When general practitioners talk about Alcohol: Exploring facilitating and hampering factors for pragmatic case finding
Abstract
Background: The aim was to explore individual and system factors facilitating or hampering pragmatic case finding, an identification strategy based on clinical signs and targeted screening. Study design: Two focus groups with general practitioners were interviewed twice, in the context of a four-session seminar on alcohol and complex drug problems, and an additional focus group interview with general practitioners not attending the seminar. Interviews focused mainly on conditions for talking about alcohol, views on collaboration with colleagues, how they deal with complex issues, and strategies for learning and quality improvement. Results: The participants presented many deliberate strategies for quality improvement and learning together, but there was a tendency to avoid discussing complex case stories or potentially controversial topics with colleagues. Possible barriers to change were presented. The majority of their stories on talking about alcohol coincided well with the concept of pragmatic case finding. The duality between shame and normality, time constraints and a need for structure were the most important individual barriers to an open and respectful conversation about alcohol with patients. Conclusions: Our study supports pragmatic case finding as a relevant and viable strategy for talking about alcohol in general practice, and as an alternative to screening and brief intervention. Quality improvement in practice is strengthened when it is adapted to the clinical setting, and builds on and stimulates the GPs’ and staff’s own strategies for learning and quality work.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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.”
Cites
Lave, J., & Wenger, E. (1991) · Cambridge University Press eBooks · doi:10.1017/cbo9780511815355 · Cited by 33,219 · see citing works
Lundahl, B., Moleni, T., Burke, B. L., Butters, R., Tollefson, D., Butler, C., & Rollnick, S. (2013) · Patient Education and Counseling · doi:10.1016/j.pec.2013.07.012 · Cited by 909 · cited 2× · see citing works
“[17] lundahl B, Moleni T, Burke Bl, et al.”
BackgroundMethodThe impact of brief alcohol interventions in primary healthcare: a systematic review of reviews
O'Donnell, A., Anderson, P., Newbury-Birch, D., Schulte, B., Schmidt, C., Reimer, J., & Kaner, E. (2014) · Alcohol and Alcoholism · doi:10.1093/alcalc/agt170 · Cited by 613 · see citing works
The effectiveness of brief alcohol interventions in primary care settings: A systematic review
KANER, E. F. S., DICKINSON, H. O., BEYER, F., PIENAAR, E., SCHLESINGER, C., CAMPBELL, F., SAUNDERS, J. B., BURNAND, B., & HEATHER, N. (2009) · Drug and Alcohol Review · doi:10.1111/j.1465-3362.2009.00071.x · Cited by 434 · see citing works
Kaner, E., Bland, M., Cassidy, P., Coulton, S., Dale, V., Deluca, P., Gilvarry, E., Godfrey, C., Heather, N., Myles, J., et al. (2013) · BMJ · doi:10.1136/bmj.e8501 · Cited by 277 · cited 8× · see citing works
“Our study supports pragmatic case finding as a relevant and viable strategy for talking about alcohol in general practice, as an alternative to SBI.”
BackgroundInfluentialvan Beurden, I., Anderson, P., Akkermans, R. P., Grol, R. P. T. M., Wensing, M., & Laurant, M. G. H. (2012) · Addiction · doi:10.1111/j.1360-0443.2012.03868.x · Cited by 73 · see citing works
General practitioners’ strategies to identify alcohol problems: A focus group study
Lid, T. G., & Malterud, K. (2012) · Scandinavian Journal of Primary Health Care · doi:10.3109/02813432.2012.679229 · Cited by 44 · see citing works
Self-citationAsking patients about their drinking
Holmqvist, M., Bendtsen, P., Spak, F., Rommelsjö, A., Geirsson, M., & Nilsen, P. (2008) · Addictive Behaviors · doi:10.1016/j.addbeh.2007.09.021 · Cited by 42 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Rosário, F., Santos, M. I., Angus, K., Pas, L., Ribeiro, C., & Fitzgerald, N. (2021) · Implementation Science · doi:10.1186/s13012-020-01073-0 · Cited by 141 · see citing works
“Doctors and nurses own drinking habits UK(2); Norway(1) [77, 87, 89]”
