When general practitioners talk about Alcohol: Exploring facilitating and hampering factors for pragmatic case finding

Lid, Torgeir Gilje; Nesvåg, Sverre; Meland, Eivind

doi:10.1177/1403494814565129

Cited by 20 publications

(26 citation statements)

References 27 publications

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“…In addition, increased awareness of the elevated use of alcohol and psychotropic drugs is required when healthcare personnel and GPs apply for or facilitate services for older people (Duckert et al, 2008;Johannessen et al, 2014Johannessen et al, , 2015Sandvik, 2014). A study by Lid, Nesvåg, and Meland (2015) emphasised that improvement of practice can be strengthened by using clinical cases in healthcare staff discussions.…”

Section: Discussionmentioning

confidence: 99%

Alcohol and prescribed psychotropic drug use among patients admitted to a department of old-age psychiatry in Norway

Johannesen

Engedal

Larsen

et al. 2017

Nordic Studies on Alcohol and Drugs

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Background: Although alcohol and prescribed psychotropic drug use has increased among older people, the usefulness of information provided about these substances in patients’ referrals to departments of old-age psychiatry (OAPsy) is unknown. Aims: To examine whether patients’ self-reported elevated use of alcohol and prescribed psychotropic drugs corresponds with information provided in the referrals to OAPsy departments and to explore the factors associated with elevated self-reported use of these substances. Methods: We recorded the information provided in referrals about the elevated use of alcohol and psychotropic drugs in a sample of 206 patients (69 men) from 12 OAPsy departments. The Alcohol Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT) helped to assess self-reported use. We also collected demographic data, as well as information about cognitive functioning and symptoms of anxiety and depression. Results: Seventy-three patients (35%) scored above the cut-off for alcohol use for women/men (AUDIT ≥ 3/4) or psychotropic drugs (DUDIT ≥ 6/8), if not both. Twenty patients (10%) reported an elevated use of both alcohol and psychotropic drugs, and the referrals for eight (40%) and ten (50%) of them, respectively, included information about this use. There was a significant association between self-reported use of alcohol above the cut-off and information about elevated use in the referrals. However, no such association was found between information in the referrals and self-reported use of prescribed psychotropic drugs. Elevated alcohol use was associated with more years of education, while elevated use of psychotropic drugs was associated with younger age and severe symptoms of anxiety and depression. Conclusion: The information reported in referrals about the elevated use of alcohol and psychotropic drugs demonstrated a trend in associations with self-reported use. However, the risk factors for elevated use of alcohol and psychotropic drugs in the elderly need to be examined further.

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Section: Discussionmentioning

confidence: 99%

Alcohol and prescribed psychotropic drug use among patients admitted to a department of old-age psychiatry in Norway

Johannesen

Engedal

Larsen

et al. 2017

Nordic Studies on Alcohol and Drugs

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“…The lack of knowledge and confidence in bringing up the issue of alcohol was strongly emphasized at the baseline and mentioned as an important reason for not bringing up the issue. The staff also expressed insecurity in how to introduce the issue and how to intervene, as seen previously in most studies [ 5 , 6 , 12 , 14 ]. However, this is somewhat surprising since Sweden has made a strong national effort over 5 years to educate large sections of primary health care in SBI from 2004 to 2010 at a total cost of 25 million euros.…”

Section: Discussionmentioning

confidence: 82%

“…Most previous researches have measured role security and therapeutic commitment at one point in time or just after a training session using standardized questionnaires [ 5 , 10 , 12 ]. The few studies that have measured role security and therapeutic commitment before and after an educational session do not provide information about how a change in engagement is accomplished or mediated [ 8 , 14 ]. Thus, there is a lack of qualitative studies following staff practices over time in implementation projects aiming to establish new routines.…”

Section: Introductionmentioning

confidence: 99%

The Impact of an Implementation Project on Primary Care Staff Perceptions of Delivering Brief Alcohol Advice

