Intervention against Excessive Alcohol Consumption in Primary Health Care: A Survey of GPs' Attitudes and Practices in England 10 Years On

Abstract

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.

Acceptability of screening for early detection of liver disease in hazardous/harmful drinkers in primary care

“…[7][8][9] The main setting for detecting those at risk and intervening is primary care 10 with the attitudes and involvement of GPs as key factors in the success of brief alcohol interventions. 11,12 However many barriers to implementing brief alcohol interventions in primary care exist in Europe 13 and the UK 14,15 with GPs reporting a lack of time in consultations, support and training, 12,13,15 and fears that discussing alcohol consumption will cause offence. 16 A survey of patients' attitudes towards screening for 'at risk' drinking with selfreport questionnaires and an alcohol biomarker blood test showed that patients are in favour of these techniques being used.…”

Factors Influencing the Implementation of Screening and Brief Interventions for Alcohol Use in Primary Care Practices: A Systematic Review Protocol

“…3,18 Furthermore, of the many patients visiting primary care who are at-risk drinkers, [19][20][21] few currently receive any alcohol-related advice or intervention from their doctor. [22][23][24][25][26][27][28] They are therefore denied the opportunity to understand the risks and make an informed decision about whether or not to cut down.…”

“…Lack of training, lack of time, lack of motivation, and lack of suitable counselling materials are among the most commonly cited barriers 23,[29][30][31][32][33][34][35][36][37] ; whereas having patients who seek advice for alcohol issues, more training, and ready availability of support services, screening and counselling materials are commonly reported facilitators. 23,30,31,38 Whilst several studies have documented or tested training, financial or other interventions designed to increase the implementation of alcohol SBI in primary care, 26,39 few are theoretically informed 40 and reporting of the content of training and follow up support is often poor. 41 Johnson et al reviewed the barriers and facilitators for implementing alcohol screening and brief intervention in 2009, 42 giving priority to studies judged to best inform the UK practice.…”

Opportunities for primary care to reduce hospital admissions: a cross-sectional study of geographical variation

“…For example, wide disparities have been identified in the quality of diabetes care (such as foot surveillance) and severe mental illness management (such as care planning), 14,19 and some GPs have reported low levels of knowledge or motivation to deal with alcohol problems. 22 Conditions where a high proportion of admissions originate from primary care (for example, iron deficiency anaemia) are likely to be more sensitive to variation in GP referral thresholds than those where patients typically go directly to A&E (for example, fractured proximal femur). Availability of clear referral guidelines and alternative treatment pathways could reduce admissions originating from primary care.…”