Ann Deehan

How do general practitioners manage alcohol-misusing patients? Results from a national survey of GPs in England and Wales.

The appropriateness of the primary care setting to undertake health promotional activities has been emphasized, but little is known about the clinical work of GPs with patients misusing alcohol. This study examines how GPs managed alcohol-misusing patients. A 20% random sample of all general practitioners in England and Wales were surveyed using a postal questionnaire. A 44% response rate was achieved. GPs reported managing different levels of severity of drinking problems differently. Basic interventions, such as reporting the alcohol misuse diagnosis and the provision of advice and information, were routine. Health promotion leaflets were not used uniformly, even with the less severe problem drinkers. Detoxification, prescribing of drugs and the management of medical complications were undertaken mainly with dependent patients. Dependent drinkers were the most likely group to be referred to specialist services, while internal practice referrals occurred with all drinking status categories. Anti-depressants were the drugs most usually prescribed to alcohol-misusing patients. The data point to a need for basic guidelines, not only on how to manage and refer dependent drinkers, but also on how to detect and manage those who are not yet manifesting problems but are drinking above recommended guidelines. One of the most evident areas in which there appears to be a need for guidelines is that of prescribing within primary care.

Increasing practice nurse access to alcohol training

Policy makers have repeatedly placed emphasis on the role of primary care in screening for at-risk alcohol consumption and delivering public health messages to the general population. Research has pointed to primary care staff holding negative attitudes towards alcohol misusing patients. Training has traditionally been seen as the key to increasing the capacity of the medical field to engage with alcohol misusing patients but little work has been undertaken to examine the potential barriers to training take up. Consequently, the aim of this study was to explore the willingness of practice nurses to be trained in alcohol screening and brief intervention, and whether identifiable barriers to training exist and how they may be overcome. All practice nurses (n = 82) in an outer London (UK) Health Authority Area were twice mailed an invitation to an alcohol training seminar and a telephone invitation was made to all of those who did not reply to the mailings. Those who did not attend (n = 66) were contacted to take part in a short structured telephone interview - 89% (59/66) were contacted successfully and interviewed. Respondents were experienced in primary care and viewed health promotional activity as a valid part of their role. Few had undertaken previous alcohol training and as a group they were highly active in attending training events with training undertaken tending to be related directly to perceived practice needs and priorities: thus this group could not be characterized as unwilling to be trained. Barriers to training at alcohol events were found to be either personal or work-related, with most nurses interested in receiving further training or information. These data imply that the ways in which training is organized and delivered require sensitivity to identifiable barriers if it is to reach and effect changing practice among practice nurses successfully. A range of possibilities are identified as alternative approaches to the provision of elective training events which may be more acceptable to the target population of health-care staff.