Marie-Claire Lambrechts

What factors determine Belgian general practitioners' approaches to detecting and managing substance abuse? A qualitative study based on the I-Change Model.

BackgroundGeneral practitioners (GPs) are considered to play a major role in detecting and managing substance abuse. However, little is known about how or why they decide to manage it. This study investigated the factors that influence GP behaviours with regard to the abuse of alcohol, illegal drugs, hypnotics, and tranquilisers among working Belgians.MethodsTwenty Belgian GPs were interviewed. De Vries’ Integrated Change Model was used to guide the interviews and qualitative data analyses.ResultsGPs perceived higher levels of substance abuse in urban locations and among lower socioeconomic groups. Guidelines, if they existed, were primarily used in Flanders. Specific training was unevenly applied but considered useful. GPs who accepted abuse management cited strong interpersonal skills and available multidisciplinary networks as facilitators.GPs relied on their clinical common sense to detect abuse or initiate management. Specific patients’ situations and their social, psychological, or professional dysfunctions were cited as cues to action.GPs were strongly influenced by their personal representations of abuse, which included the balance between their professional responsibilities toward their patients and the patients’ responsibilities in managing their own health as well the GPs’ abilities to cope with unsatisfying patient outcomes without reaching professional exhaustion. GPs perceived substance abuse along a continuum ranging from a chronic disease (whose management was part of their responsibility) to a moral failing of untrustworthy people. Alcohol and cannabis were more socially acceptable than other drugs. Personal experiences of emotional burdens (including those regarding substance abuse) increased feelings of empathy or rejection toward patients.Multidisciplinary practices and professional experiences were cited as important factors with regard to engaging GPs in substance abuse management. Time constraints and personal investments were cited as important barriers.Satisfaction with treatment was rare.ConclusionsMotivational factors, including subjective beliefs not supported by the literature, were central in deciding whether to manage cases of substance abuse. A lack of theoretical knowledge and training were secondary to personal attitudes and motivation. Personal development, emotional health, self-awareness, and self-care should be taught to and fostered among GPs to help them maintain a patient-centred focus. Health authorities should support collaborative care.

0193 Alcohol and other drugs among workers: prevalence and job related consequences

Few data on the use of alcohol and other drugs in workers and possible effects on job performance are available. In 2016 an anonymized questionnaire was distributed among Belgian employees while waiting for a periodical medical examination. AUDIT-C and One Single Questions were used to measure prevalence of substance use. Effects on absenteeism, lost productivity, workplace accidents, conflicts with co-workers and sanctions by employers respectively experienced by the workers and observed among colleagues were investigated. 5367 workers completed the questionnaires. 83% drank at least one standard unit in the 12 months preceding the survey; 7.5% had used cannabis or other illegal drugs, 9.3% hypnotics, 5.5% tranquillizers and 7.9% antidepressants; 11.3% took prescribed drugs for nonmedical reasons. 11.4% of current drinkers had an average consumption of 5 to 6 units a day, which was significantly higher among employees<35 year; 8.5% exhibited binge drinking at least once a week. 39.1% of last year drinkers had an indication of problem drinking and 12.2% experienced consequences on the job. 27.8% observed negative effects among their colleagues, especially being late at work (18.3%), irregular job performances (18%) and absenteeism (15.7%) Due to illicit drug use, 1.2% of the respondents experienced some negative effects on the job, 7.2% observed negative effects among their colleagues. Regarding the use of psychoactive medication, significantly more used by women, this was respectively 3% and 10.7%. As the negative impact of work related substance use, especially of alcohol, is obvious, a tailored and multicomponent alcohol and drug policy is appropriate.

The approach taken to substance abuse by occupational physicians : a qualitative study on influencing factors

Objective: Aiming to enhance occupational physicians’ (OPs) practice when dealing with employee substance abuse, this study analyzes the experiences of OPs to gain insight into the factors influencing their behavior. Methods: Semi-structured interviews were conducted and analyzed using Interpretative Phenomenological Analysis. Results: OPs act differently depending on the type of drug. Their approach was mainly determined by contextual factors and by their attitudes and skills. Many OPs want to invest in health promotion. Barriers such as lack of time and focus on periodic examinations often hamper both adequate prevention and the management of workers with substance abuse. Conclusions: The approach to substance abuse by OPs could be supported by initiatives both at the individual and the collective level. A facilitating work context seems to be particularly important in their commitment to alcohol- and drug-related issues at work.

