Adverse events: an expensive and avoidable hospital problem.

INTRODUCTION: Adverse healthcare-related events (AE) entail reduced patient safety. Estimating their frequency, characteristics, avoidability and impact is a means to identify targets for improvement in the quality of care. METHODS: This was a descriptive observational study conducted within the Patient Safety Incident Study in Hospitals in the Community of Madrid (ESHMAD). The study was conducted in a high-complexity hospital in May 2019 through a two-phase electronic medical record review: (1) AE screening and epidemiological and clinical data collection and (2) AE review and classification and analysis of their impact, avoidability, and associated costs. RESULTS: A total of 636 patients were studied. The prevalence of AE was 12.4%. Death during the stay was associated with the presence of AE (OR [CI95%]: 2.15 [1.07 to 4.52]) versus absence and emergency admission (OR [CI95%]: 17.11[6.63 to 46.26]) versus scheduled. A total of 70.2% of the AEs were avoidable. Avoidable AEs were associated with the presence of pressure ulcers (OR [CI95%]: 2.77 [1.39 to 5.51]), central venous catheter (OR [CI95%]: 2.58 [1.33 to 5.00]) and impaired mobility (OR [CI95%]: 2.24[1.35 to 3.71]), versus absences. They were associated too with the stays in the intensive care unit (OR [CI95%]: 2.75 [1.07 to 7.06]) versus medical service. AEs were responsible for additional costs of €909,716.8 for extra days of stay and €12,461.9 per patient with AE. CONCLUSIONS: The prevalence of AEs was similar to that found in other studies. AEs led to worse patient outcomes and were associated with the patient's death. Although avoidable AEs were less severe, their higher frequency produced a greater impact on the patient and healthcare system.Key messagesAdverse events are one of the main problems in healthcare delivery and patients who suffer from at least one AE are double as likely to die during hospitalization.Avoidable adverse events are the most frequent in health care and they are a good target where achieve improvement areas that allow getting optimal patient safety and quality of care levels.Patients hospitalized in the ICU, with the previous presence of pressure ulcers, central venous catheter, or impaired mobility were associated with the development of avoidable AE, so optimal management of these patients would reduce the impact of AE.

Recommendations for prevention of infection in systemic autoimmune rheumatic diseases.

OBJECTIVES: To develop recommendations for the prevention of infection in adult patients with systemic autoimmune rheumatic diseases (SARD). METHODS: Clinical research questions relevant to the objective of the document were identified by a panel of experts selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network criteria. Specific recommendations were made. RESULTS: Five questions were selected, referring to prevention of infection by Pneumocystis jirovecii with trimethoprim/sulfamethoxazole, primary and secondary prophylactic measures against hepatitis B virus, vaccination against human papillomavirus, vaccination against Streptococcus pneumoniae and vaccination against influenza virus, making a total of 18 recommendations, structured by question, based on the evidence found for the different SARD and/or expert consensus. CONCLUSIONS: There is enough evidence on the safety and efficacy of vaccinations and other prophylactic measures against the microorganisms reviewed in this document to specifically recommend them for patients with SARD.

Recommendations for prevention of infection in systemic autoimmune rheumatic diseases. / Recomendaciones SER sobre prevención de infección en enfermedades reumáticas autoinmunes sistémicas.

OBJECTIVES: To develop recommendations for the prevention of infection in adult patients with systemic autoimmune rheumatic diseases (SARD). METHODS: Clinical research questions relevant to the objective of the document were identified by a panel of experts selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network criteria. Specific recommendations were made. RESULTS: Five questions were selected, referring to prevention of infection by Pneumocystis jirovecii with trimethoprim/sulfamethoxazole, primary and secondary prophylactic measures against hepatitis B virus, vaccination against human papillomavirus, vaccination against Streptococcus pneumoniae and vaccination against influenza virus, making a total of 18 recommendations, structured by question, based on the evidence found for the different SARD and/or expert consensus. CONCLUSIONS: There is enough evidence on the safety and efficacy of vaccinations and other prophylactic measures against the microorganisms reviewed in this document to specifically recommend them for patients with SARD.

[Binge drinking: the challenges of definition and its impact on health.] / Episodios de consumo intensivo de alcohol "Binge drinking": retos en su definición e impacto en salud.

