BMJ 2002;325:870 ( 19 October )

Primary care

Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners

Anders Beich, research fellow, ^a Dorte Gannik, associate professor, ^a Kirsti Malterud, professor. ^b

^a Central Research Unit and Department of General Practice, University of Copenhagen, Panum Institute, DK-2200 Copenhagen, Denmark, ^b Section for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Ulriksdal 8c, N-5009 Bergen, Norway

Correspondence to: Anders Beich a.beich{at}gpract.ku.dk

Objective: To explore the suitability of a screening based intervention for excessive alcohol use by describing the experiences of general practitioners who tried such an intervention in their everyday practice.
Design: Qualitative interviews with general practitioners who had participated in a pragmatic study of a combined programme of screening and a brief intervention for excessive alcohol use. Doctors were interviewed either individually or in focus groups. A computer based, descriptive, phenomenological method was used to directly analyse the digitally recorded interviews.
Setting and participants: 24 of 39 general practitioners in four Danish counties who volunteered to take part in the pragmatic study were interviewed.
Results: The doctors were surprised at how difficult it was to establish rapport with the patients who had a positive result on the screening and to ensure compliance with the intervention. Although the doctors considered the doctor-patient relationship robust enough to sustain targeting of alcohol use, they often failed to follow up on initial interventions, and some expressed a lack of confidence in their ability to counsel patients effectively on lifestyle issues. The doctors questioned the rationale of screening in young drinkers who may grow out of excessive drinking behaviour. The programme needed considerable resources, and it interrupted the natural course of consultations and was inflexible. The doctors could not recommend the screening and brief intervention programme, although they thought it important to counsel their patients on drinking.
Conclusions: Screening for excessive alcohol use created more problems than it solved for the participating doctors. The results underline the value of carrying out pragmatic studies on the suitability of seemingly efficacious healthcare programmes.

What is already known on this topic Efficacy studies have shown that in ideal conditions a brief intervention in primary care can lower alcohol consumption Health authorities recommend the implementation of screening for excessive alcohol use and a brief intervention to modify drinking behaviour, but such screening and brief intervention programmes have not yet proved to be successful What this study adds General practitioners who have tried a screening and brief intervention programme in their practice find the extra workload onerous and have problems in establishing rapport with excessive drinkers located by screening The programme disrupts normal patterns of work and cooperation in the general practice setting while failing to detect and deal with some problem drinkers

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Rapid Responses:

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Lifestyle advice

Pablo Millares
bmj.com, 18 Oct 2002 [Full text]

Conclusions do not take account of all the relevant data

Tim Lancaster
bmj.com, 21 Oct 2002 [Full text]

Re: Conclusions do not take account of all the relevant data

Anders Beich
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Strange definition of excessive drinking

Adam Jacobs
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Re: Strange definition of excessive drinking

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Talking about drink: Why GP experiences are important

Jim McCambridge, et al.
bmj.com, 8 Nov 2002 [Full text]

IMPLEMENTATION OF BRIEF ALCOHOL INTERVENTION DEPENDS ON THOROUGH PREPARATION AND PROPER TRAINING

Kaija Seppä, et al.
bmj.com, 13 Nov 2002 [Full text]

Re: Talking about drink: Why GP experiences are important

Anders Beich
bmj.com, 13 Nov 2002 [Full text]

Re: IMPLEMENTATION OF BRIEF ALCOHOL INTERVENTION DEPENDS ON THOROUGH PREPARATION AND PROPER TRAINING

Anders Beich, et al.
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OPEN DEBATE ABOUT A COMPLEX INTERVENTION

Stephen Rollnick
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Open mind on screening and brief alcohol intervention

Kaija Seppä, et al.
bmj.com, 23 Nov 2002 [Full text]

Re: Open mind on screening and brief alcohol intervention

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