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  • 1. Barnett, NP
    et al.
    Monti, PM
    Cherpitel, C
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Beroendekliniken IHS. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Dependency.
    Borges, G
    Colby, SM
    Nordqvist, Cecilia
    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.
    Johansson, Kjell
    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.
    Identification and brief treatment of alcohol problems with medical patients: An international perspective2003In: Alcoholism: Clinical and Experimental Research, ISSN 0145-6008, E-ISSN 1530-0277, Vol. 27, no 2, p. 262-270Article in journal (Refereed)
    Abstract [en]

    This article summarizes the proceedings of a symposium at the 2002 RSA meeting in San Francisco, California. The chair was Peter Monti and co-chair was Nancy Barnett. The aim of the symposium was to bring together researchers from the United States, Sweden, and Mexico to present current findings on the development and implementation of screening and intervention research in Emergency Departments (ED). Cheryl Cherpitel presented findings on the performance of the Rapid Alcohol Problems Screen (RAPS4), a 4-item instrument used for screening for alcohol dependence and harmful drinking in the ED. Dr. Cherpitel also presented for her collaborator, Guilherme Borges, their research on the performance of a number of screening measures including the RAPS among Mexicans and Mexican-Americans with alcohol-related disorders in the ED. Preben Bendtsen described the implementation of an alcohol screening and intervention procedure delivered by ordinary ED staff in Sweden. Nancy Barnett presented data on characteristics related to readiness to change alcohol use in a sample of young adults who were treated in an ED for injury or intoxication.

  • 2.
    Bendtsen, Preben
    et al.
    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 Central Östergötland, Department of Acute Internal Medicine.
    Johansson, Kjell
    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.
    Vart är alkoholpreventionen inom primärvården på väg?2004In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 3, p. 207-213Article in journal (Other academic)
  • 3.
    Bendtsen, Preben
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Beroendekliniken IHS. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Dependency.
    Johansson, Kjell
    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.
    Nordqvist, Cecilia
    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.
    How to implement screening for high alcohol consumption in the daily routine in an emergency department2002In: 2002 Scieentific Meeting of the RSA and the 11th Congress of the ISBRA, San Fransisco 2002,2002, 2002Conference paper (Refereed)
  • 4.
    Bendtsen, Preben
    et al.
    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 Central Östergötland, Department of Acute Internal Medicine.
    Johansson, Kjell
    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.
    Åkerlind, Ingemar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Feasibility of an email-based electronic screening and brief intervention (e-SBI) to college students in Sweden.2006In: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 31, p. 777-787Article in journal (Refereed)
  • 5.
    Bendtsen, Preben
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care in Linköping. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Stark Ekman, Diana
    Karlstad University.
    Johansson, Anne Lie
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Carlfjord, Siw
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Leijon, Matti
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Johansson, Kjell
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Referral to an electronic screening and brief alcohol intervention in primary health care in Sweden: impact of staff referral to the computer2011In: International Journal of Telemedicine and Applications, ISSN 1687-6415, E-ISSN 1687-6423, Vol. 2011, p. 1-11, article id 918763Article in journal (Refereed)
    Abstract [en]

    The aim of this paper was to evaluate whether primary health care staff's referral of patients to perform an electronic screening and brief intervention (e-SBI) for alcohol use had a greater impact on change in alcohol consumption after 3 month, compared to patients who performed the test on their own initiative. Staff-referred responders reported reduced weekly alcohol consumption with an average decrease of 8.4 grams. In contrast, self-referred responders reported an average increase in weekly alcohol consumption of 2.4 grams. Staff-referred responders reported a 49% reduction of average number of heavy episodic drinking (HED) occasions per month. The corresponding reduction for self-referred responders was 62%. The differences between staff- and self-referred patient groups in the number who moved from risky drinking to nonrisky drinking at the followup were not statistically significant. Our results indicate that standalone computers with touchscreens that provide e-SBIs for risky drinking have the same effect on drinking behaviour in both staff-referred patients and self-referred patients.