Heavy episodic drinking, or binge drinking, is a drinking pattern characterized by the intake of large amounts of alcohol in a short period of time, which often leads to alcohol intoxication. There is no consensus on its operational definition, finding large methodological differences between studies in estimating the amount of alcohol consumed, as well as in defining the occasion of drinking and the reference time period. Keep in mind that most drinkers with this pattern have a low risk total average alcohol consumption. Therefore, actively detecting binge drinking is essential to be able to identify and classify all risk drinkers and characterize the global impact of alcohol consumption on health, society or the economy. Its negative effects affect the drinker himself (intoxication, cardiovascular diseases, dependence, neurocognitive and developmental disorders, among others), but also causes harm to others (accidents, violence, harmful effects on fetal and perinatal neuronal development). These effects can be acute or chronic, even among those who adopt binge drinking sporadically. Different thresholds or ways of characterizing this pattern of alcohol consumption could more adequately predict each of the associated acute and chronic effects, especially if we consider the intensity and frequency of the episodes. However, the absence of a safe threshold for alcohol consumption, both regularly and occasionally, is clear; Any intake with a binge drinking pattern, regardless of the threshold we establish, carries significant risks, not only for the health of the drinker, but also for the people around them.

El patrón de episodios de consumo intensivo de alcohol o binge drinking, se caracteriza por la ingesta de grandes cantidades de alcohol concentrada en un corto espacio de tiempo, que comporta con frecuencia una intoxicación alcohólica. No existe consenso en su definición operativa, hallando entre los estudios grandes diferencias metodológicas en la estimación de la cantidad de alcohol consumido, así como en la definición de la ocasión de bebida y el periodo temporal de referencia. Hay que tener en cuenta que una mayoría de los bebedores con este patrón tienen un consumo de alcohol promedio total de bajo riesgo. Por ello, detectar de forma activa el patrón de consumo intensivo episódico, resulta fundamental para poder identificar y clasificar a todos los bebedores de riesgo y caracterizar el impacto global del consumo de alcohol en la salud, la sociedad o la economía. Sus efectos negativos afectan al propio bebedor (intoxicación, enfermedades cardiovasculares, dependencia, alteraciones neurocognitivas y de maduración entre otros), pero también potencialmente a terceras personas (accidentes, violencia, efectos perjudiciales en el desarrollo neuronal fetal y perinatal). Estos efectos se pueden manifestar de forma aguda, pero también crónica, incluso entre los que adoptan el binge drinking de forma esporádica. Distintos umbrales o formas de caracterizar este patrón de consumo de alcohol podrían predecir de forma más adecuada cada uno de los efectos agudos y crónicos asociados, especialmente si consideramos la intensidad y la frecuencia con que se adopta. No obstante, resulta clara la ausencia de un umbral seguro de consumo de alcohol, tanto de forma regular como puntual; cualquier ingesta con un patrón binge drinking, con independencia del umbral que establezcamos, comporta riesgos importantes, no solo para la salud del bebedor, sino también para las personas de su entorno.

How Much of Root Cause Analysis Translates into Improved Patient Safety: A Systematic Review.

OBJECTIVES: The aim of this systematic review was to consolidate studies to determine whether root cause analysis (RCA) is an adequate method to decrease recurrence of avoidable adverse events (AAEs). METHODS: A systematic search of databases from creation until December 2018 was performed using PubMed, Scopus and EMBASE. We included articles published in scientific journals describing the practical usefulness in and impact of RCA on the reduction of AAEs and whether professionals consider it feasible. The Mixed Methods Appraisal Tool was used to assess the quality of studies. RESULTS: Twenty-one articles met the inclusion criteria. Samples included in these studies ranged from 20 to 1,707 analyses of RCAs, AAEs, recommendations, audits or interviews with professionals. The most common setting was hospitals (86%; n = 18), and the type of incident most analysed was AAEs, in 71% (n = 15) of the cases; 47% (n = 10) of the studies stated that the main weakness of RCA is its recommendations. The most common causes involved in the occurrence of AEs were communication problems among professionals, human error and faults in the organisation of the health care process. Despite the widespread implementation of RCA in the past decades, only 2 studies could to some extent establish an improvement in patient safety due to RCAs. CONCLUSIONS: RCA is a useful tool for the identification of the remote and immediate causes of safety incidents, but not for implementing effective measures to prevent their recurrence.

