What May Stimulate General Practitioners to Undertake Screening and Brief Intervention for Excess Alcohol Consumption in Slovenia? A Focus Group Study

Department of Family Medicine, Medical Faculty Maribor, University of Maribor, Maribor, Slovenia.
The Journal of international medical research (Impact Factor: 1.44). 10/2009; 37(5):1561-9. DOI: 10.1177/147323000903700534
Source: PubMed


Screening and brief intervention (SBI) presents an effective early response by healthcare professionals to their patients' alcohol-related problems. This qualitative research study used focus group discussions with general practitioners (GPs) to identify incentives that may increase the use of SBI in Slovene general practice. Seven categories of actions that may improve the use of SBI were identified: motivation, professional institution, financial support, adequate knowledge and skills, community support, workload (i.e. relief from the burden of current obligations in order to allow more time for prevention), and record keeping (suitable medical documentation). Several of these actions can be changed by the GPs themselves (motivation, adequate knowledge and skills, and record keeping), while the remaining four require more extensive community action on the part of society as a whole, e.g. government intervention. The results of this study will guide future changes in the way that prevention strategies for excess alcohol consumption will be implemented in Slovenia.

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    • "In addition, previous research also points toward a series of structural and organizational factors that influence alcohol intervention delivery. Lack of training or suitable intervention materials (68, 72), inadequate financial incentives (73, 74), unsupportive specialist alcohol service provision (3, 67), and everyday time pressures (67, 75) has all been identified by GPs and other health practitioners as barriers to their successful engagement in and delivery of brief interventions for alcohol (32, 59, 62, 64, 73, 76–79). Moreover, these barriers are often interrelated. "
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    ABSTRACT: Background: Robust evidence supports the effectiveness of screening and brief alcohol interventions in primary healthcare. However, lack of understanding about their "active ingredients" and concerns over the extent to which current approaches remain faithful to their original theoretical roots has led some to demand a cautious approach to future roll-out pending further research. Against this background, this paper provides a timely overview of the development of the brief alcohol intervention evidence base to assess the extent to which it has achieved the four key levels of intervention research: efficacy, effectiveness, implementation, and demonstration. Methods: Narrative overview based on (1) the results of a review of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare and (2) synthesis of the findings of key additional primary studies on the improvement and evaluation of brief alcohol intervention implementation in routine primary healthcare. Results: The brief intervention field seems to constitute an almost perfect example of the evaluation of a complex intervention. Early evaluations of screening and brief intervention approaches included more tightly controlled efficacy trials and have been followed by more pragmatic trials of effectiveness in routine clinical practice. Most recently, attention has shifted to dissemination, implementation, and wider-scale roll-out. However, delivery in routine primary health remains inconsistent, with an identified knowledge gap around how to successfully embed brief alcohol intervention approaches in mainstream care, and as yet unanswered questions concerning what specific intervention component prompt the positive changes in alcohol consumption. Conclusion: Both the efficacy and effectiveness of brief alcohol interventions have been comprehensively demonstrated, and intervention effects seem replicable and stable over time, and across different study contexts. Thus, while unanswered questions remain, given the positive evidence amassed to date, research efforts should maintain a continued focus on promoting sustained implementation of screening and brief alcohol intervention approaches in primary care to ensure that those who might benefit from screening and brief alcohol interventions actually receive such support.
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    • "Other Slovenian studies also addressed some issues related to this topic (8,21-24) and showed that preventive measures were important both to family physicians and patients. This is also in line with some foreign studies (2,3). "
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    ABSTRACT: To assess patients' attitudes toward changing unhealthy lifestyle, confidence in the success, and desired involvement of their family physicians in facilitating this change. We conducted a cross-sectional study in 15 family physicians' practices on a consecutive sample of 472 patients (44.9% men, mean age(±standard deviation) 49.3±10.9 years) from October 2007 to May 2008. Patients were given a self-administered questionnaire on attitudes toward changing unhealthy diet, increasing physical activity, and reducing body weight. It also included questions on confidence in the success, planning lifestyle changes, and advice from family physicians. Nearly 20% of patients planned to change their eating habits, increase physical activity, and reach normal body weight. Approximately 30% of patients (more men than women) said that they wanted to receive advice on this issue from their family physicians. Younger patients and patients with higher education were more confident that they could improve their lifestyle. Patients who planned to change their lifestyle and were more confident in the success wanted to receive advice from their family physicians. Family physicians should regularly ask the patients about the intention of changing their lifestyle and offer them help in carrying out this intention.
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    ABSTRACT: In his famous novel 'Anna Karenina' Konstantin Levin, a farmer who is commonly considered to represent the author Leo Tolstoy himself, listens to another farmer's opinions on the land reform. He highly respects these opinions which, as he says, 'had been brought not by a desire of finding some exercise for an idle brain, but a thought which had grown up out of the conditions of his life'. Researchers and policy makers, far from the realities of primary health care, seem to be more interested in brief alcohol interventions for hazardous drinkers than do general practitioners or other professionals working in this setting. Should brief intervention be removed to some other setting, buried forever as not being suitable for real life, or would it just now be perfect time for general practitioners and nurses in primary health care to take command of brief interventions and make it suitable for their own setting?
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