"This project offers concrete evidence of the scale of the challenge to improve the identification and treatment of alcohol dependence among America's workers," said Eric Goplerud, Ph.D., director of Ensuring Solutions to Alcohol Problems at the George Washington University Medical Center in Washington, D.C. Researchers at Ensuring Solutions analyzed data from the alcohol use disorders section of the 2005 eValue8 RFI Initiative, which captures voluntarily reported data from more than 250 health plans nationwide. The National Business Coalition on Health, a national membership organization of regional employer coalitions that aims to improve health care quality, sponsored the project.
The findings indicate that the systemic failure to address alcohol dependence begins with a failure to adequately identify people with alcohol problems. Although approximately 8 percent of working adults suffer from alcohol dependence or a related condition, only about .06 percent of all health plan members (or just 8 percent of those estimated to have the disease) receive such a diagnosis. In comparison, health plans identify about 40 percent of patients with depression, 65 percent of diabetics and 70 percent of those with hypertension.
The data also showed that less than half--44 percent--of members identified as alcohol dependent attend even a single alcohol or drug treatment session within 14 days. Only about 16 percent receive the recommended three chemical dependency health care services in the month following diagnosis. Health plans also are failing to reach out to members in ways that would promote successful treatment, Dr. Goplerud said. For example, few plans are sending educational materials, and only 17 percent are making follow-up calls to members who miss appointments.
However, the responsibility lies not just with health plans but with physicians, employers and others who have not treated alcohol dependence on par with other diseases, said Dr. Goplerud, who is also a research professor in the Department of Health Policy at the GWU School of Public Health and Health Services.
"Imagine discovering an illness that kills about 85,000 people annually, and then imagine that we identify only one in 20 of those people--even though we have effective treatments that can be administered by primary care physicians or specialists. Wouldn't there be an outcry to establish a national approach to improving access to quality care for this disease?" he said. "Here we have such an illness: alcoholism. Yet we accept low rates of identification and treatment. Our approach to alcohol treatment is unlike what we expect and demand for treatment of diabetes, high blood pressure, asthma or virtually any other health condition."
There were some bright spots in the data, Dr. Goplerud said. Seventy-five percent of plans require primary care physicians and behavioral health care providers to use screening tools that have been proven effective, a number that continues to increase. The fact that alcohol dependence treatment is now being tracked, both through eValu8 and through accreditation programs such as those of the National Committee for Quality Assurance (NCQA), may raise awareness and lead to positive changes.
"The mere presence of quality measures is not enough," said Dr. Goplerud. "With diabetes, the American Diabetes Association, the Veterans Administration and Medicare got together to develop standards for identification and treatment. The initial rates were not very good. But because these large groups said they cared about it, there was tremendous energy around increasing identification and treatment rates. For alcohol problems, we're at a very low level but effective tools are now available. It's time for employers and health plans to care about using them."