  • 6.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care Centres.
    Johansson, Kjell
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Association Between Frequency of Heavy Episodic Drinking and Self-reported Consequences: A Cross-sectional Study in a Swedish Population2012In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 47, no 6, p. 719-724Article in journal (Refereed)
    Abstract [en]

    Aims: To describe perceived negative consequences (PNCs) of alcohol consumption related to the frequency of heavy episodic drinking (HED) in a Swedish population attending primary health care (PHC). Methods: Data from a computer-based assessment, including questions about alcohol consumption and PNC, were collected from 28 PHC centres in Sweden. The analysis included 4559 responders. Risk ratios concerning PNC for different frequencies of HED were calculated. Results: Engaging in HED once a month for women and two to three times a month for men significantly raised the proportion of individuals reporting PNC, compared with engaging in HED less than once a month. The men reported PNC of alcohol consumption to a higher degree than the women, and in general, the proportion of individuals reporting PNC was associated with the frequency of HED. Conclusion: Engaging in HED once a month for women and two to three times a month for men are critical levels regarding PNC of alcohol consumption. To identify a cut-off value for categorizing individuals as hazardous alcohol consumers due to the frequency of HED, further studies are needed.

  • 7.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Johansson, Kjell
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Staff perspectives on the use of a computer-based concept for lifestyle intervention implemented in primary health care2010In: HEALTH EDUCATION JOURNAL, ISSN 0017-8969, Vol. 69, no 3, p. 246-256Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to evaluate staff experiences of the use of a computer-based concept for lifestyle testing and tailored advice implemented in routine primary health care (PHC). Design: The design of the study was a cross-sectional, retrospective survey. Setting: The study population consisted of staff at nine PHC units in the county of Ostergotland, Sweden. Method: After a computer-based concept for lifestyle intervention had been in operation for 1 year, a questionnaire was distributed to all staff members. The questions concerned experiences of and attitudes to the concept, and comments on addressing lifestyle issues in PHC. Results: Of the 291 potential respondents, 59 per cent returned the questionnaire. Eighty-five per cent found it positive to refer to the computer-based test, and 93 per cent of those who had read the written advice generated by the computer agreed with the advice provided. Seventy-five per cent thought that the concept could have an effect on a patients lifestyle, and 78 per cent had confidence in the computer-based test. Staff at smaller PHC units had more positive attitudes (p = 0.003) and referred a higher proportion of their patients to the computer-based test than staff at larger units (p = 0.000). Follow-up rates showed no significant differences between the categories. Staff believed that inclusion of more lifestyle areas, e. g. smoking and dietary habits, would make the test more useful. More time, education and the establishment of lifestyle practices were issues suggested in order to enhance the focus on lifestyle factors. Conclusion: Staff members have confidence in the computerized test and consider it a valuable tool. A development towards more lifestyle areas will make it even more useful.

  • 8.
    Carlfjord, Siw
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care.
    Nilsen, Per
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Andersson, A
    Johansson, Kjell
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Computerized lifestyle intervention in routine primary health care: Evaluation of usage on provider and responder levels2009In: PATIENT EDUCATION AND COUNSELING, ISSN 0738-3991, Vol. 75, no 2, p. 238-243Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to evaluate the use of a computerized concept for lifestyle intervention in routine primary health care (PHC).

    Methods: Nine PHC units were equipped with computers providing a lifestyle test and tailored printed advice regarding alcohol consumption and physical activity. Patients were referred by staff, and performed the test anonymously. Data were collected over a period of I year.

    Results: During the study period 3065 tests were completed, representing 5.7% of the individuals visiting the PHC units during the period. there were great differences between the units in the number of tests performed and in the proportion of patients referred. One-fifth of the respondents scored for hazardous alcohol consumption, and one-fourth reported low levels of physical activity. The majority of respondents found the test easy to perform, and a majority of those referred to the test found referral positive.

    Conclusion: The computerized test can be used for screening and intervention regarding lifestyle behaviours in PHC. Responders are positive to the test and to referral.

    Practice implications: A more widespread implementation of computerized lifestyle tests could be a beneficial complement to face-to-face interventions in PHC.

  • 9.
    Johansson, Kjell
    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.
    Towards a new strategy for systematic screening for hazardous and harmful alcohol consumption in primary health care2005Doctoral 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.

