The management of alcohol, tobacco and illicit drug use problems by general practitioners in Australia

Abstract

The aim of this study was to document the frequency of the management of illicit drug, alcohol and tobacco problems in general practice in Australia. Data from the Bettering the Evaluation and Care of Health (BEACH) study of general practice, April 1998 to March 2003, were analysed. BEACH is an ongoing national study of general practice in Australia. Each year a random sample of approximately 1000 general practitioners (GPs) participate, each providing details of 100 patient encounters. Samples are drawn from the Medicare data held by the Health Insurance Commission. Patient demographic breakdowns, medication, other treatment, referrals and other medical procedures ordered were examined for all problems labelled by GPs as illicit, alcohol and tobacco problems. Annually in Australia, it was estimated that 615,000 GP encounters--or 0.6% of all encounters--involved the management of illicit drug use problems presumably most commonly for problematic heroin use. Despite a much higher population prevalence of use and use disorders, the management of alcohol or tobacco use problems was less common, with 0.4% and 0.3% of encounters, respectively, comprising treatment of these problems. Clear demographic differences existed across the groups. The management of problems also differed, with illicit drug use problems more likely to involve provision of medication, and alcohol and tobacco treatment more likely to involve counselling and/or health advice. Despite higher rates of alcohol and tobacco use problems among patients seeing GPs in Australia, the rate of treatment for such problems was relatively lower than it was for illicit drug use problems. More efforts need to be directed towards assisting GPs to identify and target problematic alcohol and tobacco use among their patients.

Comparing methods of detecting alcohol-related emergency department presentations

“…The results from the current study suggest that clinicians are using their clinical judgement as to when to ask patients about their alcohol use rather than screening systematically. As in studies of general practice,17 their ability to detect risky drinkers was very limited, with only 47% of those scoring 8 or more on AUDIT having an alcohol history recorded. It is possible that clinicians may be asking patients about their alcohol consumption but not recording it when it is seen as irrelevant, particularly among older patients who may no longer drink alcohol.…”

A cross-sectional study describing factors associated with utilisation of GP services by a cohort of people who inject drugs

“…The objective of these services was to enable a coordinated and comprehensive primary health care response to enhance the health and welfare of PWID who were reluctant to utilise mainstream services [19]. The primary health care setting provides a contact opportunity and service system entry point with this otherwise hard-to-reach population where they can be identified and engaged in harm reduction [20-22]. Distinguishing between dependence-related GP services (primarily opioid substitution therapy) and general health services serves to understand if PWID who are not accessing OST have sufficient access to preventive health services provided by GPs.…”

Psychologists and Smoking Cessation Intervention: Unrealised Potential

“…The apparent reluctance of psychologists to address smoking relative to other behaviours is mirrored among other health professional groups, such as general practitioners (Degenhardt et al, 2006;Vogt et al, 2005). Smoking, unfortunately, seems to hold a special place with respect to a reluctance by health care professionals to see it as appropriate or possible to successfully intervene.…”