Problem alcohol use among problem drug users in primary care: a qualitative study of what patients think about screening and treatment

Abstract

BackgroundProblem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment. This paper aims to describe patients’ experience of, and attitude towards, screening and therapeutic interventions for problem alcohol use in primary care.MethodsThis qualitative study recruited problem drug users (N = 28) from primary care based methadone programmes in the Ireland’s Eastern region, using a stratified sampling matrix to include size of general practice and geographical area. Semi-structured interviews were conducted and analysed using thematic analysis, and audited by a third reviewer.ResultsWe identified three overarching themes relevant to the purpose of this paper: (1) patients’ experience of, and (2) attitude towards, screening and treatment for problem alcohol use in primary care, as well as their (3) views on service improvement. While most patients reported being screened for problem alcohol use at initial assessment, few recalled routine screening or treatment. Among the barriers and enablers to screening and treatment, patients highlighted the importance of the practitioner-patient relationship in helping them address the issue. Nevertheless, patients felt that healthcare professionals should be more proactive in the management of problem alcohol use at a primary care level and that primary care can play an important role in their treatment.ConclusionsProblem alcohol use is an important challenge in the care of problem drug users. While primary care is well placed to address this issue, little data has reported on this topic. The development of interventions which promote screening and brief interventions in practice are likely to benefit this at-risk group and further research and education, that help achieve this goal, are a priority. Strategies such as dissemination of clinical guidelines, educational videos, academic detailing and practice visits, should be explored.

Alcohol Screening among Opioid Agonist Patients in a Primary Care Clinic and an Opioid Treatment Program

“…Up to 37% patients in other opioid treatment programs in the U.S. screened positive for an alcohol use disorder (Hartzler, Donovan and Huang 2010; Ryder et al 2009), Qualitative studies with health care providers and patients in other treatment programs in the U.S. noted that professional education and training and a lack of specialist staff were key barriers hindering management of alcohol use disorders (Field et al 2013; Nyamathi et al 2009; Nyamathi et al 2007). These findings were echoed in our interviews – primary care professionals needed an extra person to perform warm hand-offs and periodic refresher training.…”

“…Positive patients were assessed with three instruments: AUDIT (Alcohol Use Disorder Identification Test) (Babor and Higgins-Biddle 2001), DAST (Drug Abuse Screening Test) (Skinner 1982) and PHQ (Patient Health Questionnaire) (Kroenke, Spitzer and Williams 2001). Trained research staff retrieved electronic health records for eligible patients and abstracted patient characteristics, results of the most recent screen, and alcohol-related interventions, if any, using a form adapted from prior research (Field et al 2013; Cullen et al 2009). Based on clinic policy, all buprenorphine patients should be screened annually for alcohol use disorders.…”

“…Alcohol use disorders are typically assessed as a safety concern rather than a health concern. In Ireland, where general practitioners can prescribe methadone for opioid dependent patients, interviews with 39 health professionals noted two major barriers to screening for alcohol use disorders among methadone patients: 1) insufficient knowledge, training and experience working with patients with alcohol use disorders and 2) a lack of specialist support (Childers et al 2012; Field et al 2013). …”

Addressing a Training Gap through Addiction Research Education for Medical Students: Letter to the Editor

“…Nevertheless, the multi-disciplinary group developed the guidelines, which were informed largely by expert consensus and qualitative interviews with healthcare professionals and patients 9,10 . The Problem Alcohol / Drug Use Guideline Development…”

Differences in the implementation methadone programme to European countries

“…Депресија је била изражена код пације-ната лошег физичког здравља, код оних који су раније примили трансфузију крви, код те-жих алкохоличара и млађих пацијената 52 . Испитани пацијенти били су незадовољни едукацијом о ризицима истовремене употребе алкохола и метадона, скринингом и терапијом 53 . Проблем са којим се сусрећу запослени и Ирској су значајне разлике у приступу лечења метадоном у различитим деловима земље.…”