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Factors influencing GPs' decisions regarding screening for high alcohol consumption: a focus group study in Swedish primary 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.
2005 (English)In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 119, no 9, 781-788 p.Article in journal (Refereed) Published
Abstract [en]

Objective The aim of this study was to explore factors that influence general practitioners' (GPs') decisions regarding screening for high alcohol consumption.

Methods GPs working at three primary healthcare centres in Sweden participated in focus group interviews. The interviews were recorded and transcribed verbatim, and a deductive framework approach was used for the analysis.

Results The majority of the participating GPs did not believe in asking all patients about their alcohol consumption. Reported factors that influenced how many and which patients were questioned about alcohol consumption were time, age of the patient, consultation setting, patient–physician relationship, what symptoms the patient presented with, and knowledge of measures if patients appear to have a high alcohol consumption. Thus, alcohol screening and intervention were not performed in all patient groups as was originally intended, but were performed in limited groups of patients such as those with alcohol-related symptoms.

Conclusions Although the number of participants in this study was small and the conclusions cannot be generalized, the results provide some valuable insights into why GPs are hesitant to engage in screening for high alcohol consumption. Since prevention of alcohol-related health problems is an important public health issue, many different screening and intervention strategies have to be formulated and evaluated in order to reach patients with both hazardous and harmful alcohol consumption within the healthcare system. Screening all consecutive patients for a limited period or screening patient groups known to include a fairly high frequency of high alcohol consumers are two ways of limiting the time requirements and increasing role legitimacy. Still, there is a need for a broader public health strategy involving many players in the community in alcohol preventive measures, especially in more primary preventive approaches.

Place, publisher, year, edition, pages
2005. Vol. 119, no 9, 781-788 p.
Keyword [en]
Alcohol, screening, primary health care, dissemtion, GPs attitudes
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-29718DOI: 10.1016/j.puhe.2004.12.006Local ID: 15112OAI: oai:DiVA.org:liu-29718DiVA: diva2:250535
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically 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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