Primary Care Residents Lack Comfort and Experience with Alcohol Screening and Brief Intervention: A Multi-Site Survey

Abstract

BACKGROUNDApproximately one in six adults in the United States (U.S.) binge drinks. The U.S. Preventive Services Task Force recommends that primary care physicians screen patients for such hazardous alcohol use, and when warranted, deliver a brief intervention.OBJECTIVEWe aimed to determine primary care residents’ current practices, perceived barriers and confidence with conducting alcohol screening and brief interventions (SBI).DESIGNThis was a multi-site, cross-sectional survey conducted from March 2010 through December 2012.PARTICIPANTSWe invited all residents in six primary care residency programs (three internal medicine programs and three family medicine programs) to participate. Of 244 residents, 210 completed the survey (response rate 86 %).MAIN MEASURESOur survey assessed residents’ alcohol screening practices (instruments used and frequency of screening), perceived barriers to discussing alcohol, brief intervention content, and self-rated ability to help hazardous drinkers. To determine the quality of brief interventions delivered, we examined how often residents reported including the three key recommended elements of feedback, advice, and goal-setting.KEY RESULTSMost residents (60 %, 125/208) reported “usually” or “always” screening patients for alcohol misuse at the initial clinic visit, but few residents routinely screened patients at subsequent acute-care (17 %, 35/208) or chronic-care visits (33 %, 68/208). Only 19 % (39/210) of residents used screening instruments capable of detecting binge drinking. The most frequently reported barrier to SBI was lack of adequate training (54 %, 108/202), and only 21 % (43/208) of residents felt confident they could help at -risk drinkers. When residents did perform a brief intervention, only 24 % (49/208) “usually” or “always” included the three recommended elements.CONCLUSIONSA minority of residents in this multi-site study appropriately screen or intervene with at-risk alcohol users. To equip residents to effectively address hazardous alcohol use, there is a critical need for educational and clinic interventions to support alcohol-related SBI.

Profile of Consumption of Psychoactive Substances and Its Relationship to Sociodemographic Characteristics: A Contribution to a Brief Intervention in Primary Health Care, Rio De Janeiro, Brazil

“…In this sense, national 2,11,14,16 and international 20,[22][23] authors have pointed out the efficacy of this model of brief intervention performed by professionals working in primary health care. Therefore, the present study emphasizes the importance of the qualification of the health professionals that develop their activities in primary health care in the FHS in order to provide a better service to people with problems related to alcohol and other drugs welcomed at the health system gateway.…”

“…Authors have been pointing out religiosity as a protective factor against the consumption of drugs, [18][19][20] reinforcing that religiosity remains a protective factor against the use of psychoactive substances, both licit and illicit. In this context, it is possible to infer that religion may represent a strength in the sense of helping the professional of the Family Health team to develop preventive actions for the community in partnership with the churches in the covered area in the planning of educational actions for health.…”

“…In visits of patients with hypertension, diabetes, leprosy, tuberculosis, or pregnant women in prenatal visits, and also in health education for groups of adolescents, nurses may help people that may benefit by reducing or quitting the use of such substances. 11,[14][15]20,24 However, it is important to mention that this study presents some limitations, such as the possibility of occurrence of memory biases as it was conducted in one single area of the city of Rio de Janeiro covered by the FHS. Finally, this study highlights the importance of developing other studies on the theme aimed at knowing the magnitude of the use of psychoactive substances in primary health care that may support the strengthening of public health policies in this area.…”

Implementation and Quality Improvement of a Screening and Counseling Program for Unhealthy Alcohol Use in an Academic General Internal Medicine Practice

“…(D'Amico, Paddock, Burnam, & Kung, 2005; McKnight-Eily, Liu, Brewer, Kanny, Lu, Denny et al, 2014) Further, primary care residents have been shown to lack comfort and experience with alcohol screening and brief intervention. (Le, Johnson, Seale, Woodall, Clark, Parish et al, 2015) Barriers to screening and counseling include competing priorities, lack of provider training, misconceptions about patient comfort with discussing alcohol, and lack of appropriate infrastructure and protocols. To address these shortcomings, we sought to develop and implement, using quality improvement techniques, a systematic approach to screening and counseling primary care patients for unhealthy alcohol use.…”

Associação entre o consumo de bebidas alcoólicas e tabaco e a religiosidade

“…In addition, it is a field to develop actions on early identification, preventive actions and health promotion. (8,9) Studies show the need for identifying the pattern of consumption of psychoactive substances in the population served, mainly in PHC, to provide them with the required level of care, information about the damages resulting from the use of these substances, assisting the prevention of diseases caused by consumption. (9)(10)(11)(12) In the context of problems related to the use of alcohol and other drugs, and due to short national literature on the topic, the authors would like to emphasize that this is a different study because it understands religiosity relevance as an additional element to prevent diseases and to assist the actions implemented in the practice of health professionals.…”