How primary care providers talk to patients about alcohol a qualitative study

McCormick, Kinsey A.; Cochran, Nan; Back, Anthony L.; Merrill, Joseph O.; Williams, Emily C.; Bradley, Katharine A.

doi:10.1007/bf02743146

Cited by 109 publications

(117 citation statements)

References 44 publications

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“…In a study about physician alcohol screening practices, Sharp and Vacha-Haase (2010) noted physician alcohol screening practices and indicated that physicians reported screening 73% of their new patients upon intake and only 44% of their existing patients. Despite the lack of conversations about alcohol, research has suggested that conversations and brief alcohol counseling during primary care appointments reduce alcohol consumption, adverse health consequences, and health care utilization in patients who drink above recommended limits (Bertholet, Daeppen, Wielishbach et al, 2005;McCormick, Cochran, Back et al, 2006;Moyer, Finney, Wearingen et al, 2002). Regardless of the positive health benefits, patient-doctor conversations about alcohol use remain sparse due to the topic's sensitive nature.…”

Section: Chapter 5: Discussionmentioning

confidence: 99%

Older adult patient--doctor communication regarding alcohol use: A qualitative study

Sharp¹

2011

PsycEXTRA Dataset

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Section: Chapter 5: Discussionmentioning

confidence: 99%

Older adult patient--doctor communication regarding alcohol use: A qualitative study

Sharp¹

2011

PsycEXTRA Dataset

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“…35 These challenges, in addition to ambiguous guidelines and research findings about HCVand alcohol consumption, 6,7 little formal training about HCV, and caring for fewer symptomatic HCV patients than GI providers, may lay the groundwork for ambiguous alcohol recommendations to HCV patients seen in IM clinics. In addition, studies on advice about alcohol consumption in IM settings have focused only on "at-risk" or "heavy drinkers" 36 those "screening positive for alcohol misuse" 37,38 and those who have undergone alcohol treatment recently. 39 HCV is a major public health issue with just over four million Americans currently infected, 40 and projected medical costs for the years 2010 to 2019 of almost $11 billion, and societal costs of $54 billion due to years of life lost under the age of 65.…”

Section: Discussionmentioning

confidence: 99%

Communicating About Alcohol Consumption to Nonharmful Drinkers with Hepatitis C: Patient and Provider Perspectives

et al. 2008

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BACKGROUND:Abstaining from alcohol consumption is generally recommended for patients with Hepatitis C (HCV). However, mixed research findings coupled with a lack of consistent guidelines on alcohol consumption and HCV may influence what healthcare providers tell their HCV patients about drinking. This may be more problematic when advising nonharmful drinkers with HCV, a population for whom consumption would not be a problem in the absence of their HCV diagnosis. OBJECTIVE:This study explores what healthcare providers advise their HCV patients who are drinking alcohol at nonharmful levels about alcohol use and what these patients actually hear. DESIGN:We conducted separate focus groups and interviews about alcohol use and HCV with nonharmful drinkers with HCV (N=50) and healthcare providers (N= 14) at a metropolitan teaching hospital. All focus groups and interviews were audio-taped, transcribed, and analyzed using NVivo, a qualitative data management and analysis program. RESULTS:We found similar themes about HCV and alcohol consumption (stop completely, occasional drink is ok, cut down, and provision of mixed/ambiguous messages), reported by both providers and patients. Patient respondents who reported hearing "stop completely" were more likely to have had their last medical visit at the gastroenterology (GI) clinic as opposed to the internal medicine (IM) clinic. Furthermore, IM providers were more likely to give their recommendations in "medical language" than were GI providers. CONCLUSIONS:To make the best health-related decisions about their disease, HCV patients need consistent information about alcohol consumption. Departments of Internal Medicine can increase provider knowledge about HCV and alcohol use by providing more education and training on HCV.

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“…A study in non-HIV patients of audio-recorded conversations between 47 patients with problematic alcohol use and their providers found that providers seemed uncomfortable when talking about alcohol, engaged in little follow-up to disclosures, and tended to give tentative advice. 22 Similarly, a study in New Zealand that analyzed the dialogue between 171 patients and their providers found that discussion of alcohol or drugs (including tobacco) occurred in less than 25 % of visits. 20 Neither of these studies assessed how clinicians ask about substance use.…”

Section: Introductionmentioning

confidence: 99%

Assessing Problematic Substance Use in HIV Care: Which Questions Elicit Accurate Patient Disclosures?

et al. 2016

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BACKGROUND: Substance use is associated with higher rates of antiretroviral non-adherence and poor HIV outcomes. This study examined how HIV care providers assess substance use, and which questions elicit accurate patient disclosures. METHODS: We conducted a conversation analysis of audio-recorded encounters between 56 providers and 162 patients living with HIV (PLWH) reporting active substance use in post-encounter interviews (cocaine or heroin use in the past 30 days, > 4 days intoxicated in past 30 days, or AUDIT score ≥ 8). We assessed the frequency of substance use discussion, characterized the types of questions used by providers, and determined the frequency of accurate patient disclosure by question type. RESULTS: In 55 reports of active substance use, providers already knew about the use (n = 16) or patients disclosed unpromptednn = 39). Among the remaining 155 instances of substance use in which providers had the opportunity to elicit disclosure, 78 reports (50 %) of substance use were not discussed. Of the remaining 77 reports in which the provider asked about substance use, 55 (71 %) patients disclosed and 22 (29 %) did not disclose. Questions were classified as: open-ended (n = 18, BHow's the drinking going?^); normalizing (n = 14, BWhen was the last time you used?^); closed-ended (n = 36, BHave you used any cocaine?^); leading towards non-use (n = 9, BHave you been clean?^). Accurate disclosure followed 100 % of open-ended and normalizing questions, 58 % of closed-ended questions, and 22 % of leading questions. After adjusting for drug type, closed-ended questions were 41 % less likely (p < 0.001), and 'leading' questions 78 % less likely (p = 0.016) than broad and normalizing questions to elicit disclosures. CONCLUSION: Providers in this sample missed almost half of the opportunities to identify and discuss substance use with PLWH. Providers can increase the probability of patient disclosure by using open-ended or normalizing questions that ask about the Blast time^that the patient used drugs or alcohol.

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How primary care providers talk to patients about alcohol a qualitative study

Cited by 109 publications

References 44 publications

Older adult patient--doctor communication regarding alcohol use: A qualitative study

Older adult patient--doctor communication regarding alcohol use: A qualitative study

Communicating About Alcohol Consumption to Nonharmful Drinkers with Hepatitis C: Patient and Provider Perspectives

Assessing Problematic Substance Use in HIV Care: Which Questions Elicit Accurate Patient Disclosures?

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