Qualitative exploration of barriers to alcohol management in patients with chronic disease in a regional setting.

Abstract

Chronic diseases are a major contributor to the burden of disease in Australia. Alcohol consumption is similar in people with chronic disease and the general public, and may contribute to management challenges. In regional Australia, there are limited options for the management of excess alcohol consumption, so most of this burden falls to general practitioners. This study explored how staff in general practices are managing alcohol in patients with chronic disease with a view to determining what additional services may be appropriate. Brief interviews were conducted with doctors, nurses and allied health practitioners across three general practices in a regional centre. Interviews were analysed using abductive thematic techniques to elicit broad themes. In all, 18 interviews were conducted. All interviewees found the management of patients with chronic disease who were drinking in excess of guidelines to be challenging. The complexity of patients, in terms of health needs and social circumstances, affected management and self-care. Australian drinking cultural norms also affected patients' and practitioners' behaviour. Multidisciplinary care was highlighted by all health professionals; however, there were challenges maintaining staff motivation, a lack of training in alcohol management and a lack of referral or assistance services. Experienced practitioners identified that the patient was the key stakeholder who needed to take ownership of their health. The combined burden of excess alcohol consumption and chronic disease is a common management challenge faced by staff in general practice. Although there was evidence of awareness of the issue and a concerted effort to address the problem, most staff felt they had inadequate training, skills and resources. More undergraduate or postgraduate training in alcohol management and more resources are required to support general practitioners in this area.