BackgroundInfluentialAktualisierung der S3-Leitlinie „Screening, Diagnose und Behandlung alkoholbezogener Störungen“
Kiefer, F., Batra, A., Bischof, G., Funke, W., Lindenmeyer, J., Mueller, S., Preuss, U., Schäfer, M., Thomasius, R., Veltrup, C., et al. (2021) · Suchttherapie · doi:10.1024/0939-5911/a000464 · Cited by 106
Physician Reluctance to Intervene in Addiction
Campopiano, M., Nolan, L., Corbin, M., Farinelli, L., Pytell, J. D., Simon, C., Weiss, S. T., & Compton, W. M. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.20837 · Cited by 60 · see citing works
Factors influencing doctors’ counselling on patients’ lifestyle habits: a cohort study
Belfrage, A., Grotmol, K. S., Tyssen, R., Moum, T., Finset, A., Rø, K. I., & Lien, L. (2018) · BJGP Open · doi:10.3399/bjgpopen18x101607 · Cited by 40 · see citing works
“Still, one qualitative Norwegian study indicates that ’pragmatic case finding’ (where the patient’s alcohol habits are addressed as part of other clinical problems where alcohol habits may have an effect) is a better alternative than screening instruments or brief interventions when it comes to alcohol counselling.(51…”
BackgroundHanschmidt, F., Manthey, J., Kraus, L., Scafato, E., Gual, A., Grimm, C., & Rehm, J. (2017) · Alcohol and Alcoholism · doi:10.1093/alcalc/agx032 · Cited by 34 · see citing works
“The observed pattern may be partially explained by contextual differences in social norms regarding tolerable levels of alcohol consumption, which may impact on the perceived acceptability of screening about alcohol use among GPs (Rapley et al., 2006; Lid et al., 2015).”
BackgroundBareham, B., Stewart, J., Kaner, E., & Hanratty, B. (2021) · The British journal of general practice : the journal of the Royal College of General Practitioners · doi:10.3399/bjgp.2020.1118 · Cited by 10 · see citing works
“21 Characteristics of practitioners were recorded, capturing factors that influence practitioner views about alcohol use (listed in Table 1, as indicated in wider literature 14,22–24 ).”
Finn, S. W., Hammarberg, A., Andréasson, S., & Jirwe, M. (2021) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2021.1882079 · Cited by 9 · see citing works
Use of drugs for alcohol use disorder in Norway 2004–16.
Heldal, A. T., Skurtveit, S., Lobmaier, P., Vederhus, J., & Bramness, J. (2018) · Tidsskrift for Den Norske Laegeforening · doi:10.4045/tidsskr.18.0383 · Cited by 8 · see citing works
“Fastlegene har en helt sentral rolle i de e arbeidet (23).”
BackgroundPotthoff, S., O'Donnell, A., Karlsen, A., Brendryen, H., & Lid, T. G. (2022) · Frontiers in Health Services · doi:10.3389/frhs.2022.940383 · Cited by 7 · see citing works
“At this stage we considered existing research on barriers and facilitators of PCF and SBI more widely (21, 29), but decided that a more in-depth exploration using a robust implementation framework would be warranted.”
BackgroundMethodSelf-citationAddressing Patients’ Alcohol Consumption–A Population-Based Survey of Patient Experiences
Lid, T. G., Karlsson, N. E., Thomas, K., Skagerström, J., O'Donnell, A., Abidi, L., & Nilsen, P. (2021) · International Journal of Public Health · doi:10.3389/ijph.2021.1604298 · Cited by 7 · see citing works
“One important barrier concerns HCPs’ preconceptions of alcohol as a sensitive and stigmatising topic, potentially affecting the doctor-patient relationship if brought up [8, 11, 12].”
BackgroundSelf-citationJohannesen, A., Engedal, K., Larsen, M., Lillehovde, E. J., Stelander, L. T., & Helvik, A. (2017) · The Naturalist · doi:10.1177/1455072516682642 · Cited by 5 · see citing works
“A study by Lid, Nesvåg, and Meland (2015) emphasised that improvement of practice can be strengthened by using clinical cases in healthcare staff discussions.”
BackgroundLid, T. G., Eide, G. E., Dalen, I., & Meland, E. (2016) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2016.1207138 · Cited by 5 · see citing works
“[38,39] SBI has shown a lack of diagnostic accuracy, intervention efficacy, and feasibility.[8,11,17,40] Methods focusing on the present situation and the patient’s problem will probably increase relevance and recognition for the patient.”
