Differences in brief interventions on excessive drinking and smoking by primary care physicians: qualitative study
Abstract
Background Brief interventions by primary care physicians have been shown to be effective in reducing both smoking and excessive drinking. However, physicians seem to target smoking more often than drinking. We aimed to explore this difference in health promotion practises for finding ways to improve alcohol interventions in primary health centres.Methods Qualitative semistructured interviews of 35 physicians in four health centres in Finland, and triangulation by audit of notes made by these doctors concerning alcohol drinking and smoking in medical records (n = 1200) of randomly selected 20-60 years old patients, who had visited their physician at least once in a 12-month study period.Results On the basis of the interviews, there were five main differences in preventive work between issues of alcohol use and smoking: recognition, perceived importance as a health risk factor, intervention tools available, stigmatising label, and expectations about the effectiveness of counselling. In 106 (8.8%) of medical records, there was a mention of smoking, and in 82 (6.8%) of alcohol use (P < 0,0001). Quantity of alcohol consumption was described obscurely. When one of the visits was made for hypertension, diabetes, dyspepsia, general health check or heart arrhythmias, smoking was recorded more often than alcohol consumption.Conclusions Tobacco use was mentioned more often in medical records than alcohol drinking. Physicians were more comfortable in undertaking a preventive approach for smoking than for alcohol use. The factors contributing to this difference must be considered in any attempts to improve implementation of secondary prevention of alcohol misuse.
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One interview study from Finland found that GPs were unaware of whether or not patients they advised reduced their drinking because GPs do not schedule follow-up appointments.
“One interview study from Finland found that GPs were unaware of whether or not patients they advised reduced their drinking because GPs do not schedule follow-up appointments [42].”
Four studies from the Nordic countries mentioned that GPs asked their patients about alcohol only if there was something that made them suspect the patient was a heavy drinker.
“Four studies (3 qualitative and 1 quantitative) from the Nordic countries mentioned that GPs asked their patients about alcohol only if there was something that made them suspect the patient was a heavy drinker [38, 41, 42, 74].”
In 4 quantitative and 4 qualitative studies, GPs were sceptical that patients would follow their advice.
“In 4 quantitative and 4 qualitative studies GPs were sceptical that patients would follow their advice [20, 42, 47, 49, 78, 83, 91, 107];”
Data mainly from qualitative studies suggested that GPs and nurses do not screen systematically for alcohol but only when they suspected heavy consumption or when the patient's complaint was likely to be alcohol-related.
“Data, mainly from qualitative studies, suggested that GPs and nurses do not screen systematically for alcohol but only when they suspected heavy consumption, or when the patient’s complaint was likely to be alcohol-related [41, 42, 58, 67, 72–74, 88].”
Lack of resources included lack of screening tools, counselling materials, and specific guidelines.
“Lack of resources included lack of screening tools [20, 23, 47, 74, 78], counselling materials [20, 23, 42, 47, 78, 109] and specific guidelines [103].”
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References 25 · Cited by 45
- Authors
- Aira, M., Kauhanen, J., Larivaara, P., & Rautio, P.
- Affiliations
- University of Eastern Finland (FI)
- University of Oulu (FI)
- Corresponding author
- Aira, Marja
- ORCID
- Kauhanen, Jussi
- Venue
- Preventive Medicine
- Publisher
- Elsevier BV
- Published
- 2004-04
- Volume
- 38
- Issue
- 4
- Pages
- 473-478
- ISSN
- 0091-7435 (ISSN-L)
- OpenAlex
- W2031189674
- Cited by
- 45
- References
- 25
- Citations by year
- 2025: 4 · 2024: 2 · 2021: 8 · 2020: 1 · 2018: 1 · 2017: 2 · 2015: 2 · 2014: 3 · 2013: 2 · 2012: 2
- FWCI
- 1.92
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Preventive Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- brief intervention, excessive alcohol drinking, smoking, primary care physicians, health promotion, physician attitudes, medical records, tobacco use, alcohol consumption, stigma, counseling effectiveness
- MeSH terms
- Smoking Prevention, Adult, Alcohol Drinking, Attitude of Health Personnel, Female, Humans, Interviews as Topic, Male, Medical History Taking, Medical Records, Middle Aged, Physicians, Family, Smoking
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