High test-retest reliability of the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire completed by primary care patients in routine care

Claire B Simon; Connor J McCabe; Theresa E Matson; Malia Oliver; Katharine A Bradley; Kevin A Hallgren

doi:10.1111/acer.15245

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):302-308. doi: 10.1111/acer.15245. Epub 2023 Dec 23.

Authors

Claire B Simon¹, Connor J McCabe², Theresa E Matson³, Malia Oliver³, Katharine A Bradley^{3

4

5}, Kevin A Hallgren^{2

3

5}

Affiliations

¹ Department of Family Medicine, University of Washington, Seattle, Washington, USA.
² Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.
³ Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA.
⁴ Kaiser Permanente School of Medicine, Pasadena, California, USA.
⁵ Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA.

PMID: 38099421
PMCID: PMC10922542 (available on 2025-02-01)
DOI: 10.1111/acer.15245

Abstract

Background: The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a three-item screening measure of unhealthy alcohol use that is widely used in healthcare settings. Evidence shows high test-retest reliability of the AUDIT-C in research samples, but most studies had limited external validity and used small samples that could not be used to evaluate reliability across demographic subgroups and/or screening modalities. This study evaluates the test-retest reliability of the AUDIT-C completed in routine care in a large primary care sample, including across demographic subgroups defined by age, sex, race, ethnicity, and screening modality (i.e., completed in-clinic or online).

Methods: We used electronic health record (EHR) data from Kaiser Permanente Washington. The sample included 18,491 adult primary care patients who completed two AUDIT-C screens 1-21 days apart as part of routine care in 2021. Test-retest reliability was evaluated for AUDIT-C total scores (0-12) and for a binary measure indicating unhealthy alcohol use (scores ≥3 women, ≥4 men). Using previously established cutoffs, we interpreted reliability coefficients >0.75 as indicating "excellent" reliability.

Results: AUDIT-C screens completed in routine care and documented in EHRs had excellent test-retest reliability for total scores (ICC = 0.87, 95% CI: 0.87-0.87) and the binary indicator of unhealthy alcohol use (κ = 0.79, 95% CI: 0.78-0.80). Reliability coefficients were good to excellent across all demographic groups and for in-clinic and online modalities. Higher reliability was seen when both screens were completed through online patient portals (ICC = 0.93, 95% CI: 0.93-0.93) versus in-clinic (ICC = 0.81, 95% CI: 0.79-0.82) or when one screen was completed using each modality (ICC = 0.83, 95% CI: 0.82-0.83). Lower reliability was seen in American Indian/Alaska Native (ICC = 0.82, 95% CI: 0.75-0.87) and multiracial individuals (ICC = 0.82, 95% 0.80-0.84).

Conclusions: In real-world routine care conditions, AUDIT-C screens have excellent test-retest reliability across demographic subgroups and modalities (online and in-clinic). Future research should examine why reliability varies slightly across modalities and demographic subgroups.

Keywords: AUDIT-C; behavioral health screening; primary care; psychometrics; test-retest reliability.

Abstract

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