Self-citationKamsvaag, B., Bergh, S., Benth, J. Š., Selbæk, G., Tevik, K., & Helvik, A. (2021) · Aging & Mental Health · doi:10.1080/13607863.2021.1950618 · Cited by 4 · see citing works
Hanschmidt, F., Manthey, J., Kraus, L., Scafato, E., Gual, A., Grimm, C., & Rehm, J. (2017) · Alcohol and Alcoholism · doi:10.1093/alcalc/agx042 · Cited by 4
Kamsvaag, B., Tevik, K., Benth, J. Š., Wu, B., Bergh, S., Selbæk, G., & Helvik, A. (2022) · Dementia and Geriatric Cognitive Disorders Extra · doi:10.1159/000521924 · Cited by 4 · see citing works
Potthoff, S., Brendryen, H., Bosnic, H., Bhardwaj-Gosling, R., Iden, K. R., Njå, A. L. M., O'Donnell, A. J., & Lid, T. G. (2025) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2025.2598835 · Cited by 2 · see citing works
“…by a study describing the development of the eOVs [32], while the clinical intervention (PcF) draws on earlier work by lid and colleagues [10,33]. specific mechanisms of impact were not hypothesised a priori but were explored inductively through qualitative analysis, consistent with the…”
Self-citationTevik, K., Skråstad, R. B., Benth, J. Š., Selbæk, G., Bergh, S., Spigset, O., Krokstad, S., & Helvik, A. (2025) · PLoS ONE · doi:10.1371/journal.pone.0334556 · Cited by 2 · see citing works
Odokonyero, R. F., Nakasujja, N., Turiho, A. K., Sanyu, N., Muyindike, W. R., Nansera, D., Semitala, F. C., Kamya, M. R., Katahoire, A., Hahn, J. A., et al. (2024) · Addiction Science & Clinical Practice · doi:10.1186/s13722-024-00495-1 · Cited by 1 · see citing works
“Our findings, similar to those in other primary care settings [33, 34], show that HIV care providers recognized alcohol use as a serious concern among young people attending their clinic.”
BackgroundResultInfluentialCosta, M., Marcellin, F., Coste, M., Barré, T., Nordmann, S., Mora, M., Maradan, G., Tanti, M., Cutarella, C., Casanova, D., et al. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-024669 · Cited by 1 · see citing works
“point of contact, GP are numerous and provide comprehensive and coordinated care (9,10).”
BackgroundReinholdz, H., Bendtsen, P., Spak, F., & Müssener, U. (2016) · Journal of Addiction · doi:10.1155/2016/4731571 · Cited by 1 · see citing works
“The few studies that have measured role security and therapeutic commitment before and after an educational session do not provide information about how a change in engagement is accomplished or mediated [8, 14].”
BackgroundResultScarth, M., Bjørnebekk, A., Bramness, J., Abebe, D. S., & Stavseth, M. (2026) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2026.113248
Naltrekson i behandlingen av alkoholavhengighet
Bramness, J. (2025) · Tidsskrift for Den Norske Laegeforening · doi:10.4045/tidsskr.25.0514
Berge, S. D., Brekke, M., Meland, E., & Mildestvedt, T. (2022) · Family Practice · doi:10.1093/fampra/cmac010
Self-citation
- Authors
- lid, T. G., Nesvåg, S., & Meland, E.
- Affiliations
- Stavanger University Hospital (NO)
- University of Bergen (NO)
- Venue
- Scandinavian Journal of Public Health
- Publisher
- SAGE Publications
- Published
- 2015-01-06
- Volume
- 43
- Issue
- 2
- Pages
- 153-158
- ISSN
- 1403-4948 (ISSN-L)
- 1651-1905
- OpenAlex
- W2098187936
- Cited by
- 29
- References
- 0
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2022: 4 · 2021: 10 · 2020: 1 · 2018: 3 · 2017: 2 · 2016: 3
- FWCI
- 2.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Scandinavian Journal of Public Health (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- alcohol consumption, general practitioners, time constraints, quality improvement, learning together, collaboration with colleagues, screening and brief intervention
- MeSH terms
- Adult, Aged, Alcohol Drinking, Communication, Female, Humans, Male, Middle Aged, Physician-Patient Relations, Focus Groups, Alcohol-Related Disorders, Qualitative Research, General Practitioners, General Practice, Quality Improvement
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
