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- Page navigation anchor for Overcoming obstacles to improving recognition of gambling problems in primary careOvercoming obstacles to improving recognition of gambling problems in primary care
van den Dool et al.1 raise questions about our recent study2 which initially relate to the variability in deprivation among practices, and management of missing data on gambling problems. As indicated in the paper, the study involved sampling of practices according to official metrics of population deprivation. This produced four practices from deprived areas (top 30% for deprivation in England), two practices from areas of low deprivation (bottom 30%), and three practices in the middle 40%, which we regard as indicating meaningful diversity. In contrast, we agree that usage of ‘zero fill’ techniques for missing data could underestimate the extent of gambling problems. We expect that underestimation will be modest (given that most missing data was attributable to patients reporting low intensity gambling), and suggest that conservative estimates are preferable to figures that may overstate such levels.
The final question from van den Dool et al.1 relates to ways of implementing recommendations for training and support for clinical staff. Working with practices in this study revealed ambivalence about whether gambling problems were a health-related concern (versus a social issue), and whether these could be prioritized given other pressures on primary care. In the UK, the Department for Culture, Media and Sport also leads the societal response to gambling, rather than the Department for Health. Gambling...
Show MoreCompeting Interests: None declared. - Page navigation anchor for Gambling problems among patients in primary care: a cross-sectional study of general practicesGambling problems among patients in primary care: a cross-sectional study of general practicesWith interest, we read the article of Cowlishaw et al.1 about gambling in general practice. We think it is a relevant article since gambling in general practice is a relatively unrecognized topic. In addition, information about the associations between gambling and other psychosomatic complaints can be very useful for GPs. However, after reading the article, we were left with some questions.One of the aims of the study was to explore variability in gambling problems according to practice and patient characteristics, and thereby indicate clinical settings experiencing heightened vulnerability. However, we question the diversity of the practices included in this study regarding to deprivation of the areas. It seems like practices from more deprived areas were included and no practices from areas without deprivation, including a practice for the homeless and a student health service were included. Because it is known that the risk of gambling problems increases with lower socioeconomic status,2 the selection of practices may have limit the generalizability of the results.Furthermore, we think the results could be an underestimation of the extent of gambling problems. Firstly, gambling problems were assessed with a questionnaire directly in the waiting room. This could create an environment in which people are reluctant to provide honest answers about their gambling problems. Secondly, we q...Show MoreCompeting Interests: None declared.