Addressing patient alcohol use: a view from general practice

Mules, Thomas; Taylor, Jennifer; Price, R. V.; Walker, Logan; Singh, Baneet; Newsam, Patrick; Palaniyappan, Thenmoli; Snook, Toby; Ruselan, Mahfuzah; Ryan, John; Santhirasegaran, Jaishree; Shearman, Phoebe; Watson, Petronella; Zino, Richard; Signal, Louise; Fougere, Geoff; Moriarty, Helen; Jenkin, Gabrielle

doi:10.1071/hc12217

Cited by 35 publications

(44 citation statements)

References 12 publications

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“…In contrast to the reported perspectives of GPs elsewhere,20 our GP participants overwhelmingly supported the statement that, in a usual month, they were likely to routinely ask patients about their alcohol status. Previous research has noted discrepancies between the perceptions of GPs and those of patients with regard to the frequency of alcohol-related enquiries.…”

Section: Discussioncontrasting

confidence: 76%

How Australian general practitioners engage in discussions about alcohol with their patients: a cross-sectional study

et al. 2016

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ObjectiveThis study aimed to investigate factors that inhibit and facilitate discussion about alcohol between general practitioners (GPs) and patients.DesignData analysis from a cross-sectional survey.Setting and participants894 GP delegates of a national health seminar series held in five capital cities of Australia in 2014.Main outcome measuresLikelihood of routine alcohol enquiry; self-assessed confidence in assessing and managing alcohol issues in primary healthcare.ResultsMost GPs (87%) reported that they were likely to routinely ask patients about their alcohol consumption and had sufficient skills to manage alcohol issues (74%). Potential barriers to enquiring about alcohol included perceptions that patients are not always honest about alcohol intake (84%) and communication difficulties (44%). ‘I usually ask about alcohol’ was ranked by 36% as the number one presentation likely to prompt alcohol discussion. Altered liver function test results followed by suspected clinical depression were most frequently ranked in the top three presentations. Suspicious or frequent injuries, frequent requests for sickness certificates and long-term unemployment were ranked in the top three presentations by 20% or less. Confidence in managing alcohol issues independently predicted likelihood to ‘routinely ask’ about alcohol consumption. Lack of time emerged as the single most important barrier to routinely asking about alcohol. Lack of time was predicted by perceptions of competing health issues in patients, fear of eliciting negative responses and lower confidence in ability to manage alcohol-related issues.ConclusionsImproving GPs' confidence and ability to identify, assess and manage at-risk drinking through relevant education may facilitate greater uptake of alcohol-related enquiries in general practice settings. Routine establishment of brief alcohol assessments might improve confidence in managing alcohol issues, reduce the time burden in risk assessment, decrease potential stigma associated with raising alcohol issues and reduce the potential for negative responses from patients.

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Section: Discussioncontrasting

confidence: 76%

How Australian general practitioners engage in discussions about alcohol with their patients: a cross-sectional study

et al. 2016

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“…In contrast to previous studies (37,43), practitioners reported the screening questions were useful for understanding their patients' alcohol consumption. Moreover, practitioners participating in the COMBAT Trial did not engage mechanically with the CDSS.…”

Section: Discussioncontrasting

confidence: 70%

Integrating brief alcohol interventions with tobacco addictions treatment in primary care: qualitative study of health care practitioner perceptions