    List of papers
    1. Advice to patients in Swedish primary care regarding alcohol and other lifestyle habits: how patients report the actions of GPs in relation to their own expectations and satisfaction with the consultation
    Open this publication in new window or tab >>Advice to patients in Swedish primary care regarding alcohol and other lifestyle habits: how patients report the actions of GPs in relation to their own expectations and satisfaction with the consultation
    2005 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 15, no 6, p. 615-620Article in journal (Refereed) Published
    Abstract [en]

    Background: Lifestyle advice given by general practitioners (GPs) may be a cost-effective means of health promotion; however, it is not fully put into routine practice. The aim of this study was to explore to what extent GPs' patients expect and receive advice concerning alcohol, tobacco, exercise and diet in relation to sociodemographic characteristics, type of visit and patient satisfaction.

    Methods: A postal questionnaire was sent to a representative sample (n = 9750) of patients who had consulted GPs in a county in Sweden. The response rate was 69% (n = 6734).

    Results: Exercise was the most (16%) and alcohol the least (5%) common type of advice. The patients received advice more often than they expected in all areas except alcohol. The patients reported the highest rate of unfulfilled advice expectation and the lowest rate of unexpected advice in the case of alcohol. Male gender, poorer self-rated health and scheduled appointment were independent predictors of all types of advice. Continuity of GP contact was only favourable for exercise and diet advice. The patients who received advice were more satisfied with their visit to the doctor.

    Conclusions: A tertiary preventive perspective guides GPs' practice of giving advice. Male patients with advanced illnesses are given priority. Women and patients with long-term risk habits are more neglected. The GPs tend to misjudge the expectations and needs of their patients and are too restrained in their counselling practice. Alcohol is the most disregarded area of advice in proportion to the patients' expectations and needs.

    Keywords
    alcohol drinking, counselling, health behaviour, patient satisfaction, primary health care
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-29717 (URN)10.1093/eurpub/cki046 (DOI)15111 (Local ID)15111 (Archive number)15111 (OAI)
    Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
    2. Early intervention for problem drinkers: readiness to participate among general practitioners and nurses in Swedish primary health care
    Open this publication in new window or tab >>Early intervention for problem drinkers: readiness to participate among general practitioners and nurses in Swedish primary health care
    2002 (English)In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 37, no 1, p. 38-42Article 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.

    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-26254 (URN)10.1093/alcalc/37.1.38 (DOI)10760 (Local ID)10760 (Archive number)10760 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    3. Under what circumstances are nurses willing to engage in brief alcohol interventions?: a qualitative study from primary care in Swedena
    Open this publication in new window or tab >>Under what circumstances are nurses willing to engage in brief alcohol interventions?: a qualitative study from primary care in Swedena
    2005 (English)In: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 30, no 5, p. 1049-1053Article in journal (Refereed) Published
    Abstract [en]

    To improve alcohol prevention in primary health care, it has been suggested that primary care nurses are an under-utilised resource. The aim of this study was to identify under what circumstances primary care nurses in Sweden are willing to engage in alcohol prevention. All nurses at three primary health care centres in Östergötland, Sweden were invited to participate in focus group interviews; 26 nurses participated. The nurses considered primary health care to be just one among other sectors within the community with responsibility for alcohol prevention. The role of health care in alcohol prevention was perceived to be important but mainly secondary preventive. The nurses felt justified screening all patients' alcohol habits only when they could refer to an obligation or a time-limited project. Otherwise, they mainly wanted to engage in screening patients with alcohol-related symptoms or diagnoses and other risk groups. Reasons for refraining from alcohol screening and intervention included lack of self-efficacy, time consumption and fear of harming their relationship with the patient. New strategies for alcohol prevention in primary care are discussed.

    Keywords
    Primary care, nurses, alcohol prevention, dissemination strategies, focus groups
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-29733 (URN)10.1016/j.addbeh.2004.09.008 (DOI)15132 (Local ID)15132 (Archive number)15132 (OAI)
    Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
    4. Factors influencing GPs' decisions regarding screening for high alcohol consumption: a focus group study in Swedish primary care
    Open this publication in new window or tab >>Factors influencing GPs' decisions regarding screening for high alcohol consumption: a focus group study in Swedish primary care
    2005 (English)In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 119, no 9, p. 781-788Article 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.

