Primary health care professionals' activity in intervening in patients' alcohol drinking: a patient perspective
Introduction
There are at least two reasons to determine whether a patient drinks too heavily. First, there are many instances in which recognition of excessive drinking would expedite the diagnostic process. If underlying excessive drinking is not diagnosed, patients may be subjected to procedures that are useless. Secondly, there are many clinical opportunities for excessive drinkers' counselling and referral, and non-dependent excessive drinkers can be offered an effective brief intervention treatment to reduce their alcohol consumption (Wallace et al., 1988, Babor et al., 1994, Fleming et al., 1997). Recent meta-analysis found that excessive drinkers who received brief intervention were twice as likely to moderate their drinking when compared to excessive drinkers who did not receive any intervention (Wilk et al., 1997).
It is well documented in primary health care based studies that the majority of patients with alcohol problems go unrecognised (Reid et al., 1986, Rydon et al., 1992). One reason for the low level of detection has been suggested to be the difficulty of the diagnosis (Reid et al., 1986). However, the frequency with which patients are asked about alcohol consumption and advised about their alcohol drinking has received less attention and only a few studies have used patients as a source of information (Wallace et al., 1987, Richmond et al., 1996, Volk et al., 1996). Further, we do not have any knowledge of primary health care professionals' activity in intervening in patients' alcohol drinking at the consultation in question. This would be an important piece of information when evaluating how successful the implementation of brief intervention has been. Finland, with well preventive oriented primary health care and a long tradition of promoting brief intervention, is a place where this activity could be expected to be better than in many other countries.
The present study examines primary health care professionals' activity in asking and advising patients about alcohol drinking in the area where brief intervention has been actively promoted in recent years. It also describes patients' attitudes towards this activity.
Section snippets
Method
This study was conducted in two primary health care centres covering a population of about 30,000 inhabitants in the Finnish city of Tampere, population approximately 200,000. A total of 14 general practitioners and 10 nurses were working in these two centres during the study period. In Finland primary health care centres provide equal access health care services to the population of a certain geographical area. Depending on the area, 60–75% of its inhabitants attend their primary health care
Results
The two primary health care centres did not differ significantly from each other in any questions and thus the material was handled as one corpus. During the consultation in question or during the past year 19.1% (127/665) of patients were asked about their alcohol drinking. The majority (64.7%; 430/665) of the patients were never asked about their alcohol drinking in the participating centres (Table 1). There were significantly more of those who were never asked about alcohol drinking among
Methodological considerations
The subjects formed an average Finnish city primary health care population in age and gender distribution. The alcohol consumption level in the city also is of average level in Finland. The amount of excessive drinkers in the present study was comparable to the previous study in Finland (Aalto et al., 1999). The response rate for the survey was reasonably good. Additionally, the timing was so planned that no specific epidemics or seasonal diseases were likely to occur.
There are only few
Acknowledgements
This study was supported by Ministry of Social Affairs and Health, Helsinki, Finland. The study was part of the Phase IV of WHO Collaborative Project on Identification and Management of Alcohol-Related Problems in Primary Health Care.
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2012, Addictive BehaviorsCitation Excerpt :Among the barriers are perceived lack of time, insufficient skills and knowledge to recognize and respond to drinkers, and possible adverse effects on relationships with patients arising from raising a subject that may be difficult to discuss (Holmqvist, 2009). There has been some research into patient attitudes toward alcohol and other lifestyle risk factors being raised in health care consultations (Aalto, Pekuri, & Seppa, 2002; Duaso & Cheung, 2002; Herbert & Bass, 1997; Johansson, Bendtsen, & Åkerlind, 2005; Miller, Thomas, & Mallin, 2006; Richmond, Heather, Wodak, Kehoe & Webster, 1995; Wallace, Brennan, & Haines, 1987; Wallace & Haines, 1984). Most of these studies focus on the recall of and satisfaction with such discussions.