Minian

Noormohamed

Lingam

et al. 2019

Preprint

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Background Randomized trials of complex interventions are increasingly including qualitative components to further understand factors that contribute to the success of complex interventions. In this paper, we explore the experiences of health care professionals who participated in the COMBAT trial; a web-based intervention implemented in the Ontario-wide Smoking Treatment for Ontario Patients (STOP) Program to prompt primary care practitioner delivery of a brief alcohol intervention as part of a smoking cessation program. This study conducted qualitative interviews with primary care practitioners to understand the factors influencing implementation and acceptability of the intervention. Methods Twenty three primary care practitioners were selected for a qualitative interview using intensity sampling, ensuring representation across study arms, organization types, and rates of intervention delivery. Interviews were 45 to 90 minutes in length and conducted by phone using an interview guide that was informed the National Implementation Research Network’s Hexagon tool. Interview recordings were transcribed and coded iteratively between three researchers to achieve consensus on emerging themes. Results Most interviewed practitioners recognized the need to simultaneously address risky alcohol use and tobacco use, and shared that this type of work fits within the priorities of their respective clinics. Although most practitioners were knowledgeable about the evidence of health risks associated with dual alcohol and tobacco use, most still felt they could have benefited from additional training – beyond the two webinars delivered by the STOP program – prior to the launch of the COMBAT initiative. Practitioners acknowledged the value of adding a validated screening tool to the STOP program’s baseline questionnaire; however, following through with a brief intervention and referral to treatment proved challenging due to limited time. Conclusions While practitioners recognized the value of the COMBAT initiative, insufficient training and time were frequently reported as barriers to adoption and delivery. The results of the study also show that practitioners’ beliefs were reflective of the current social norms around alcohol use and this influenced their decision to offer a brief alcohol intervention to patients. Future designs of primary care-based interventions need emphasize organizational and sociocultural factors as part of the design.

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“…Specially trained paraprofessionals, such as the HEs in this study, have frequently been used as an alternative, with favorable outcomes with regard to costs [16] and patient satisfaction [17]. In addition, the use of peer HEs who screen patients for substance use outside the medical encounter might serve to reduce actual or perceived social stigma [18]. …”

Section: Methodsmentioning

confidence: 99%

Randomized controlled trial to evaluate screening and brief intervention for drug-using multiethnic emergency and trauma department patients

Eisenberg¹,

Woodruff

2013

Addict Sci Clin Pract

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BackgroundScreening and brief intervention (SBI) is a comprehensive, integrated public health approach to identify and deliver a spectrum of early detection and intervention services for substance use in general medical care settings. Although the SBI approach has shown promise for alcohol use, relatively little is known about its effectiveness for illicit drug use. We are evaluating the SBI approach for drug use using a rigorous randomized controlled trial. The purpose of the report is to describe the overall trial and its programmatic and methodological strengths with a focus on health educator (HE) selection and training. In addition, the baseline characteristics of the recently enrolled multiethnic cohort are described.Methods/designA randomized two-group repeated measures design is being used in which drug-related outcomes of an intervention group will be compared with those of an attention-placebo control group. Selection of bicultural paraprofessional HEs—their training in research concepts, comorbid mental health issues, special treatment of marijuana use, and nonscripted enhanced motivational interviewing as well as their ongoing monitoring and evaluation—are among the features described. The HEs enrolled, consented, and conducted an intervention among 700 illicit drug users in two large hospital emergency departments/trauma units. To be eligible, a participant needed to be an adult (age ≥18 years), an English or Spanish speaker, awake and able to give consent, and reachable by telephone to schedule a six-month follow-up interview.DiscussionA comprehensive HE training protocol combined with rigorous, ongoing process measurement resulted in skill mastery in many areas and a successful participant recruitment period. Strengths and limitations of the study protocol are discussed as well as the characteristics of those recruited. This trial will be among the first to provide information about the effectiveness of SBI for illicit drug use. Outcome analysis has not yet been completed, but demonstrated programming and design successes have implications for future research and service delivery.Trial registrationhttp://NCT01683227

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Addressing patient alcohol use: a view from general practice

Cited by 35 publications

References 12 publications

How Australian general practitioners engage in discussions about alcohol with their patients: a cross-sectional study

How Australian general practitioners engage in discussions about alcohol with their patients: a cross-sectional study

Integrating brief alcohol interventions with tobacco addictions treatment in primary care: qualitative study of health care practitioner perceptions

Randomized controlled trial to evaluate screening and brief intervention for drug-using multiethnic emergency and trauma department patients

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