    Keywords
    Alcohol, screening, primary health care, dissemtion, GPs attitudes
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-29718 (URN)10.1016/j.puhe.2004.12.006 (DOI)15112 (Local ID)15112 (Archive number)15112 (OAI)
    Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
    5. Towards implementation of alcohol preventive interventions into primary health care: testing a new model for selection of clinically meaningful patient groups for alcohol screening
    Open this publication in new window or tab >>Towards implementation of alcohol preventive interventions into primary health care: testing a new model for selection of clinically meaningful patient groups for alcohol screening
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: The aim of the study was to explore alcohol consumption and drinking patterns among primary health care patients in relation to their complaints as presented to the nurse in the reception at the health care centre. A model for identifying clinically meaningful groups of patients to be included in systematic screening for hazardous alcohol consumption was empirically tested.

    Methods : The study was conducted at two primary health care centres in a large city in the county of Ostergiitland in southern Sweden. All patients 16 years or older visiting the health care centres during a 2-week period, received a questionnaire concerning their complaints and alcohol habits when registering at the reception. The patients returned the completed questionnaires in sealed boxes before leaving the health care centre. A model for identifying clinically meaningful patient groups to be included in systematic alcohol screening was developed and applied on the results from the questionmrire.

    Results: Among 358 female respondents 10.6% (38 patients) were hazardous drinkers and among the 203 male respondents 20.2% (41 patients). When applying the model on the questionnaire results, it was possible to identify the most optimal patient groups for systematic alcohol screening on basis of the patient's complaints. Among the female respondents the most optimal patient groups to screen were those presenting skin, stomach/bowel, psychological, lung, or urinary tract complaints. Among the males were the patient groups presenting complaints concerning lungs, psychological problems, back, neck or shoulder problems, hypertension or injuries found to be the most optimal. There were, however, no significant differences in the proportion of hazardous drinkers for the different complaints, with the exception of male respondents with lung complaints, where 100% were hazardous drinkers.

    Conclusions: As the proportion of hazardous drinkers among primary health care patients within each presented complaint was found to be rather low during the two week study period, it was not possible to make any definite conclusion about an optimal screening strategy. However the model presented may be useful in future research to identify clinically meaningful patient groups to be included in selective screening, although this requires a much larger data collection

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-82032 (URN)
    Available from: 2012-09-28 Created: 2012-09-28 Last updated: 2012-09-28Bibliographically approved
  • 10.
    Johansson, Kjell
    et al.
    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.
    Bendtsen, Preben
    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.
    Towards implementation of alcohol preventive interventions into primary health care: testing a new model for selection of clinically meaningful patient groups for alcohol screeningManuscript (preprint) (Other academic)
    Abstract [en]

    Background: The aim of the study was to explore alcohol consumption and drinking patterns among primary health care patients in relation to their complaints as presented to the nurse in the reception at the health care centre. A model for identifying clinically meaningful groups of patients to be included in systematic screening for hazardous alcohol consumption was empirically tested.

    Methods : The study was conducted at two primary health care centres in a large city in the county of Ostergiitland in southern Sweden. All patients 16 years or older visiting the health care centres during a 2-week period, received a questionnaire concerning their complaints and alcohol habits when registering at the reception. The patients returned the completed questionnaires in sealed boxes before leaving the health care centre. A model for identifying clinically meaningful patient groups to be included in systematic alcohol screening was developed and applied on the results from the questionmrire.

    Results: Among 358 female respondents 10.6% (38 patients) were hazardous drinkers and among the 203 male respondents 20.2% (41 patients). When applying the model on the questionnaire results, it was possible to identify the most optimal patient groups for systematic alcohol screening on basis of the patient's complaints. Among the female respondents the most optimal patient groups to screen were those presenting skin, stomach/bowel, psychological, lung, or urinary tract complaints. Among the males were the patient groups presenting complaints concerning lungs, psychological problems, back, neck or shoulder problems, hypertension or injuries found to be the most optimal. There were, however, no significant differences in the proportion of hazardous drinkers for the different complaints, with the exception of male respondents with lung complaints, where 100% were hazardous drinkers.

