Addressing alcohol problems in primary care settings: A study of general medical practitioners in Cape Town, South Africa
Abstract
Aims: To explore alcohol-related practices among general practitioners (GPs) in the Cape Town metropole and to examine barriers to addressing risky drinking among patients. Method: A cross-sectional survey of 50 GPs was conducted between November 2004 and April 2005. A questionnaire assessing GPs' alcohol-related practices and barriers to alcohol-related interventions was administered to participating GPs. Results: In the past 12 months, most GPs reported seeing only 11—30 patients for alcohol problems specifically. While only 12% thought that they could effectively help patients reduce their alcohol consumption, 78% of GPs indicated that, given adequate training and support, they could become more effective. Among the barriers that hindered their ability to intervene in patients' alcohol-related problems were difficulties in getting reimbursed for treating patients with alcohol problems, insufficient training, lack of materials with which to do screening and counselling, perceptions of ineffectiveness, and time constraints. Conclusions: GPs are willing to conduct interventions for risky drinking but require additional training in these interventions as well as appropriate support and intervention tools.
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Primary care providers in these overwhelmed clinics have significant time constraints.
“Because primary care providers in these overwhelmed clinics have significant time constraints (Koopman et al., 2008), alternative delivery models are important to examine.”
From Effectiveness of Nurse-Practitioner-Delivered Brief Motivational Intervention for Young Adult Alcohol and Drug Use in Primary Care in South Africa: A Randomized Clinical Trial (2014) · cites this paper as Koopman et al., 2008
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].”
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.”
The majority of GPs in 9 studies and of nurses in 3 quantitative studies felt they were not skilled enough to deliver alcohol SBI.
“On the one hand, the majority of the GPs in 9 [20, 44, 47, 57, 59, 62, 67, 83, 104], and of the nurses in 3 quantitative studies [20, 59, 84] felt they were not skilled enough to deliver alcohol SBI;”
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.”
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];”
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 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].”
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].”
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].”
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].”
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- Authors
- Koopman, F. A., Parry, C. D. H., Myers, B., & Reagon, G.
- Affiliations
- South African Medical Research Council (ZA)
- University of the Western Cape (ZA)
- Corresponding author
- Parry, Charles D.H.
- Venue
- Scandinavian Journal of Public Health
- Publisher
- SAGE Publications
- Published
- 2008-05
- Volume
- 36
- Issue
- 3
- Pages
- 298-302
- ISSN
- 1403-4948 (ISSN-L)
- 1651-1905
- OpenAlex
- W2024235540
- Cited by
- 21
- References
- 8
- Citations by year
- 2024: 1 · 2021: 9 · 2019: 2 · 2018: 1 · 2014: 2 · 2013: 1 · 2012: 2
- FWCI
- 0.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Scandinavian Journal of Public Health (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- University of the Western Cape
- Medical Research Council
- 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
- alcohol-related problems, hazardous drinking, general practitioners, primary care, alcohol screening, alcohol counseling, barriers to intervention, physician training, time constraints, Cape Town
- MeSH terms
- Adult, Alcohol Drinking, Alcoholism, Cross-Sectional Studies, Education, Medical, Continuing, Family Practice, Humans, Middle Aged, Physician-Patient Relations, Practice Patterns, Physicians', Physicians, Family, Surveys and Questionnaires, Risk Factors, South Africa
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