Factors influencing inquiry about patients’ alcohol consumption by primary health care physicians: qualitative semi-structured interview study
Abstract
BACKGROUND: Early recognition of and intervention in risky alcohol consumption has been shown to be an effective way to reduce the harm. However, primary care physicians are still not screening for and intervening sufficiently in their patients' alcohol misuse. OBJECTIVE: The purpose of this study was to explore factors having an effect on primary health care physicians inquiring about patients' alcohol consumption. METHOD: A qualitative study of primary care physicians' experiences and views based on tape recorded semi-structured interviews was carried out on all physicians (n = 35) working at four health centres in Eastern Finland. RESULTS: Seven main categories were identified that either prevent or promote discussion about alcohol consumption: the sensitive nature of alcohol drinking; the reason for consultation; awareness of a patient's alcohol problem; patient factors; availability of intervention tools; expectations of effectiveness of interventions; and lack of time. CONCLUSIONS: There still exist many barriers to initiating discussions about alcohol in the consultation room. Changing the frame of reference of the concept of alcohol drinking from an addictive disease to a general lifestyle risk factor could overcome many of these barriers.
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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].”
From Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework (2021) · cites this paper as [41]
The Patient factor section (p. 3) says physicians often assessed whether a patient might be an excessive drinker before asking, and sometimes did not ask when unsure. But the Reason for consultation section (p. 3) also says they asked when symptoms or findings made alcohol relevant, without necessarily suspecting heavy drinking. The paper therefore supports selective inquiry, but not the claim's strict 'only if' condition. (LLM, conf=0.85)
Experimental — accuracy not yet measuredData 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].”
From Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework (2021) · cites this paper as [41]
The Reason for consultation section (p. 3) says none of the interviewed physicians asked routinely at every consultation and that they raised alcohol use when the complaint was connected to it. The Patient factor section (p. 3) also describes physicians assessing whether a patient might drink excessively before asking. The study interviewed physicians, not nurses, and does not establish that these were the only circumstances in which they asked. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn 1 qualitative study from Finland, it was pointed out that GPs are members of the community and that it is only natural that they have the same attitudes towards alcohol as their patients.
“In 1 qualitative study from Finland it was pointed out that GPs are members of the community and that it is only natural that they have the same attitudes towards alcohol as their patients [41].”
From Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework (2021) · cites this paper as [41]
The Discussion (p. 4) says doctors and patients both fail to distinguish alcoholism from excessive drinking as a lifestyle risk, and notes that attitudes depend partly on the social and cultural environment. It does not make the broader claim that GPs, as community members, naturally share their patients’ attitudes toward alcohol in general. (LLM, conf=0.78)
Experimental — accuracy not yet measuredAsking patients about alcohol was found easy to forget in 2 qualitative studies on GPs from the Nordic countries.
“Asking patients about alcohol was found easy to forget in 2 qualitative studies on GPs from the Nordic countries [41, 74].”
In 10 qualitative studies, primary health care providers considered asking about alcohol a delicate task because alcohol is viewed as a sensitive issue, making them feel uncomfortable.
“In 10 qualitative studies, primary health care (PHC) providers considered asking about alcohol a delicate task because alcohol is viewed as a sensitive issue, making them feel uncomfortable [37, 41, 54, 77, 89, 91, 97, 99, 109, 115].”
Six pieces of data from 3 qualitative, 1 quantitative and 1 mixed methods studies alluded that both GPs' and nurses' screening activities were influenced by patients' characteristics.
“Six pieces of data from 3 qualitative, 1 quantitative and 1 mixed methods studies alluded that both GPs and nurses screening activities were influenced by patients’ characteristics [41, 51, 74, 105, 115].”
GPs and nurses often cited improving professional teamwork as a facilitator.
“GPs and nurses often cited improving professional teamwork (e.g. having a practice nurse delivering SBI, having receptionists giving patients screening tools) as a facilitator [39, 41, 54, 70, 71, 73, 76, 80, 91, 93, 97, 99].”
From Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework (2021) · cites this paper as [41]
The study interviewed physicians, not nurses (Participants, p. 2). Its Availability of intervention tools section (p. 3) says health nurses were not used to help counsel patients about excessive drinking, but does not address improved teamwork as a facilitator. Searches for teamwork, practice nurses delivering brief interventions, and receptionists distributing screening tools found no supporting passage in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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- 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
- Family Practice
- Publisher
- Oxford University Press (OUP)
- Published
- 2003-06
- Volume
- 20
- Issue
- 3
- Pages
- 270-275
- ISSN
- 0263-2136 (ISSN-L)
- 1460-2229
- OpenAlex
- W2141516186
- Cited by
- 164
- References
- 27
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 7 · 2023: 7 · 2022: 7 · 2021: 14 · 2020: 6 · 2019: 4 · 2018: 8 · 2017: 4 · 2016: 4 · 2015: 12 · 2014: 10 · 2013: 11 · 2012: 15
- FWCI
- 3.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Family Practice (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Keywords
- alcohol consumption, alcohol screening, primary care physicians, physician-patient communication, barriers to discussion, alcohol abuse, intervention tools, patient factors
- MeSH terms
- Adult, Alcohol Drinking, Alcoholism, Attitude of Health Personnel, Female, Finland, Humans, Interviews as Topic, Health Knowledge, Attitudes, Practice, Male, Medical History Taking, Middle Aged, Physician-Patient Relations, Primary Health Care, Qualitative Research
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