Are screening and brief alcohol interventions adequately embedded in routine primary care?

Talk Code: 
EP1D.09
Presenter: 
Amy O'Donnell
Co-authors: 
Eileen Kaner, Barbara Hanratty
Author institutions: 
Insitute of Health and Society, Newcastle University

Problem

Between 20-30% of UK primary care patients are drinking above recommended limits, with heavy drinkers attending more frequently than those drinking at lower risk levels. Excessive alcohol consumption has been shown to be causally related to over 60 different medical conditions, including liver cirrhosis, cancer and cardiovascular disease. Despite a large and robust evidence base for the effectiveness of screening and brief interventions for alcohol to reduce harmful drinking, their organisation and provision in primary care remains highly inconsistent. Some of the challenges experienced by GPs in delivering alcohol interventions are well known, including lack of time, training and financial incentives. However, the role played by other primary care staff (such as practice nurses and administrators) in screening and brief alcohol intervention implementation remains under-researched. Further, whilst trial evidence suggests that patients find brief interventions acceptable in principle, we have little understanding of what they think about being questioned about their alcohol consumption, or receiving advice to help them to cut down, in everyday general practice situations.

Approach

Qualitative study comprising semi-structured, theory-informed interviews with up to 15 practice staff (GPs, nurses and administrators) and 15 patients in the North East of England who have experience of screening and / or brief alcohol interventions in primary care. Normalisation Process Theory (NPT) will inform the interview design, analysis and interpretation. NPT helps explain the ‘work’ involved in enacting (implementing, embedding, and integrating) a set of practices (screening and brief alcohol interventions) through the operation of four core mechanisms: coherence; cognitive participation; collective action; and reflexive monitoring.

Findings

This pitch will present emerging findings from a study to explore the views of patients and providers on the delivery of screening and brief interventions for alcohol in routine primary care. Objectives are threefold, to: (1) investigate the acceptability / feasibility of screening and brief alcohol interventions to primary care patients and practitioners; (2) understand the barriers / facilitators that exist to their routine delivery; and (3) assess the extent to which the various activities comprising screening and brief alcohol interventions can be considered effectively embedded within UK primary care.

Consequences

This study will improve our understanding of the health-relevant beliefs, motivations, and personality traits of patients and providers that might influence the outcomes of screening and brief alcohol intervention implementation in routine primary care. Empirical data will be presented to explore the extent to which alcohol interventions are currently being delivered as intended in day-to-day practice. This information will improve our understanding of why alcohol interventions are not routinely adopted and delivered in the UK, and thus help inform the design of future policy initiatives to reduce alcohol consumption.

Submitted by: 
Amy O'Donnell
Funding acknowledgement: 
This study is funded by a Post-doctoral NIHR School for Primary Care Research Fellowship award.