Episodios de consumo intensivo de alcohol "binge drinking": retos en su definición e impacto en salud / Binge drinking: the challenges of definition and its impact on health

El patrón de episodios de consumo intensivo de alcohol o binge drinking, se caracteriza por la ingesta de grandes cantidades de alcohol concentrada en un corto espacio de tiempo, que comporta con frecuencia una intoxicación alcohólica. No existe consenso en su definición operativa, hallando entre los estudios grandes diferencias metodológicas en la estimación de la cantidad de alcohol consumido, así como en la definición de la ocasión de bebida y el periodo temporal de referencia. Hay que tener en cuenta que una mayoría de los bebedores con este patrón tienen un consumo de alcohol promedio total de bajo riesgo. Por ello, detectar de forma activa el patrón de consumo intensivo episódico, resulta fundamental para poder identificar y clasificar a todos los bebedores de riesgo y caracterizar el impacto global del consumo de alcohol en la salud, la sociedad o la economía. Sus efectos negativos afectan al propio bebedor (intoxicación, enfermedades cardiovasculares, dependencia, alteraciones neurocognitivas y de maduración entre otros), pero también potencialmente a terceras personas (accidentes, violencia, efectos perjudiciales en el desarrollo neuronal fetal y perinatal). Estos efectos se pueden manifestar de forma aguda, pero también crónica, incluso entre los que adoptan el binge drinking de forma esporádica. Distintos umbrales o formas de caracterizar este patrón de consumo de alcohol podrían predecir de forma más adecuada cada uno de los efectos agudos y crónicos asociados, especialmente si consideramos la intensidad y la frecuencia con que se adopta. No obstante, resulta clara la ausencia de un umbral seguro de consumo de alcohol, tanto de forma regular como puntual; cualquier ingesta con un patrón binge drinking, con independencia del umbral que establezcamos, comporta riesgos importantes, no solo para la salud del bebedor, sino también para las personas de su entorno

Heavy episodic drinking, or binge drinking, is a drinking pattern characterized by the intake of large amounts of alcohol in a short period of time, which often leads to alcohol intoxication. There is no consensus on its operational definition, finding large methodological differences between studies in estimating the amount of alcohol consumed, as well as in defining the occasion of drinking and the reference time period. Keep in mind that most drinkers with this pattern have a low risk total average alcohol consumption. Therefore, actively detecting binge drinking is essential to be able to identify and classify all risk drinkers and characterize the global impact of alcohol consumption on health, society or the economy. Its negative effects affect the drinker himself (intoxication, cardiovascular diseases, dependence, neurocognitive and developmental disorders, among others), but also causes harm to others (accidents, violence, harmful effects on fetal and perinatal neuronal development). These effects can be acute or chronic, even among those who adopt binge drinking sporadically. Different thresholds or ways of characterizing this pattern of alcohol consumption could more adequately predict each of the associated acute and chronic effects, especially if we consider the intensity and frequency of the episodes. However, the absence of a safe threshold for alcohol consumption, both regularly and occasionally, is clear; Any intake with a binge drinking pattern, regardless of the threshold we establish, carries significant risks, not only for the health of the drinker, but also for the people around them

Root Cause? Yes of course … but then what?

[EXCERPT]. Analyzing the causes of unsafe care can reduce the number of ‘near misses’ (incidents that may cause harm to patients) and adverse events (that actually produce harm). This is an important mandate for health care organizations committed to providing a safe environment for patients. Although guaranteeing absolute safety in all interventions is not always possible, hospitals and other health care institutions implement safety practices and surveillance methods to understand how these unsafe incidents occur. In many cases, these incidents were not generated by a single cause; and remote causes are as significant as more proximate ones...

Low-value clinical practices and harm caused by non-adherence to 'do not do' recommendations in primary care in Spain: a Delphi study.

OBJECTIVE: To determine the non-adherence to the primary care 'do not do' recommendations (DNDs) and their likelihood to cause harm. DESIGN: Delphi study. SETTING: Spanish National Health System. PARTICIPANTS: A total of 128 professionals were recruited (50 general practitioners [GPs], 28 pediatricians [PEDs], 31 nurses who care for adult patients [RNs] and 19 pediatric nurses [PNs]). INTERVENTIONS: A selection of 27 DNDs directed at GPs, 8 at PEDs, 9 at RNs and 4 at PNs were included in the Delphi technique. A 10-point scale was used to assess whether a given practice was still present and the likelihood of it causing of an adverse event. MAIN OUTCOME MEASURE: Impact calculated by multiplying an event's frequency and likelihood to cause harm. RESULTS: A total of 100 professionals responded to wave 1 (78% response rate) and 97 of them to wave 2 (97% response rate). In all, 22% (6/27) of the practices for GPs, 12% (1/8) for PEDs, 33% (3/9) for RNs and none for PNs were cataloged as frequent. A total of 37% (10/27) of these practices for GPs, 25% (2/8) for PEDs, 33% (3/9) for RNs and 25% (1/4) for PNs were considered as potential causes of harm. Only 26% (7/27) of the DNDs for GPs showed scores equal to or higher than 36 points. The impact measure was higher for ordering benzodiazepines to treat insomnia, agitation or delirium in elderly patients (mean = 57.8, SD = 25.3). CONCLUSIONS: Low-value and potentially dangerous practices were identified; avoiding these could improve care quality.

