Abstract
BackgroundDespite evidence supporting the effectiveness of alcohol screening and brief advice to reduce heavy drinking, implementation in primary healthcare remains limited. The challenges that clinicians experience when delivering such interventions are well-known, but we have little understanding of the patient perspective. We used Normalization Process Theory (NPT) informed interviews to explore patients’ views on alcohol screening and brief advice in routine primary healthcare.MethodsSemi-structured qualitative interviews with 22 primary care patients who had been screened for heavy drinking and/or received brief alcohol advice were analysed thematically, informed by Normalisation Process Theory constructs (coherence, cognitive participation, collective action, reflexive monitoring).ResultsWe found mixed understanding of the adverse health consequences of heavy drinking, particularly longer-term risks. There was some awareness of current alcohol guidelines but these were viewed flexibly, depending on the individual drinker and drinking context. Most described alcohol screening as routine, with clinicians viewed as trustworthy and objective. Patients enacted a range of self-regulatory techniques to limit their drinking but perceived such strategies as learned through experience rather than based on clinical advice. However, most saw alcohol advice as a valuable component of preventative healthcare, especially those experiencing co-occurring health conditions.ConclusionsDespite strong acceptance of the screening role played by primary care clinicians, patients have less confidence in the effectiveness of alcohol advice. Primary care-based alcohol brief advice needs to reflect how individuals actually drink, and harness strategies that patients already commonly employ, such as self-regulation, to boost its relevance.
Highlights
Despite evidence supporting the effectiveness of alcohol screening and brief advice to reduce heavy drinking, implementation in primary healthcare remains limited
The challenges experienced by general practitioners (GPs) in delivering alcohol screening and brief advice are well-established, including lack of training [15], time [16], and financial incentives [17], alongside a fear of upsetting patients by asking about their drinking [18]
Patients were identified by practice administrative staff using standardised GP Read Code searches on the basis of their electronic medical record as having: (1) been asked about their alcohol consumption; (2) screened for heavy drinking using a validated questionnaire (recorded administration of either the Alcohol Use Disorder Identification Test (AUDIT), its abbreviated version (AUDIT-C), or the Fast Alcohol Screening Test (FAST) [30]); and / or (3) received brief alcohol advice from their GP or nurse in the past 6 months
Summary
Despite evidence supporting the effectiveness of alcohol screening and brief advice to reduce heavy drinking, implementation in primary healthcare remains limited. Primary care clinicians can help patients reduce their drinking by identifying individuals potentially at risk using a validated screening questionnaire [4], and providing brief advice to those needing support [5]. Despite extensive evidence for the effectiveness of alcohol screening and brief advice [6], the evidence to practice gap remains wide [7]. Few clinicians screen their patients systematically for heavy drinking, and often those identified as problem drinkers fail to receive. There is limited evidence of patients’ real world experiences of discussing their own alcohol consumption as part of routine consultations
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