Differences in brief interventions on excessive drinking and smoking by primary care physicians: qualitative study
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
References (23)
- et al.
Primary health care professionals' activity in intervening in patients's alcohol drinking: a patient perspective
Drug Alcohol depend.
(2002) - et al.
Research in general practice for smokers and excessive drinkers in Australia and the UK: I. Interpretation of results
Addiction
(1994) - et al.
Comparison of patient questionnaire, medical record, and audio tape in assessment of health promotion in general practice consultations
BMJ
(1994) - et al.
Our healthier nation: are general practitioners willing and able to deliver? A survey of attitudes to and involvement in health promotion and lifestyle counselling
Br. J. Gen. Pract.
(1999) - et al.
The physician's role in health promotion revisited—A survey of primary care practitioners
NEJM
(1996) - et al.
Research in general practice for smokers and excessive drinkers in Australia and the UK: II. Representativeness of the results
Addiction
(1994) - et al.
Research in general practice for smokers and excessive drinkers in Australia and the UK: III. Dissemination of interventions
Addiction
(1994) - et al.
The relationship between patient income and physician discussion of health risk behaviors
JAMA
(1997) - et al.
Basics of qualitative research
Techniques and procedures for developing grounded theory
(1998) Interviews: an introduction to qualitative research interviewing
(1996)
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Identification of smokers, drinkers and risky drinkers by general practitioners
2015, Drug and Alcohol DependenceCitation Excerpt :First, precise GP assessments of patients’ smoking behavior corroborate other studies (e.g., Szatkowski et al., 2012; Wilson et al., 2000) that found high agreement for smoking but contrast the study by Mant et al. (2000) who reported similar agreement measures for both smoking and drinking. Our figures indicated that GPs are less precise in ascertaining the patients’ use of alcohol than of tobacco, which is highly consistent with other studies reporting that GPs prefer assessing smoking rather than drinking (Aira et al., 2004; Geirsson et al., 2005; McAvoy et al., 1999) due to barriers they face (Arborelius and Thakker, 1995; Geirsson et al., 2005) or their lack of commitment (Anderson et al., 2014). Second, the observed gap in recognizing users also applies to different risky use patterns: While the GPs’ estimate and patient self-reported number of cigarettes smoked daily was very similar, much lower degrees of agreement could be observed on all risky drinking measures.
Barriers and Pathways to Changing Smoking and Risky Drinking in Primary Care Patients With Chronic Conditions Who Failed to Respond to Brief Advice
2021, Primary Care Companion for CNS DisordersAlcohol-related activities in primary health care
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