Patterns of alcohol consumption in the older population of Spain, 2008-2010.

BACKGROUND: Older adults are a growing segment of the European population and alcohol is an important cause of disease burden; thus, it is noteworthy that little information is available on alcohol intake among older adults in Europe. OBJECTIVE: The aim of this study was to examine alcohol consumption patterns and their association with demographic and clinical variables in the older population of Spain. DESIGN: This was a cross-sectional study. PARTICIPANTS/SETTING: The sample included 3,058 individuals, representative of the Spanish population aged ≥60 years during 2008-2010. MAIN OUTCOME MEASURE: Regular alcohol consumption was measured with a validated diet history questionnaire. The threshold between moderate and heavy drinking was ≥40 g alcohol/day in men (≥24 g in women). Binge drinking was defined as intake of ≥80 g alcohol in men (≥60 g in women) during any drinking occasion in the previous month, and problem drinking by a CAGE score ≥2. STATISTICAL ANALYSIS PERFORMED: The prevalence and 95% CI of the drinking patterns were calculated after accounting for sampling design. RESULTS: The prevalence of moderate drinking was 44.3% (95% CI 42.0% to 46.6%) and of heavy drinking was 7.8% (95% CI 6.7% to 8.9%). In total, 68.4% (95% CI 65.7% to 71.2%) of individuals obtained >80% of alcohol from wine and 61.8% (95% CI 58.9% to 64.6%) drank only with meals. Furthermore, 1% (95% CI 0.6% to 1.4%) showed binge drinking and 3.1% (95% CI 2.3% to 3.8%) showed problem drinking. Heavy alcohol consumption was significantly more frequent in men. Moderate alcohol consumption was significantly less frequent among women, persons who were not married, living alone, with a diagnosis of diabetes, receiving treatment for diabetes, and with suboptimal self-rated health. About 5% to 10% of individuals with diagnosed hypertension, diabetes, or cardiovascular disease showed heavy drinking. Among those taking sleeping pills or antidiabetes or antithrombotic treatment, 37% to 46% had moderate alcohol intake and 5% to 8% had heavy intake. CONCLUSIONS: Alcohol consumption among older adults in Spain is frequent and mostly consistent with the traditional Mediterranean drinking pattern. However, a proportion of individuals were heavy drinkers and used medication that may interact with alcohol.

[Methodological issues in the measurement of alcohol consumption: the importance of drinking patterns]. / Aspectos metodológicos en la medición del consumo de alcohol: la importancia de los patrones de consumo.

Measurement of alcohol consumption is essential for proper investigation of its effects on health. However, its estimation is extremely complex, because of the diversity of forms of alcohol consumption and their highly heterogeneous classification. Moreover, each form may have different effects on health; therefore, not considering the most important drinking patterns when estimating alcohol intake could mask the important role of consumption patterns in these effects. All these issues make it very difficult to compare the results of different studies and to establish consistent associations for understanding the true effects of alcohol consumption, both overall and specific to each drinking pattern. This article reviews the main methods and sources of information available in Spain for estimating the most important aspects of alcohol consumption, as well as the most frequent methodological problems encountered in the measurement and classification of drinking patterns.

[Alcohol drinking patterns in Spain: a country in transition]. / Patrones de consumo de alcohol en España: un país en transición.