    Conclusions: As the proportion of hazardous drinkers among primary health care patients within each presented complaint was found to be rather low during the two week study period, it was not possible to make any definite conclusion about an optimal screening strategy. However the model presented may be useful in future research to identify clinically meaningful patient groups to be included in selective screening, although this requires a much larger data collection

  • 11.
    Johansson, Kjell
    et al.
    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.
    Bendtsen, Preben
    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.
    Åkerlind, Ingemar
    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, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Advice to patients in Swedish primary care regarding alcohol and other lifestyle habits: how patients report the actions of GPs in relation to their own expectations and satisfaction with the consultation2005In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 15, no 6, p. 615-620Article in journal (Refereed)
    Abstract [en]

    Background: Lifestyle advice given by general practitioners (GPs) may be a cost-effective means of health promotion; however, it is not fully put into routine practice. The aim of this study was to explore to what extent GPs' patients expect and receive advice concerning alcohol, tobacco, exercise and diet in relation to sociodemographic characteristics, type of visit and patient satisfaction.

    Methods: A postal questionnaire was sent to a representative sample (n = 9750) of patients who had consulted GPs in a county in Sweden. The response rate was 69% (n = 6734).

    Results: Exercise was the most (16%) and alcohol the least (5%) common type of advice. The patients received advice more often than they expected in all areas except alcohol. The patients reported the highest rate of unfulfilled advice expectation and the lowest rate of unexpected advice in the case of alcohol. Male gender, poorer self-rated health and scheduled appointment were independent predictors of all types of advice. Continuity of GP contact was only favourable for exercise and diet advice. The patients who received advice were more satisfied with their visit to the doctor.

    Conclusions: A tertiary preventive perspective guides GPs' practice of giving advice. Male patients with advanced illnesses are given priority. Women and patients with long-term risk habits are more neglected. The GPs tend to misjudge the expectations and needs of their patients and are too restrained in their counselling practice. Alcohol is the most disregarded area of advice in proportion to the patients' expectations and needs.

  • 12.
    Johansson, Kjell
    et al.
    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.
    Bendtsen, Preben
    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.
    Åkerlind, Ingemar
    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.
    Early intervention for problem drinkers: readiness to participate among general practitioners and nurses in Swedish primary health care2002In: Alcohol and Alcoholism, ISSN 0735-0414, E-ISSN 1464-3502, Vol. 37, no 1, p. 38-42Article in journal (Refereed)
    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.

  • 13.
    Johansson, Kjell
    et al.
    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.
    Bendtsen, Preben
    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.
    Åkerlind, Ingemar
    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.
    Factors influencing GPs' decisions regarding screening for high alcohol consumption: a focus group study in Swedish primary care2005In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 119, no 9, p. 781-788Article in journal (Refereed)
    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.

  • 14.
    Johansson, Kjell
    et al.
    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.
    Bendtsen, Preben
    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 Central Östergötland, Department of Acute Internal Medicine.
    Åkerlind, Ingemar
    Linköping University, Department of Department of Health and Society.
    Kartläggning av alkoholvanor bland patienter på vårdcentral i relation till besöksorsak2004In: Svenska läkarsällskapets riksstämma,2004, Katrineholm: Sörmlands grafiska Quebecor AB , 2004, p. 46-46Conference paper (Other academic)
  • 15.
    Johansson, Kjell
    et al.
    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.
    Åkerlind, Ingemar
    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.
    Bendtsen, Preben
    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.
    Under what circumstances are nurses willing to engage in brief alcohol interventions?: a qualitative study from primary care in Swedena2005In: Addictive Behaviours, ISSN 0306-4603, E-ISSN 1873-6327, Vol. 30, no 5, p. 1049-1053Article in journal (Refereed)
    Abstract [en]

    To improve alcohol prevention in primary health care, it has been suggested that primary care nurses are an under-utilised resource. The aim of this study was to identify under what circumstances primary care nurses in Sweden are willing to engage in alcohol prevention. All nurses at three primary health care centres in Östergötland, Sweden were invited to participate in focus group interviews; 26 nurses participated. The nurses considered primary health care to be just one among other sectors within the community with responsibility for alcohol prevention. The role of health care in alcohol prevention was perceived to be important but mainly secondary preventive. The nurses felt justified screening all patients' alcohol habits only when they could refer to an obligation or a time-limited project. Otherwise, they mainly wanted to engage in screening patients with alcohol-related symptoms or diagnoses and other risk groups. Reasons for refraining from alcohol screening and intervention included lack of self-efficacy, time consumption and fear of harming their relationship with the patient. New strategies for alcohol prevention in primary care are discussed.

