Elsevier

Preventive Medicine

Volume 38, Issue 4, April 2004, Pages 473-478
Preventive Medicine

Differences in brief interventions on excessive drinking and smoking by primary care physicians: qualitative study

https://doi.org/10.1016/j.ypmed.2003.11.023Get rights and content

Abstract

Background. Brief interventions by primary care physicians have been shown to be effective in reducing both smoking and excessive drinking. However, physicians seem to target smoking more often than drinking. We aimed to explore this difference in health promotion practises for finding ways to improve alcohol interventions in primary health centres.

Methods. Qualitative semistructured interviews of 35 physicians in four health centres in Finland, and triangulation by audit of notes made by these doctors concerning alcohol drinking and smoking in medical records (n = 1200) of randomly selected 20–60 years old patients, who had visited their physician at least once in a 12-month study period.

Results. On the basis of the interviews, there were five main differences in preventive work between issues of alcohol use and smoking: recognition, perceived importance as a health risk factor, intervention tools available, stigmatising label, and expectations about the effectiveness of counselling. In 106 (8.8%) of medical records, there was a mention of smoking, and in 82 (6.8%) of alcohol use (P < 0,0001). Quantity of alcohol consumption was described obscurely. When one of the visits was made for hypertension, diabetes, dyspepsia, general health check or heart arrhythmias, smoking was recorded more often than alcohol consumption.

Conclusions. Tobacco use was mentioned more often in medical records than alcohol drinking. Physicians were more comfortable in undertaking a preventive approach for smoking than for alcohol use. The factors contributing to this difference must be considered in any attempts to improve implementation of secondary prevention of alcohol misuse.

Introduction

The prevention of diseases by targeting on lifestyle risk factors is one of the major tasks for primary healthcare professionals. Tobacco smoking and excessive alcohol drinking have been shown to contribute to the occurrence of many illnesses and a general deterioration of health. These two risky lifestyle habits are similar in many respects: their use is legal in most cultures, they are addictive substances, they often coexist and brief counselling—so-called brief intervention—has been shown to be effective in helping patients to quit these habits [1].

Many studies, however, have shown that patients' smoking habits have been recorded more often in medical records than their alcohol consumption [2]. In surveys on prevention, doctors have stated that they screen patients more often for smoking than for excessive alcohol consumption [3], [4]. In addition, it has been easier to recruit patients and primary care professionals to undertake studies targeting smoking than excessive drinking [5], [6], [7]. Understanding the reasons for this difference could contribute to identifying better ways of undertaking secondary prevention of excessive alcohol consumption. Systematic comparison of two phenomena sensitises the researcher to the properties and dimensions in the qualitative data [8]. To our knowledge, there are no qualitative studies exploring the difference between drinking and smoking in prevention practise of physicians.

The aim of our study was to examine primary care physicians' views of secondary prevention of excessive alcohol consumption by comparing issues of drinking and smoking in medical records and with semistructured interviews of physicians.

Section snippets

Study setting

The study was performed in four primary health care centres in Eastern Finland in 1998. Two of them were in rural communities with about 4,000 inhabitants, and two were in towns with about 25,000 inhabitants. Physicians in Finnish primary health care centres are general practitioners. These health centres were chosen to form two comparison pairs for a future intervention study of brief alcohol counselling.

Survey of medical records

We examined a random sample of medical records of patients aged 20–60 years who had

Medical records

Two of the health centres had electronic medical records and two kept only paper copies of their records. There was no specific space in the medical forms for recording health habits separately, but physicians reported the preventive issues discussed in the consultation within other information of the visit, (like medical history, reason for the consultation, patient's examination and treatment). The four health centres did not differ statistically in the frequency of recording smoking and

Discussion

The survey of medical records confirmed the findings of qualitative interviews with doctors: smoking is approached more often than alcohol drinking in preventive work. The frequency of smoking recording and counselling was far from ideal, but still higher than that of alcohol drinking, and if we could increase secondary prevention of alcohol misuse at least to the same level, it would be one step forward. We cannot explain this difference in recording solely by difference of prevalence of

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