GP’s engagement in detecting and managing abuse of alcohol, illegal drugs, hypnotics and tranquilizers in the Belgian adult population

European General Practice Research Network (EGPRN) Abstracts from the EGPRN meeting in Kudasi, Turkey, 16th – 19 st May, 2013.s from the EGPRN meeting in Kudasi, Turkey, 16th – 19 st May, 2013. THEME: ‘ RISKY BEHAVIOURS AND HEALTHY OUTCOMES IN PRIMARY HEALTH CARE ’ Risk taking is an important component of development for the human condition; it is how we learn about our environment, relationships and opportunities in life. But risk involves the chance of danger and potential harm, which may impact on the health and wellbeing of patients, their families and their communities. The challenge to clinicians is to be able to recognise challenges and to promote healthier outcomes. The excessive use of substances harmful to health is extensive and varied across Europe and the diff ering characteristics are poorly understood. Substance use and misuse in the community is a multi-factorial problem, which needs to be understood in terms of physical, psychological and social dependency. These issues go beyond the consultation room and require a concerted approach by many diff ering sectors of society. Until recently little has been done in general practice. This presentation is focussed directly at the consulting room and the doctor patient interaction. There has been a steady shift across Europe that recognises the pivotal role of primary care in achieving good health outcomes. This is well documented in Starfield ’ s work, but considerable barriers and challenges remain. The general practitioner ’ s role in society has been largely reactive to the problems presented by its population but there is an increasing emphasis on prevention, multi-morbidity, chronic disease management and enhancing the wellbeing of the individual, families and communities. The numerous factors that affect a patient ’ s wellbeing must be seen in totality and hence a greater understanding of a person ’ s lifestyle is vital to place any risk taking behaviour into context. Initial assessment is important to establish the level of risk and context of the behaviour: ” What does it mean for the individual? ” Young people try substances from curiosity and only once ‘ hooked ’ peer pressure continues to encourage a person ’ s ‘ membership ’ . Others may have tried substances to solve a problem: abuse, deprivation, or pain (psychological and physical). Dependency is then established once an individual life revolves around the use of this substance; this may be socially acceptable (smoking, alcohol), illicit (heroin, cocaine, amphetamine) or iatrogenic (over the counter medicines, opiates, benzodiazepines). Each addiction generates a subculture of language, conduct and behaviour that should be understood to facilitate any challenge. European Journal of General Practice, 2013; 19: 162–184 ISSN 1381-4788 print/ISSN 1751-1402 online

Alcoholgebruik op het werk in België

SamenvattingVoor het eerst is bij Belgische werknemers problematisch middelengebruik en de negatieve effecten ervan op grote schaal onderzocht.

WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of exposure to long working hours and of the effect of exposure to long working hours on alcohol consumption and alcohol use disorders

BACKGROUND The World Health Organization (WHO) and the International Labour Organization (ILO) are developing a joint methodology for estimating the national and global work-related burden of disease and injury (WHO/ILO joint methodology), with contributions from a large network of experts. In this paper, we present the protocol for two systematic reviews of parameters for estimating the number of deaths and disability-adjusted life years from alcohol consumption and alcohol use disorder attributable to exposure to long working hours, to inform the development of the WHO/ILO joint methodology. OBJECTIVES We aim to systematically review studies on exposure to long working hours (Systematic Review 1) and systematically review and meta-analyse estimates of the effect of exposure to long working hours on alcohol consumption and alcohol use disorder (Systematic Review 2), applying the Navigation Guide systematic review methodology as an organizing framework. DATA SOURCES Separately for Systematic Reviews 1 and 2, we will search electronic academic databases for potentially relevant records from published and unpublished studies, including MEDLINE, Embase, Web of Science, CISDOC and PsychINFO. We will also search electronic grey literature databases, Internet search engines and organizational websites; hand-search reference list of previous systematic reviews and included study records; and consult additional experts. STUDY ELIGIBILITY AND CRITERIA We will include working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but exclude children (<15 years) and unpaid domestic workers. For Systematic Review 1, we will include quantitative prevalence studies of relevant levels of exposure to long working hours (i.e., 35-40, 41-48, 49-54 and ≥55 h/week) stratified by country, sex, age and industrial sector or occupation. For Systematic Review 2, we will include randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the relative effect of a relevant level of exposure to long working hours on total amount of alcohol consumed and on the incidence of, prevalence of or mortality from alcohol use disorders, compared with the theoretical minimum risk exposure level (i.e., worked 35-40 h/week). STUDY APPRAISAL AND SYNTHESIS METHODS At least two review authors will independently screen titles and abstracts at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. At least two review authors will assess risk of bias and quality of evidence, using the most suited tools currently available. For Systematic Review 2, if feasible, we will combine relative risks using meta-analysis. We will report results using the guidelines for accurate and transparent health estimates reporting (GATHER) for Systematic Review 1 and the preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA) for Systematic Review 2. PROSPERO registration number: CRD42018084077.