Low detection rates, negative attitudes and the failure to meet the “Health of the Nation” alcohol targets: findings from a national survey of GPs in England and Wales

Abstract

The appropriateness of the primary care setting to undertake the health promotional activities needed to meet 'Health of the Nation' alcohol targets has been acknowledged in UK government policy and the scientific literature. However, the latest data suggest these targets are not being met. A 20% random sample of all general practitioners in England and Wales were surveyed by postal questionnaire to examine their work in detecting alcohol misuse and their attitudes towards the work. Four mailing waves produced a 44% response rate. GPs had identified a mean of 3.2 patients per month drinking above recommended 'sensible' guidelines. These patients were mostly male (73%) and above 40 years of age (45%), with nearly half (45%) already dependent drinkers. Most GPs perceived alcohol misuse patients as a difficult group with whom to work. None the less, over half the respondents believed general practice was an appropriate setting for the detection of the problem. However, most did not feel trained or supported in this area of their work. More emphasis needs to be placed on the valuable contribution GPs can make with the larger number of patients who are drinking regularly above 'sensible' levels but not yet suffering adverse affects. Our findings point towards not an unwilling profession, but a profession lacking confidence. The provision of support and basic training are major factors in how GPs perceive alcohol misusers and their own role in this work. Twenty years after the Maudsley Alcohol Pilot Project research it is disappointing that, despite greater recognition by GPs of their potential impact, lack of training and lack of support are still so central to their continued low levels of therapeutic commitment.

Implementing routine screening and brief alcohol intervention in primary health care: A Delphi survey of expert opinion

“…Wallace et al 1988). However, given the very low level of delivery of SBI at present (Deehan et al 1998, it would be preferable to make SBI more acceptable to PHC staff than to recommend a mode of delivery they are unlikely to find acceptable. It is arguable that, once routine delivery of SBI has been incorporated in a limited form, an expansion of range could then be envisaged.…”

“…hazardous and harmful drinkers; Edwards et al 1982) is effective in leading to reductions in drinking (Kahan et al 1995, Moyer et al 2002, with consequent benefits for patients and for public health, together with savings to health-care resources (Fleming et al 2000(Fleming et al , 2002. Unfortunately, there is also evidence that health-care professionals have been slow to incorporate brief interventions routinely in their work (Deehan et al 1998, Lock et al 2002. What is clearly needed is the development of strategies aimed at overcoming the barriers to implementation that have been identified in research (e.g.…”

Older Adults’ Inpatient and Emergency Department Utilization for Ambulatory-Care-Sensitive Conditions: Relationship With Alcohol Consumption

“…In any case, the result may be lower use of recommended services or delays in seeking care until problems are more severe. At the same time, providers sometimes have attitudinal barriers towards patients with alcohol problems Deehan, Templeton, Taylor, Drummond, & Strang, 1998;Freidman, McCullough, Chin, & Saitz, 2000;Kaner et al, 2009) which could potentially result in differential treatment. These patients may be more difficult to treat, or scarce clinical time may be taken up with competing demands.…”

Managing the heavy drinker in primary care

“…Up to 20% of people consulting their GP drink more than the recommended upper limits, but the proportion identified - chiefly those with self-declared or 'visible' problems such as dependence - is small, with many patients at the less severe end of the spectrum going unrecognised 6 , 8. There are many barriers to their recognition in primary care 9.…”

“…Often the issue of alcohol is hidden among many other presenting problems, and the patient may be unaware of (or deny) any link between these problems and their drinking. In a recent postal survey of 5560 GPs in England and Wales, of the 44% who responded, 87% considered primary care an appropriate setting for detecting and managing alcohol problems, even though most considered alcohol misusers a difficult and time-consuming group to manage 8. While 42% felt adequately trained in detecting the problem, only 25% felt trained in its treatment, and only 35% felt adequately supported by specialist services.…”