Primary health care professionals' activity in intervening in patients' alcohol drinking: a patient perspective

Abstract

Aim: To test the hypothesis that primary health care professionals' activity in intervening in patients' alcohol drinking is low. Method: A patient questionnaire survey after consultation blind to the primary health care professionals. Subjects were 1000 16–65-year-old consecutive patients consulting a general practitioner. The response rate was 66.5%. Results: Of all participants 6.3% and of excessive drinkers 11.9% were asked about alcohol drinking at the consultation in question. Of all 64.7% and of excessive drinkers 52.4% had never been asked about drinking. Of all 6.0% and of excessive drinkers 19.0% were advised about alcohol drinking at the consultation in question. Conclusion: Alcohol drinking is rarely brought up in discussion by primary health care professionals, even in the case of excessive drinkers.

Introduction

There are at least two reasons to determine whether a patient drinks too heavily. First, there are many instances in which recognition of excessive drinking would expedite the diagnostic process. If underlying excessive drinking is not diagnosed, patients may be subjected to procedures that are useless. Secondly, there are many clinical opportunities for excessive drinkers' counselling and referral, and non-dependent excessive drinkers can be offered an effective brief intervention treatment to reduce their alcohol consumption (Wallace et al., 1988, Babor et al., 1994, Fleming et al., 1997). Recent meta-analysis found that excessive drinkers who received brief intervention were twice as likely to moderate their drinking when compared to excessive drinkers who did not receive any intervention (Wilk et al., 1997).

It is well documented in primary health care based studies that the majority of patients with alcohol problems go unrecognised (Reid et al., 1986, Rydon et al., 1992). One reason for the low level of detection has been suggested to be the difficulty of the diagnosis (Reid et al., 1986). However, the frequency with which patients are asked about alcohol consumption and advised about their alcohol drinking has received less attention and only a few studies have used patients as a source of information (Wallace et al., 1987, Richmond et al., 1996, Volk et al., 1996). Further, we do not have any knowledge of primary health care professionals' activity in intervening in patients' alcohol drinking at the consultation in question. This would be an important piece of information when evaluating how successful the implementation of brief intervention has been. Finland, with well preventive oriented primary health care and a long tradition of promoting brief intervention, is a place where this activity could be expected to be better than in many other countries.

The present study examines primary health care professionals' activity in asking and advising patients about alcohol drinking in the area where brief intervention has been actively promoted in recent years. It also describes patients' attitudes towards this activity.