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Early intervention for problem drinkers: readiness to participate among general practitioners and nurses in Swedish primary health care
Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland. Linköping University, Faculty of Health Sciences.
2002 (English)In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 37, no 1, 38-42 p.Article in journal (Refereed) Published
Abstract [en]

An exploration was made of attitudes and practices of general practitioners (GPs) and nurses concerning early identification of, and intervention for, alcohol-related problems. Sixty-five GPs and 141 nurses in 19 primary health centres in a county in southern Sweden answered a 28-item questionnaire before implementation of an intervention programme. The questionnaire covered experiences with patients with alcohol-related health problems, knowledge and perceived capacity concerning early identification and intervention, attitudes towards the role of primary care staff in early identification and intervention and current intervention methods in use at the health centre. Self-reported frequency of asking about alcohol use was higher among GPs than nurses. Both groups reported more frequently asking about alcohol consumption in cases where they believed that the health status was influenced by alcohol. For both professions, knowledge and skills concerning identification were rated as better understood than that concerning intervention methods. Nurses rated their knowledge and skills less confidently than GPs. The overall attitude was fairly positive towards early identification and intervention, but nurses were more worried than GPs that patients would react negatively to questions about alcohol. Attitudes, self-rated capacity, and practice were related. The low level of early identification and intervention in primary care appears to be related more to insufficient practical skills than to attitudes. Nurses appear to be an unexploited resource, in need of training and support. Nurses may need to be convinced that an active role does not interfere with the nurse-patient relationship. Building teams of GPs and nurses in primary care might enhance the dissemination of alcohol prevention into regular practice.

Place, publisher, year, edition, pages
2002. Vol. 37, no 1, 38-42 p.
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26254DOI: 10.1093/alcalc/37.1.38Local ID: 10760OAI: oai:DiVA.org:liu-26254DiVA: diva2:246802
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-28Bibliographically approved
In thesis
1. Towards a new strategy for systematic screening for hazardous and harmful alcohol consumption in primary health care
Open this publication in new window or tab >>Towards a new strategy for systematic screening for hazardous and harmful alcohol consumption in primary health care
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Alcohol consumption is the third largest risk factor for morbidity and mortality in developed countries. In order to counteract the negative effects of the increasing alcohol consumption in Sweden, there is an urgent need to disseminate and integrate screening for hazardous and harmful alcohol use into the existing routines of primary health care. Although the primary health care system is considered well placed to implement prevention of alcohol-related harm, this is still seldom done. This should be seen in the light of good evidence with regard to the efficacy of screening and intervention methods, which take little time to deliver.

The primary aim of this thesis was to explore the prevailing status of alcohol preventive measures in a primary health care setting. The focus was upon the staff's knowledge, skills and attitudes concerning routine screening of patients for hazardous and harmful alcohol consumption. The secondary aim was to formulate a renewed screening strategy for primary health care.

The thesis includes five studies performed in the county of Östergötland, Sweden. Alcohol is by far disseminated into the existing routines in primary health care. Alcohol is the lifestyle factor that is most seldom raised by the health care staff. The groups of patients who receive some advice about their alcohol consumption are mainly those in least need of screening and advice such as older men with advanced illness on recurring scheduled visits, in contrast to younger persons with hazardous drinking.

The health care staff are mainly screening patients in whom they expect to find excessive alcohol consumption, in one sense making screening unnecessary. Both primary health care nurses and physicians are uncertain and reluctant to screen for hazardous alcohol consumption when there are no established medical symptoms. The staff mainly fmd alcohol screening to be practical and justified when a patients' complaint is perceived to be related to alcohol consumption, i.e. when the patient is thought to have harmful consumption. The great proportion of patients with hazardous drinking, i.e. above recommended limits but with no developed harm, are thus mostly not screened and therefore not identified. However, this group of individuals has the best potential to respond positively to brief alcohol intervention when delivered by a nurse or physician.

A truly preventive measure would be to screen all patients for excessive alcohol consumption including both hazardous and harmful drinkers, but the current organisation of the primary health care does not allow this approach. Instead, both nurses and physicians in the studies suggest a more selective strategy to mainly not include hazardous drinkers without symptoms. In order to establish which patient groups are the most appropriate to select for screening, taking into account the demands from the health care staff, as well as ensuring that even hazardous drinkers are included, a model was developed and empirically tested in order to identify such groups of patients. The model appears to be a reasonable means to identify groups of patients who should be included in a selective screening strategy by their presenting complaint. However, the hazardous drinkers were distributed within the various complaints fairly evenly and thus there was not enough strength in the study to identify specific patient groups despite the inclusion of all consecutive patients during a 2-week period.

The criteria for a selective screening strategy suggested in this thesis take into consideration the demands from primary health care staff as well as the need for a truly preventive approach that includes hazardous drinkers with no established alcohol-related harm. The suggested model for identifying groups of patients fulfilling these preconditions can be used in future research in order to identify relevant groups of patients to be included in a selective screening strategy that has the potential to be integrated into the existing routines of primary health care.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2005. 82 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 886
Keyword
alcohol consumtion, screening
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-29402 (URN)14741 (Local ID)91-7373-866-2 (ISBN)14741 (Archive number)14741 (OAI)
Public defence
2005-04-01, Aulan, Hälsans hus, Universitetssjukhuset (ingång 16), Campus US, Linköpings Universitet, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-28Bibliographically approved

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Johansson, KjellBendtsen, PrebenÅkerlind, Ingemar

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Division of Preventive and Social Medicine and Public Health ScienceFaculty of Health SciencesUnit of Research and Development in Local Health Care, County of Östergötland
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Alcohol and Alcoholism
Social Sciences

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