BACKGROUND: Alcohol consumption in Mediterranean countries is in a transition period. The objective is to describe in the Spanish adult population the pattern of alcohol consumption by major sociodemographic variables. METHODS: A cross-sectional study among 20,608 individuals aged ≥ 15 years who participated in the Spanish Health Interview Survey (ENS) 2011-2012. According to average intake, people were classified as heavy drinkers if they drank ≥ 40 g/day of alcohol (men) or ≥ 24 g/day (women). Binge drinking was defined as the consumption of ≥ 6 standard drinks (men) and ≥ 5 (women) at any drinking occasion (4-6 hours) in the last year. The beverage preference and the trend for 1987-2012 (ENS of these years) were estimated. The relationship of the distribution of drinking patterns with sociodemographic variables was analyzed using adjusted logistic regression models. RESULTS: The prevalence of heavy drinkers was 1.3% (2% in men and 0.7% in women). In men, heavy drinking was more frequent among 45 to 64 year olds (odds ratio (OR)=2.92 compared to men of 15-29 years; CI 95%: 1.59-5.38) and those born in Spain (OR=3.45; CI 95%: 1.59-7.69). In women, the only differences observed were those regarding education level, with heavy drinking increasing as the level of education increases (p linear trend <0.001). The prevalence of binge drinking during the last year was 19.6% in men and 7.1% in women. In both genders, the risk of binge drinking decreased with age and increased with higher education level (p linear trend <0.001). The standardized prevalence of heavy drinkers has declined from 18.8% in 1987 to 1.3% in 2012. CONCLUSION: Alcohol consumption in Spain is consistent with the model for countries in transition, where binge drinking is the most common pattern of excessive use of alcohol. A strong decline in heavy drinkers was observed and wine has been displaced by beer in beverage preference.

Aspectos metodológicos en la medición del consumo de alcohol: La importancia de los patrones de consumo / Methodological issues in the measurement of alcohol consumption: the importance of drinking patterns

Medir correctamente el consumo de alcohol es fundamental para investigar de forma fiable sus efectos en salud. Sin embargo, esta estimación resulta enormemente compleja, tanto por la diversidad de formas de consumo de alcohol existente como por la gran heterogeneidad en su clasificación. Además, cada patrón de consumo de alcohol puede asociarse a efectos muy diferentes sobre la salud, por lo que no tenerlos en consideración cuando estimamos la ingesta de alcohol puede ocultar o confundir su importancia en estos efectos. Todo ello dificulta las comparaciones entre estudios y el establecimiento de asociaciones consistentes que permitan comprender los verdaderos efectos del consumo de alcohol, tanto globales como específicos de cada patrón de bebida. Este trabajo revisa los principales métodos y fuentes de información disponibles en España para estimar los aspectos mas relevantes del consumo de alcohol, así como las dificultades y problemas metodológicos más frecuentes en la medición y clasificación de cada uno de estos indicadores (AU)

Measurement of alcohol consumption is essential for proper investigation of its effects on health. However, its estimation is extremely complex, because of the diversity of forms of alcohol consumption and their highly heterogeneous classification. Moreover, each form may have different effects on health; therefore, not considering the most important drinking patterns when estimating alcohol intake could mask the important role of consumption patterns in these effects. All these issues make it very difficult to compare the results of different studies and to establish consistent associations for understanding the true effects of alcohol consumption, both overall and specific to each drinking pattern. This article reviews the main methods and sources of information available in Spain for estimating the most important aspects of alcohol consumption, as well as the most frequent methodological problems encountered in the measurement and classification of drinking patterns (AU)

Patrones de consumo de alcohol en España: una país en transición / Alcohol drinking patterns in Spain: a country in transition

Fundamentos: El modo en el que se consume alcohol en los países mediterráneos se encuentra en proceso de transición. El objetivo de este trabajo es describir los patrones de consumo en la población adulta española según las principales características sociodemográficas. Métodos: Estudio transversal con participantes de 15 años y más utlizando como fuente de información la Encuesta Nacional de Salud (ENS) 2011-2012 (n=20.608). Según la ingesta promedio de alcohol, se clasificó como de alto riesgo el consumo ≥40 g/día de alcohol en hombres o ≥24 g/día en mujeres. Se definió binge drinking el consumo de ≥6 bebidas estándar de alcohol (hombres) y ≥5 (mujeres) en 4-6 horas durante los últimos 12 meses. Se estimó la preferencia de bebida y la tendencia 1987- 2012 (ENS respectivas). Se analizó su distribución con variables sociodemográficas mediante modelos ajustados de regresión logística. Resultados: El 1,3% de los sujetos encuestados fueron bebedores promedio de alto riesgo (2% de hombres y 0,7% de mujeres). En hombres fue más frecuente entre los 45-64 años (odds ratio (OR)=2,92 respecto a 15-29 años; IC 95%:1,59-5,38) y en los sujetos nacidos en España (OR=3,45; IC 95%: 1,59-7,69). En mujeres se observaron diferencias estadísticamente significativas según el nivel educativo, incrementándose a medida que aumentaba éste (p tendencia lineal <0,001). El 19,6% de hombres y 7,1% y de mujeres realizaron binge drinking en el último año. Este patrón disminuyó con la edad y se incrementó con el nivel de estudios en ambos sexos (p tendencia lineal <0,001). La prevalencia estandarizada de bebedores promedio de alto riesgo descendió desde un 18,8% en 1987 hasta el 1,3% en 2012. Conclusiones: El consumo de alcohol en España es compatible con el modelo de países en transición, donde el binge drinking es el que más contribuye al riesgo global. Se observa un importante descenso del consumo promedio de alto riesgo. La cerveza desplaza al vino como bebida preferente (AU)