Reinholdz

Bendtsen

Spak

et al. 2016

Journal of Addiction

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Objective. To explore how the perceptions and experiences of working with risky drinkers change over time among primary health care staff during a systematic implementation project. Methods. Qualitative focus group interviews took place before and after the implementation of the project. Results. The staff displayed a positive change during the implementation period with regard to awareness, knowledge, and confidence that led to a change in routine practice. Throughout the project, staff were committed to engaging with risky drinkers and appeared to have been learning-by-doing. Conclusions. The results indicated a positive attitude to alcohol prevention work but staff lack knowledge and confidence in the area. The more practical experience during the study is, the more confidence seems to have been gained. This adds new knowledge to the science of implementation studies concerning alcohol prevention measures, which have otherwise shown disappointing results, emphasizing the importance of learning in practice.

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“…SBI has shown a lack of diagnostic accuracy, intervention efficacy, and feasibility. [ 8 , 11 , 17 , 40 ] Methods focusing on the present situation and the patient’s problem will probably increase relevance and recognition for the patient. [ 14 , 15 , 18 ] We should bear in mind that alcohol use may represent attempts to master a challenging life as viewed from the patients’ perspective.…”

Section: Discussionmentioning

confidence: 99%

Can routine information from electronic patient records predict a future diagnosis of alcohol use disorder?

Lid

Eide

Dalen

et al. 2016

Scandinavian Journal of Primary Health Care

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ObjectiveTo explore whether information regarding potentially alcohol-related health incidents recorded in electronic patient records might aid in earlier identification of alcohol use disorders.DesignWe extracted potentially alcohol-related information in electronic patient records and tested if alcohol-related diagnoses, prescriptions of codeine, tramadol, ethylmorphine, and benzodiazepines; elevated levels of gamma-glutamyl-transferase (GGT), and mean cell volume (MCV); and new sick leave certificates predicted specific alcohol use disorder.SettingNine general practitioner surgeries with varying size and stability.SubjectsTotally 20,764 patients with active electronic patient record until data gathering and with a history of at least four years without a specific alcohol use disorder after turning 18 years of age.MethodsThe Cox proportional hazard analysis with time-dependent covariates of potential accumulated risks over the previous four years.Main outcome measuresTime from inclusion until the first specific alcohol use disorder, defined by either an alcohol specific diagnostic code or a text fragment documenting an alcohol problem.ResultsIn the unadjusted and adjusted Cox-regression with time-dependent covariates all variables were highly significant with adjusted hazard ratios ranging from 1.25 to 3.50. Addictive drugs, sick leaves, GGT, MCV and International Classification for Primary Care version 2 (ICPC-2), and International Classification of Diseases version 10 (ICD-10) diagnoses were analyzed. Elevated GGT and MCV, ICD-10-diagnoses, and gender demonstrated the highest hazard ratios.ConclusionsMany frequent health problems are potential predictors of an increased risk or vulnerability for alcohol use disorders. However, due to the modest hazard ratios, we were unable to establish a clinically useful tool.Key Points Alcohol is potentially relevant for many health problems, but current strategies for identification and intervention in primary health care have not been successful.Many frequent clinical problems recorded in electronic patient records may indicate an increased risk for alcohol related health problems.The hazard ratios were modest and the resulting predictive model was unsatisfactory for diagnostic purposes. If we accepted a sensitivity as low as 0.50, the specificity slightly exceeded 0.75. With a low prevalent condition, it is obvious that the false positive problem will be vast.In addition to responding to elevated blood levels of liver enzymes, general practitioners should be aware of alcohol as a potentially relevant factor for patients with repeated events of many mental and psychosocial diagnoses and new sick leaves and repeated prescriptions of addictive drugs.

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When general practitioners talk about Alcohol: Exploring facilitating and hampering factors for pragmatic case finding

Cited by 20 publications

References 27 publications

Alcohol and prescribed psychotropic drug use among patients admitted to a department of old-age psychiatry in Norway

Alcohol and prescribed psychotropic drug use among patients admitted to a department of old-age psychiatry in Norway

The Impact of an Implementation Project on Primary Care Staff Perceptions of Delivering Brief Alcohol Advice

Can routine information from electronic patient records predict a future diagnosis of alcohol use disorder?

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