Psychosocial, Family History: Parental stress combined with adolescent peer pressure may be contributing to problem
Take Home Message: Sometimes alcohol use may be present, but may not be the entire diagnosis. In this case, Phoebe shows signs of depression, but her alcohol use is minimal. The physicians-in-training should counsel Phoebe as any alcohol use at her age is illegal.
Practice Tip: Speaking to Phoebe without her mother in the room helped her be more honest, which leads to proper diagnosis of alcohol-related problems
URL's: Case Study