Tackling the alcohol issue in France

Marie Blanquet; MME Fleur Peyrol; Laurent Gerbaud; Florence Morel; Bernard Maradeix; Pierre-Michel Llorca; André Morge

doi:10.3399/bjgp14X676357

Excessive alcohol consumption remains a significant problem around the world and in France, with a 30% prevalence of hazardous and harmful drinkers.1 GPs are a mainstay of the health organisation and can have a significant impact on alcohol misuse.

A project conducted in 2007 revealed that French GPs questioned only 11% of their patients about their alcohol consumption.2 We performed a representative observational survey of 69 fee-for-service GPs in the department of Puy-de-Dôme between May and October 2011. The WHO alcohol thresholds were known by less than one-quarter of the GPs, 42% of them were familiar with Screening Brief Intervention (SBI) and 10% felt SBI use was effective in their practice. The GPs felt that their prescribing role was more important (87%) than tackling the alcohol issue (48%). Questions about alcohol were asked mainly in the event of abnormalities being revealed by blood tests (63%). They thought their role in dealing with alcohol misuse was legitimate but also expressed a low level of confidence and work satisfaction. The three incentives most often identified by GPs as likely to improve SBI involved government (100%), patients (95%) or health organisation (95%).

Alcohol was not perceived as a disease risk factor by the GPs in their routine practice, and preventive procedures will be held in check as long as GPs find it easier to fulfil their prescribing role. The GPs had an ambivalent attitude, recognising that they could legitimately question and advise their patients, but at the same time complaining about the lack of education and suitable tools to help them.3

Consequently, a change in mentality and ways of thinking about primary health care and prevention is needed. French GPs do not consider that screening for hazardous and harmful drinkers falls within their remit. It is time to implement an effective preventive policy in France, highlighting patient-centred medical homes organisation4 and payment system.

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