General practitioners' (GPs') recognition of, attitudes towards, and intervention for, excessive drinking and alcohol problems among their patients were assessed in a postal questionnaire survey. Levels of recognition of, and intervention for, excessive drinking by GPs were low. GPs did not routinely enquire about alcohol and had managed only small numbers of patients specifically for excessive drinking or alcohol problems in the previous year. Enquiry about alcohol issues was elicited mainly by physical symptoms or by new patient registrations. Although 83% of GPs felt prepared to counsel excessive drinkers, only 21% felt effective in helping patients reduce consumption. Over the past 10 years, there appears to have been an increase in numbers of GPs who feel that they should be working with alcohol issues, but fewer GPs perceive themselves as being effective in this work. The main barriers to brief alcohol intervention were given as insufficient time and training, and lack of help from government policy; the main incentives related to availability of appropriate support services and proven efficacy of brief interventions.

Background.  Excessive alcohol consumption causes significant mortality, morbidity, economic and social problems in the United Kingdom (UK). Despite strong evidence for the effectiveness of brief intervention to reduce excessive drinking in primary health care, there is little indication that such intervention routinely occurs. Aims.  This study aimed to explore primary health care nurses' attitudes and practices regarding brief alcohol intervention in order to understand why it is underexploited. Methods.  The study design was qualitative, using a grounded theory approach to data collection and analysis. Semi‐structured in‐depth interviews were conducted with 24 nurses from practices that had previously been involved in a General Practitioner (GP) led brief alcohol intervention trial in the North‐east of England. A combination of convenience and purposive sampling was used to recruit subjects and gain a broad range of perspectives on issues emerging from ongoing data‐analysis until data saturation occurred. Results.  It was clear that although primary health care nurses have many opportunities to engage in alcohol intervention, most have received little or no preparation for this work. This has left nurses at a disadvantage as alcohol consumption is a confusing and emotive area for both health professionals and patients. An analysis of factors influencing nurse involvement in alcohol intervention outlined a requirement for clear health messages about alcohol, training in intervention skills, facilitation to enhance confidence regarding intervention and support to help deal with negative patient reactions. Conclusions.  As current health policy is to encourage, sustain and extend the health promotion and public health role of primary care nurses, more attention should be given to providing them with better preparation and support to carry out such work.

Aims: To ascertain the views of general practitioners (GPs) regarding the prevention and management of alcohol-related problems in practice, together with perceived barriers and incentives for this work; to compare our findings with a comparable survey conducted 10 years earlier. Methods: In total, 282 (73%) of 419 GPs surveyed in East Midlands, UK, completed a postal questionnaire, measuring practices and attitudes, including the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Results: GPs reported lower levels of post-graduate education or training on alcohol-related issues (<4 h for the majority) than in 1999 but not significantly so (P = 0.031). In the last year, GPs had most commonly requested more than 12 blood tests and managed 1–6 patients for alcohol. Reports of these preventive practices were significantly increased from 1999 (P < 0.001). Most felt that problem or dependent drinkers' alcohol issues could be legitimately (88%, 87%) and adequately (78%, 69%) addressed by GPs. However, they had low levels of motivation (42%, 35%), task-related self-esteem (53%, 49%) and job satisfaction (15%, 12%) for this. Busyness (63%) and lack of training (57%) or contractual incentives (48%) were key barriers. Endorsement for government policies on alcohol was very low. Conclusion: Among GPs, there still appears to be a gap between actual practice and potential for preventive work relating to alcohol problems; they report little specific training and a lack of support. Translational work on understanding the evidence-base supporting screening and brief intervention could incentivize intervention against excessive drinking and embedding it into everyday primary care practice.

The new COPD-GRIP (Chronic Obstructive Pulmonary Disease-Guidance, Research on Illness Perception) intervention translates evidence regarding illness perceptions and health-related quality of life (HRQoL) into a nurse intervention to guide COPD patients and to improve health outcomes. It describes how to assess and discuss illness perceptions in a structured way. This study aimed to assess the effectiveness of the intervention in primary care. A cluster randomised controlled trial was conducted within 30 general practices and five home-care centres, including 204 COPD patients. 103 patients were randomly assigned to the intervention group and 101 patients to the usual-care group. To assess differences, repeated multilevel linear mixed modelling analyses were used. Primary outcome was change in health status on the Clinical COPD Questionnaire (CCQ) at 9 months. Secondary outcomes were HRQoL, daily activities, health education impact and changes in illness perceptions. There was no significant difference between the groups in the CCQ at 9 months. We found a significant increase in health-directed behaviour at 6 weeks (p=0.024) and in personal control (p=0.005) at 9 months in favour of the intervention group. The COPD-GRIP intervention, practised by nurses, did not improve health status in COPD patients in primary care. However, the intervention has benefits in improving the ability to control the disease and health-related behaviours in the short term. Therefore, taking illness perceptions into account when stimulating healthy behaviours in COPD patients should be considered. Further study on influencing the health status and HRQoL is needed. @ERSpublications COPD illness perception intervention improved health behaviours in the short term, but did not improve health status http://ow.ly/1VSw30fQQjN Cite this article as: Weldam SWM, Schuurmans MJ, Zanen P, et al. The effectiveness of a nurse-led illness perception intervention in COPD patients: a cluster randomised trial in primary care. ERJ Open Res

No abstract

The authors examined the association between disaster-related traumatic experiences and posttraumatic stress disorder (PTSD) symptoms in 155 youth, aged 8-18 years, from the Lower Eyre Peninsula of South Australia who were affected by January 2005 bushfires. Youth completed measures of PTSD symptoms and disaster experiences 11-5 months postdisaster. Many youth (27%) reported moderate to severe levels of PTSD symptoms; younger children reported greater PTSD symptom severity than older youth. Perceived personal life threat and ongoing loss/disruption were related to greater PTSD symptomatology. Following disasters, it may be helpful to identify young children and youth who perceived that their life was threatened and experienced more ongoing life disruption, as these youth may be at higher risk for persistent PTSD symptoms.

Patient and nurse factors contributed to the selective provision of a brief intervention in primary care. If patients are to experience the beneficial effects of a brief alcohol intervention, then there is a need to improve the accuracy of delivery.

Excessive alcohol consumption causes major problems in the UK but is responsive to brief intervention. Excessive drinkers represent 20% of patients on practice lists and present twice as often as others. The potential of health professionals to reduce alcohol related problems contrasts sharply with current practice. Health professionals' report fears about negative reactions and losing rapport with patients. This study explored patients' attitudes to and experiences of alcohol and brief intervention in primary health care so that health professionals can provide a service which is more acceptable to patients. The study used a qualitative approach to data collection and analysis. Six focus groups, strati ed by age and sex, were conducted with 31 patients from practices in northeast England. A combination of random and purposive sampling was used to recruit patients with a range of perspectives on issues emerging from ongoing data-analysis until data saturation occurred. Many patients had recently altered their lifestyle to improve their health, however, only one reported reducing alcohol consumption. Over half the patients had been advised about their lifestyle but this was not always deemed to be appropriate. Patients responded positively to advice when in an appropriate context and by a health professional with whom they had developed a relationship and rapport. Overall the general practitioner was deemed the preferred health professional to discuss alcohol issues. Brief alcohol intervention is a legitimate role of the general practitioner when carried out in an appropriate context. A National Alcohol Strategy should focus on strengthening the public health campaign in order to support general practitioners in brief alcohol intervention.