Are Brief Alcohol Interventions Adequately Embedded in UK Primary Care? A Qualitative Study Utilising Normalisation Process Theory.

Amy O’Donnell,Eileen Kaner

doi:10.3390/ijerph14040350

Abstract

Despite substantial evidence for their effectiveness, the adoption of alcohol screening and brief interventions (ASBI) in routine primary care remains inconsistent. Financial incentive schemes were introduced in England between 2008 and 2015 to encourage their delivery. We used Normalisation Process Theory-informed interviews to understand the barriers and facilitators experienced by 14 general practitioners (GPs) as they implemented ASBI during this period. We found multiple factors shaped provision. GPs were broadly cognisant and supportive of preventative alcohol interventions (coherence) but this did not necessarily translate into personal investment in their delivery (cognitive participation). This lack of investment shaped how GPs operationalised such “work” in day-to-day practice (collective action), with ASBI mostly delegated to nurses, and GPs reverting to “business as usual” in their management and treatment of problem drinking (reflexive monitoring). We conclude there has been limited progress towards the goal of an effectively embedded preventative alcohol care pathway in English primary care. Future policy should consider screening strategies that prioritise patients with conditions with a recognised link with excessive alcohol consumption, and which promote more efficient identification of the most problematic drinkers. Improved GP training to build skills and awareness of evidence-based ASBI tools could also help embed best practice over time.

Highlights

Social and economic gains that could be realised through the effective implementation of screening and brief alcohol interventions, their organisation and provision in routine primary care remains inconsistent [3]
In England alone, Purshouse et al estimate that screening all newly registered patients for excessive alcohol consumption, and delivering brief behavioural interventions to those identified at risk, would deliver 32,000 quality-adjusted life years (QALYs) at £6900 per QALY gained over a thirty year period [5]
We report an in-depth Normalisation Process Theory (NPT)-informed qualitative analysis of the views of general practitioners (GPs) on the implementation of screening and brief alcohol interventions in routine primary care

Summary

Introduction

Social and economic gains that could be realised through the effective implementation of screening (using a validated self-report questionnaire to identify problem drinkers [1]) and brief alcohol interventions (brief advice or behaviour change counselling to reduce problem drinking [2]), their organisation and provision in routine primary care remains inconsistent [3]. Few eligible patients benefit from these simple, clinically- and cost-effective secondary prevention measures [4]. In England alone, Purshouse et al estimate that screening all newly registered patients for excessive alcohol consumption, and delivering brief behavioural interventions to those identified at risk, would deliver 32,000 quality-adjusted life years (QALYs) at £6900 per QALY gained over a thirty year period [5]. Public Health 2017, 14, 350; doi:10.3390/ijerph14040350 www.mdpi.com/journal/ijerph

Methods

Results

Discussion

Conclusion