Drug and alcohol related health problems in primary care — what do GPs think?

Abstract

Objective To examine knowledge, attitudes and beliefs of general practitioners (GPs) in the field of drug and alcohol related health problems. Design A cross‐sectional survey in which self‐completion postal questionnaires were sent to all identifiable GPs in the Adelaide metropolitan area. Non‐responders received a reminder letter and second questionnaire. Setting, participants The target population was doctors whose principal activity was general practice, or who were in training for general practice. Main outcome measures Demographic and “practice characteristic” information on participants. Measures of knowledge, attitudes and beliefs regarding alcohol consumption, smoking and over the counter medication. Results The response rate was 59.8%. More responders than non‐responders were affiliated with the Royal Australian College of General Practitioners. Alcohol consumption was perceived to be a more difficult issue than smoking to raise during consultations. GPs indicated that significant proportions of their patients were participating in hazardous drinking (mean estimate was 13.8% of patients), but only a third of respondents believed their effort in changing alcohol related behaviour would be effective. Sixty‐ one per cent of respondents identified hazardous daily levels of alcohol consumption for men consistent with National Health and Medical Research Council guidelines. In the case of women this figure was 42%. Longer reported appointment times were associated with greater reported levels of enquiry about alcohol consumption. Conclusions New developments in medical training and systems of payment in general practice need to address both the pessimistic attitude of GPs in dealing with drug and alcohol related health problems, and apparent inconsistencies in defining hazardous alcohol consumption.

Smoking behaviour and attitudes among Australian medical students

“… Identifying the smoker and raising the issue of smoking is the first step to intervening with smokers. Students learn that half of the patients who smoke are not identified by the doctor (Dickinson et al 1989; Weller et al 1992). In medical practice, the patient frequently presents to the doctor with a nonsmoking related problem. The students develop the elements of a smoking history including amount and duration of smoking, symptoms of disease, social pressures to smoke, level of dependence, previous attempts to give up, and triggers to smoking. They learn to allocate the smoker to the stage of readiness to change category (not ready, unsure or ready to quit) based on the transtheoretical model of change (Prochaska & DiClemente 1986).…”

“…Identifying the smoker and raising the issue of smoking is the first step to intervening with smokers. Students learn that half of the patients who smoke are not identified by the doctor (Dickinson et al 1989; Weller et al 1992). In medical practice, the patient frequently presents to the doctor with a nonsmoking related problem.…”

“…Russell et al 1983; Richmond et al 1986, 1993). However, they miss opportunities to assist their patients with quitting (Cummings et al 1989; Dickinson et al 1989; Weller et al 1992). A lack of undergraduate and postgraduate teaching on how to effectively intervene is one of many factors contributing to an inadequate response by doctors (Fiore et al 1994).…”

The influence of structured education and clinical experience on the attitudes of medical students towards substance misusers

“…Negative attitudes towards patients with drug and alcohol problems are reported commonly by medical students [9,10], trainee physicians [11], general practitioners [7,12] and other health-care providers [13]. Attitudes are most negative towards users of illicit drugs.…”

“…Attitudes are most negative towards users of illicit drugs. Pessimism regarding the effectiveness of treatment also discourages therapeutic engagement [5,7,12,15,16]. Pessimism regarding the effectiveness of treatment also discourages therapeutic engagement [5,7,12,15,16].…”