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Cited by 11Substance Abuse Treatment and OutcomesAlcohol Consumption and Health EffectsPrimary Care and Health Outcomes

Detection and management of alcohol misuse by general practitioners

Open access
Gurugama, NP, Seneviratne, SL, Peiris, DTS, De Silva, HJ·2011·Ceylon Medical Journal
DOI 10.4038/cmj.v48i4.3328
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Abstract

INTRODUCTION: Alcohol misuse and related problems are common in Sri Lanka. The appropriateness of the primary care setting in dealing with alcohol misuse is well recognised, and general practitioners (GPs) constitute an important first contact setting. METHODS: One hundred and fifty randomly selected GPs practising in the Colombo and Gampaha districts were given a questionnaire to assess how they detect and manage alcohol misuse, and their attitudes towards persons who misuse alcohol. RESULTS: Seventy per cent of GPs responded [74 male; mean age 42 years (SD 6.7)]. Our results suggest that although a majority (81%) of GPs were frequently confronted with problems related to alcohol misuse, their efforts to detect the problem and knowledge regarding risk limits of alcohol consumption were poor. Only 25.7% had even heard of CAGE and MAST questionnaires. The majority of GPs felt inadequately trained to deal with alcohol misuse, but only a few made any self-directed efforts to improve their knowledge and skills regarding its management or referred their patients for specialised care. Participation in preventive programmes was minimal, and many GPs expressed negative attitudes towards persons misusing alcohol. CONCLUSIONS: The ability of general practitioners to detect and alcohol misuse appears to be inadequate.

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Crossref · 10.4038/cmj.v48i4.3328

Cites

7 of 7 references verified0 citation errors · 0 not checkable

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  • The majority of GPs in 1 multicountry and 1 South African study reported that preventing alcohol problems was not their responsibility.

    “On the one hand, the majority of the GPs in 1 multicountry and 1 South African studies reported that these problems were not their responsibility [47, 67];”

    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 [67]

    The Discussion (page unavailable) says most GPs in this Sri Lankan survey recognised their own role in dealing with alcohol misuse—the opposite of saying it was not their responsibility. It reports minimal participation in prevention programmes, but does not equate that with rejecting responsibility. The paper is also neither a multicountry nor a South African study. (LLM, conf=0.88)

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  • 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.

    “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 [67]

    The Results report that only 16% of responding GPs routinely asked adult male patients about alcohol use, while 58% asked only when they strongly suspected excessive consumption. This supports the GP screening point, but the paper reports a questionnaire survey, not a qualitative study, and does not study nurses or say that GPs screened when a complaint appeared alcohol-related. (LLM, conf=0.88)

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  • 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].”

    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 [67]

    The Results (Table 2; page not available) support the Sri Lankan exception in a broader sense: 65 of 105 GPs agreed that people who misuse alcohol are rewarding to treat. The paper does not report whether GPs felt satisfied specifically when advising patients to cut down. The figures for the other studies are attributed to other citations, not this paper. (LLM, conf=0.82)

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  • The majority of GPs from several countries, and of nurses in 1 UK-based study, reported that more training in brief interventions would increase their motivation to work with at-risk drinkers.

    “The majority of the GPs from several countries [47, 59, 60, 67], and of the nurses in 1 UK-based study [59], reported that more training in brief interventions would increase their motivation to work with at-risk drinkers.”

    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 [67]

    The Results (Table 2) show that 73 of 105 GPs agreed that more training would encourage them to manage people who misuse alcohol; the Discussion likewise says most GPs would deal with alcohol misuse more willingly with access to training. The survey does not specify training in brief interventions, so it supports the GP motivation finding but not that narrower description. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • 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;”

    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 [67]

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Cites

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Research works printed but not linked: 4

  1. Pathmeswaran A. The Pattern and Problems of Alcohol Use in Gampaha District. MD Thesis, Postgraduate Institute of Medicine, University of Colombo, 1997.
  2. Wallace P, Cutler S, Haines A. A randomized controlled trial of general practitioner intervention with excessive alcohol consumption. British Medical Journal 1988; 297: 663-8.
  3. Babor TF, Ritson B, Hodgson R. Alcohol related problems in primary care setting: a review of early intervention strategies. British Journal of Addiction 1986; 81: 23-46.
  4. de Silva HJ, Kasthuriarachchi N, Senevirathne SL, Senarathne DC, Ellawala NS. Suicides in Sri Lanka: points to ponder. Ceylon Medical Journal 2000; 45: 17-24.

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Authors
Gurugama, N., Seneviratne, S., Peiris, D., & De Silva, H.
Affiliations
University of Kelaniya (LK)
Corresponding author
Peiris, DTS
Venue
Ceylon Medical Journal
Publisher
Sri Lanka Journals Online (JOL)
Published
2011-08-18
Volume
48
Issue
4
Pages
122
ISSN
  • 0009-0875 (ISSN-L)
  • 2386-1274
DOI
10.4038/cmj.v48i4.3328
OpenAlex
W2161177282
Cited by
11
References
7
Citations by year
2021: 7 · 2014: 1 · 2013: 1 · 2012: 1
FWCI
0.96
Type
journal article
Language
en
Open access
Locations
  • Ceylon Medical Journal (publishedVersion)
  • PubMed (publishedVersion)
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 abuse, general practitioners, alcohol screening, CAGE questionnaire, physician attitudes, primary care, training needs, Sri Lanka
MeSH terms
Adult, Alcoholism, Family Practice, Female, Humans, Male, Surveys and Questionnaires

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