Physicians' attitudes toward unhealthy alcohol use and self-efficacy for screening and counseling as predictors of their counseling and primary care patients' drinking outcomes.

A Rani Elwy,Nicholas J Horton,Richard Saitz

doi:10.1186/1747-597x-8-17

Abstract

ObjectivePatients’ unhealthy alcohol use is often undetected in primary care. Our objective was to examine whether physicians’ attitudes and their perceived self-efficacy for screening and counseling patients is associated with physicians’ counseling of patients with unhealthy alcohol use, and patients’ subsequent drinking.MethodsThis study is a prospective cohort study (nested within a randomized trial) involving 41 primary care physicians and 301 of their patients, all of whom had unhealthy alcohol use. Independent variables were physicians’ attitudes toward unhealthy substance use and self-efficacy for screening and counseling. Outcomes were patients’ reports of physicians’ counseling about unhealthy alcohol use immediately after a physician visit, and patients’ drinking six months later.ResultsNeither physicians’ attitudes nor self-efficacy had any impact on physicians’ counseling, but greater perceived self-efficacy in screening, assessing and intervening with patients was associated with more drinking by patients six months later.ConclusionsFuture research needs to further explore the relationship between physicians’ attitudes towards unhealthy alcohol use, their self-efficacy for screening and counseling and patients’ drinking outcomes, given our unexpected findings.

Highlights

Primary care physicians are expected to regularly screen for and counsel their patients on a wide variety of preventable health problems, such as diabetes, hypertension, depression, and unhealthy alcohol use, the spectrum from levels of use that risk consequences through dependence [1]
In one study, 77% of primary care providers reported that it was important or very important to intervene with patients who report unhealthy alcohol use, yet only 21% of physicians felt they could do this effectively [8]
This paper presents findings from analysis of data collected for The Screening and Intervention in Primary care (SIP) study, a cluster randomized controlled trial in an urban, academic primary care practice

Summary

Introduction

Primary care physicians are expected to regularly screen for and counsel their patients on a wide variety of preventable health problems, such as diabetes, hypertension, depression, and unhealthy alcohol use, the spectrum from levels of use that risk consequences through dependence [1]. In one study, 77% of primary care providers reported that it was important or very important to intervene with patients who report unhealthy alcohol use (positive attitude towards intervention/counseling), yet only 21% of physicians felt they could do this effectively (low self-efficacy) [8] Another possible route is that physicians’ self-efficacy alone has a direct effect on whether or not physicians screen and counsel patients. Most studies which have examined primary care physicians’ self-efficacy have focused on self-efficacy for general communication skills, not screening and counseling about alcohol use [9] It is not known whether self-efficacy and attitudes both play a role in screening and counseling for unhealthy alcohol use, or whether self-efficacy alone can predict screening and counseling for unhealthy alcohol use—both of which, in turn, can lead to improved patient outcomes

Methods

Results

Conclusion