Low detection rates, negative attitudes and the failure to meet the “Health of the Nation” alcohol targets: findings from a national survey of GPs in England and Wales
Abstract
The appropriateness of the primary care setting to undertake the health promotional activities needed to meet ‘Health of the Nation’ alcohol targets has been acknowledged in UK government policy and the scientific literature. However, the latest data suggest these targets are not being met. A 20% random sample of all general practitioners in England and Wales were surveyed by postal questionnaire to examine their work in detecting alcohol misuse and their attitudes towards the work. Four mailing waves produced a 44% response rate. GPs had identified a mean of 3.2 patients per month drinking above recommended ‘sensible’ guidelines. These patients were mostly male (73%) and above 40 years of age (45%), with nearly half (45%) already dependent drinkers. Most GPs perceived alcohol misuse patients as a difficult group with whom to work. None the less, over half the respondents believed general practice was an appropriate setting for the detection of the problem. However, most did not feel trained or supported in this area of their work. More emphasis needs to be placed on the valuable contribution GPs can make with the larger number of patients who are drinking regularly above ‘sensible’ levels but not yet suffering adverse affects. Our findings point towards not an unwilling profession, but a profession lacking confidence. The provision of support and basic training are major factors in how GPs perceive alcohol misusers and their own role in this work. Twenty years after the Maudsley Alcohol Pilot Project research it is disappointing that, despite greater recognition by GPs of their potential impact, lack of training and lack of support are still so central to their continued low levels of therapeutic commitment.
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Three survey studies from the UK found that only a minority of GPs and nurses received alcohol-specific training since graduation.
“Three survey studies from the UK found that only a minority of the GPs and nurses received alcohol-specific training since graduation [59–61].”
A quantitative study from the UK reported that only 4% of GPs agreed that their role was to treat alcohol-related medical complications only.
“Notwithstanding, a quantitative study from the UK reported that only 4% of the GPs agreed that their role was to treat alcohol-related medical complications only [61].”
The majority of GPs in 7 of 11 studies, and of nurses in 2 studies, did not feel their advice would have much impact.
“Notwithstanding, the majority of the GPs in 7 from a total of 11 studies [20, 53, 55, 59–62, 65, 78, 83, 108], and of the nurses in 2 studies [20, 85], did not feel their advice would have much impact.”
With the exception of 1 study on GPs from Sri Lanka, the majority of GPs in the remaining 13 studies and of nurses in 3 studies reported feeling unsatisfied advising patients to cut down.
“With the notable exception of 1 study on GPs from Sri Lanka [67], the majority of the GPs in the remaining 13 studies addressing this issue (8 from the UK), and of the nurses in 3 studies (2 from Sweden and 1 from the UK) reported feeling unsatisfied advising patients to cut down [16, 20, 23, 44, 57, 59–62, 73, 78, 94, 108].”
Only 35% of GPs in 1 UK-based study agreed that there is adequate support for GPs from specialized alcohol services.
“Only 35% of the GPs in 1 UK-based study agreed that there is adequate support for GPs from specialized alcohol services [61].”
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- Authors
- DEEHAN, A., TEMPLETON, L., TAYLOR, C., DRUMMOND, C., & STRANG, J.
- Affiliations
- St George's, University of London (GB)
- Corresponding author
- DEEHAN, ANN
- Venue
- Drug and Alcohol Review
- Publisher
- Wiley
- Published
- 1998-09
- Volume
- 17
- Issue
- 3
- Pages
- 249-258
- ISSN
- 0959-5236 (ISSN-L)
- 1465-3362
- OpenAlex
- W2001408947
- Cited by
- 67
- References
- 24
- Citations by year
- 2023: 1 · 2021: 7 · 2020: 1 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 5 · 2014: 2 · 2013: 2 · 2012: 5
- FWCI
- 3.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drug and Alcohol Review (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- general practitioners, alcohol screening, GP attitudes, alcoholism, alcohol guidelines
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