INTERVENTION FOR EXCESSIVE ALCOHOL CONSUMPTION IN PRIMARY HEALTH CARE: ATTITUDES AND PRACTICES OF ENGLISH GENERAL PRACTITIONERS

Three survey studies showed that 40 to 86% of GPs believed general practices are not organized to do preventive counselling.

“Three survey studies showed that 40 to 86% of the GPs believed general practices are not organized to do preventive counselling [47, 78, 83].”

Alcohol was not a goal priority for GPs because they were too busy, which makes them neglect alcohol issues in favour of other presenting problems.

“Alcohol was not a goal priority for GPs because they were too busy, which makes them neglect alcohol issues in favour of other presenting problems [23, 47, 78, 83, 92, 105, 106].”

The majority of GPs in 14 studies and of nurses in 2 quantitative studies reported the opposite, that they felt skilled enough to deliver alcohol SBI.

“on the other hand, the majority of the GPs in 14 [16, 20, 23, 36, 52, 62, 64, 70, 78, 83, 95, 106, 108, 111], and of the nurses in 2 quantitative studies [36, 70] reported the opposite.”

Several studies on both GPs and nurses reported availability of educational and training programmes as an important facilitator.

“Several studies on both GPs and nurses reported availability of educational and training programmes as an important facilitator [23, 36, 55, 73, 78, 84].”

In 9 survey studies, the majority of GPs and nurses who received training reported that those programmes lasted less than four hours.

“In 9 survey studies, the majority of the GPs and nurses who received training reported that those programmes lasted less than four hours [20, 23, 44, 46, 47, 70, 76, 78, 79].”

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.”

GPs and nurses reported more training for improving counselling skills and feedback on successful cases as facilitators.

“GPs and nurses reported more training for improving counselling skills [20, 49, 78, 83] and feedback on successful cases [71] as facilitators.”

More information about the effectiveness of brief interventions and feedback on successful cases were identified as implementation facilitators.

“More information about the effectiveness of brief interventions [23, 36, 39, 47, 78, 84, 87, 92] and feedback on successful cases [71, 109] were identified as implementation facilitators.”

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];”

In 5 survey studies among GPs, 4 found that a majority of GPs did not believe patients would resent being asked about alcohol.

“This issue was addressed in 5 survey studies among GPs, of which 4 found a majority of GPs did not believe patients would resent being asked [20, 23, 47, 56, 78].”

The majority of GPs in 2 UK and 1 USA study thought that preventing alcohol problems was their responsibility.

“on the other hand, the majority of the GPs in 2 studies from the UK and 1 study from the USA thought the opposite [23, 65, 78].”

Fourteen to 54% of GPs in 3 quantitative studies considered alcohol an unimportant issue in primary health care.

“Fourteen to 54% of the GPs in 3 quantitative studies considered alcohol an unimportant issue in PHC [23, 47, 78].”

The majority of GPs in 4 of 6 quantitative studies reported feeling comfortable asking about alcohol.

“Notwithstanding, the majority of the GPs in 4 from a total of 6 quantitative studies reported feeling comfortable asking about alcohol [23, 47, 56, 78, 83, 116].”

The majority of GPs in 8 of 10 quantitative studies felt unmotivated to work with at-risk drinkers.

“The majority of the GPs in 8 from a total of 10 quantitative studies felt unmotivated to work with at-risk drinkers [16, 23, 44, 57, 62, 66, 78, 94, 95, 108].”

The majority of GPs in 3 quantitative studies reported that alcohol SBI activities were not reimbursable under government health schemes.

“The majority of the GPs in 3 quantitative studies reported that alcohol SBI activities were not reimbursable under government health schemes [47, 78, 83].”

More training for improving counselling skills and feedback on successful cases were reported as facilitators.

“More training for improving counselling skills [49, 78] and feedback on successful cases [71] were reported as facilitators.”

For some doctors and nurses, alcohol SBI was too time-consuming and they were already too busy dealing with other problems.

“For some doctors and nurses, alcohol SBI was too time-consuming [72, 95, 106] and they were already too busy dealing with other problems [23, 47, 78, 83, 92, 106].”

Better co-operation with specialized services, involving other professionals in general practice, public health educational campaigns, and more media attention were among the most commonly cited facilitators.

“Better co-operation with specialized services [20, 39, 59, 60, 80], involving other professionals in general practice (e.g. an addiction consultant or a specialized nurse) [39, 71, 105], public health educational campaigns [23, 47, 78, 99, 110] and more media attention [39, 110] were among the most commonly cited facilitators.”

The majority of GPs in 3 survey studies reported lack of support from government health policies.

“The majority of the GPs in 3 survey studies reported lack of support from government health policies [47, 78, 83].”

Having these resources and displaying information in the waiting room were reported as facilitators in several studies.

“Having these resources and displaying information in the waiting room (e.g. posters) were reported as facilitators in several studies [20, 23, 37, 39, 47, 55, 78, 92].”

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].”