  • 16.
    Karlsson, Anna
    et al.
    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.
    Johansson, Kjell
    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.
    Nordqvist, Cecilia
    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.
    Bendtsen, Preben
    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 Central Östergötland, Department of Acute Internal Medicine.
    Feasibility of a computorized alcohol screening and personalized written advice in the ED: opportunities and obstacles2005In: Accident and Emergency Nursing, ISSN 0965-2302, E-ISSN 1532-9267, Vol. 13, p. 44-53Article in journal (Refereed)
  • 17.
    Nordqvist, Cecilia
    et al.
    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.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Beroendekliniken IHS. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Dependency.
    Johansson, Kjell
    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.
    Lindqvist, Kent
    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.
    Sekundärprevention av alkoholproblem på Motala lasaretts akutmottagning2002In: Riksstämman 2002,2002, 2002Conference paper (Refereed)
  • 18.
    Nordqvist, Cecilia
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Johansson, Kjell
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Routine screening for risky alcohol consumption at an emergency department using the AUDIT-C questionnaire2004In: Drug and Alcohol Dependence, ISSN 0376-8716, Vol. 74, no 1, p. 71-75Article in journal (Refereed)
    Abstract [en]

    A questionnaire including the three AUDIT-C items was used to screen for alcohol use among trauma patients. The aim was to display, in a pragmatic way, how the AUDIT-C scores can be converted into different levels and kind of risky drinking. Using AUDIT-C scores with a cut-off score of 4 points for women and 5 for men indicated that 28% of the women and 40% of the men were risky drinkers. When calculating weekly alcohol consumption from the answers in AUDIT-C, 3% of the women and 7% of the men were hazardous and/or harmful drinkers. Regarding heavy episodic drinking 7% of the women and 30% of the men was drinking 72 g alcohol or more at on at least one occasion a month. These results indicate that the AUDIT-C score as such give little information about the pattern of alcohol consumption and that evaluation of risky drinking must be calculated from the three items in order to differentiate between risky drinking in terms of alcohol consumed per week and heavy episodic drinking.

  • 19.
    Nordqvist, Cecilia
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Johansson, Kjell
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Alcohol prevention measures at an emergency department: physicians` perspectives. Short communication2005In: Public Health, ISSN 0033-3506, Vol. 119, no 9, p. 789-791Article in journal (Refereed)
  • 20.
    Nordqvist, Cecilia
    et al.
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Johansson, Kjell
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Lindqvist, Kent
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Bendtsen, Preben
    Linköping University, Department of Medicine and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Attitude changes among emergency department triage staff after conducting routine alcohol screening2006In: Addictive Behaviors, ISSN 0306-4603, Vol. 31, no 2, p. 191-202Article in journal (Refereed)
    Abstract [en]

    Excessive alcohol consumption is common among injury patients, but routine alcohol interventions seem to be difficult to implement in emergency departments. An obstacle seen in previous studies is the limited time available in a real-world setting for staff to participate in routine alcohol screening and interventions. In the present study, ordinary staff participated in a simple alcohol screening procedure. The aim of the study was to evaluate the feasibility of this procedure and if there was any change in attitudes and practices among triage staff after the implementation. We analyzed interviews with six staff members and questionnaires completed by 29 nurses and medical secretaries before and after a period of systematic routine screening. The staff reported that the routine worked well and that few patients reacted negatively. A positive change was seen in attitudes towards alcohol preventive measures in general. However, this seems not to be sufficient for the staff to spontaneously engage more actively. In fact, more of the staff were uncertain after the study period whether the emergency department is an appropriate place for alcohol screening and intervention despite an increased role legitimacy and perceived competence. There is a need for further development of alcohol prevention models that are acceptable for the staff to implement as part of the daily routine.

  • 21.
    Åkerlind, Ingemar
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation.
    Johansson, Kjell
    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.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Beroendekliniken IHS. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Dependency.
    How often are patients receiving advice about alcohol and other lifestyle habits in primary care in Sweden?2002In: Eur J Public Health,2002, 2002, p. 35-36Conference paper (Refereed)
1 - 21 of 21
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