Problem alcohol use among problem drug users in primary care: a qualitative study of what patients think about screening and treatment

Catherine Anne Field,Gerard Bury,Joseph Barry,Walter Cullen,Bobby P Smyth,Jan Klimas,Eamon Keenan

doi:10.1186/1471-2296-14-98

Abstract

BackgroundProblem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment. This paper aims to describe patients’ experience of, and attitude towards, screening and therapeutic interventions for problem alcohol use in primary care.MethodsThis qualitative study recruited problem drug users (N = 28) from primary care based methadone programmes in the Ireland’s Eastern region, using a stratified sampling matrix to include size of general practice and geographical area. Semi-structured interviews were conducted and analysed using thematic analysis, and audited by a third reviewer.ResultsWe identified three overarching themes relevant to the purpose of this paper: (1) patients’ experience of, and (2) attitude towards, screening and treatment for problem alcohol use in primary care, as well as their (3) views on service improvement. While most patients reported being screened for problem alcohol use at initial assessment, few recalled routine screening or treatment. Among the barriers and enablers to screening and treatment, patients highlighted the importance of the practitioner-patient relationship in helping them address the issue. Nevertheless, patients felt that healthcare professionals should be more proactive in the management of problem alcohol use at a primary care level and that primary care can play an important role in their treatment.ConclusionsProblem alcohol use is an important challenge in the care of problem drug users. While primary care is well placed to address this issue, little data has reported on this topic. The development of interventions which promote screening and brief interventions in practice are likely to benefit this at-risk group and further research and education, that help achieve this goal, are a priority. Strategies such as dissemination of clinical guidelines, educational videos, academic detailing and practice visits, should be explored.

Highlights

Problem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment
For the purpose of this study, we consider ‘primary care’ to consist of general practices (GP) that prescribe methadone and addiction treatment clinics that are based in a community and where general practitioners are responsible for clinical patient care
We presented results of the first qualitative study to explore the experience of, and attitude towards, screening and treatment for problem alcohol use among problem drug users attending primary care and their views on service development

Summary

Introduction

Problem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment. Early therapeutic interventions, such as screening and brief intervention, are effective in primary care [13] Though they can reduce the extent of problem alcohol use by 10-35% [14,15], they are not routinely implemented in primary care [16,17,18]. Their positive effect was confirmed by a clinical trial among problem drug users conducted in a specialist, secondary-care clinic [19], which suggests that if they are applied to this group attending primary care, they may work for them as well

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