Background:Alcohol consumption inMediterranean countries is in a transition period. The objective is to describe in the Spanish adult population the pattern of alcohol consumption by major sociodemographic variables. Methods:Across-sectional study among 20,608 individuals aged ≥15 years who participated in the Spanish Health Interview Survey (ENS) 2011-2012. According to average intake, people were classified as heavy drinkers if they drank ≥40 g/day of alcohol (men) or ≥24 g/day (women). Binge drinking was defined as the consumption of ≥6 standard drinks (men) and ≥5 (women) at any drinking occasion (4-6 hours) in the last year. The beverage preference and the trend for 1987-2012 (ENS of these years) were estimated. The relationship of the distribution of drinking patterns with sociodemographic variables was analyzed using adjusted logistic regression models. Results: The prevalence of heavy drinkers was 1.3% (2% in men and 0.7% in women). In men, heavy drinking was more frequent among 45 to 64 year olds (odds ratio (OR)=2.92 compared to men of 15-29 years; CI 95%: 1.59-5.38) and those born in Spain (OR=3.45; CI 95%: 1.59-7.69). In women, the only differences observed were those regarding education level, with heavy drinking increasing as the level of education increases (p linear trend <0.001). The prevalence of binge drinking during the last year was 19.6% in men and 7.1% in women. In both genders, the risk of binge drinking decreased with age and increased with higher education level (p linear trend <0.001). The standardized prevalence of heavy drinkers hasdeclined from 18.8% in 1987 to 1.3% in 2012. Conclusion: Alcohol consumption in Spain is consistent with the model for countries in transition, where binge drinking is the most common pattern of excessive use of alcohol. Astrong decline in heavy drinkers was observed and wine has been displaced by beer in beverage preference (AU)

The association between alcohol consumption patterns and adherence to food consumption guidelines.

OBJECTIVE: To examine the association between alcohol consumption patterns and adherence to major food consumption guidelines in adults in Spain. METHODS: Telephone survey of 12,037 persons, representative of the population age 18 to 64 years in the region of Madrid, conducted from 2000 to 2005. The threshold between average moderate and excessive drinking was 40 g alcohol/d in men and 24 g/d in women. Binge drinking was defined as intake of ≥80 g alcohol in men and ≥60 g in women during 1 drinking session in the last 30 days. Food consumption was measured with a 24-hour recall. Statistical analyses were performed using logistic regression and adjusted for the main confounders. RESULTS: In total, 4.3% of study participants were excessive drinkers and 10.3% binge drinkers; 6.5% preferred spirits and 24.2% drank with meals. In comparison with never drinking, average moderate drinking with binge drinking was associated with excessive meat consumption (>1 serving/d). Excessive alcohol consumption without binge drinking was associated with insufficient intake of milk products (<2 servings/d) and excessive consumption of meat, fish, and eggs (>2 servings/d). Excessive drinkers with binge drinking more often did not meet the guidelines on consumption of fruit and vegetables (<3 servings/d), milk products, and meat. Excessive drinkers, with and without binge drinking, were more likely to skip a meal, especially breakfast. Consumption mainly of spirits was associated with insufficient fruit and vegetable consumption, and with skipping a meal. Finally, drinking at mealtimes was associated with poor adherence to most of the food consumption guidelines. No dietary differences between men and women were found in relation to alcohol consumption. CONCLUSIONS: Average excessive alcohol consumption, binge drinking, preference for spirits, and drinking alcohol at mealtimes are associated with poor adherence to major food consumption guidelines.