How can alcohol brief interventions be embedded into routine primary care? A qualitative study of clinicians and patients perspectives

Conference:

SAPC ASM 2021 - virtual

Talk Code:

2D.1

Presenter:

Liz Sturgiss

Twitter:

@LizSturgiss

Co-authors:

Nilakshi Gunatillaka1, Grant Russell1, Suzanne Nielsen2, Tina Lam2, Renée O'Donnell3, Helen Skouteris3,4, Lauren Ball5, Chris Barton1, David Jacka6, Michael Tam7, Danielle Mazza1, Catriona Rowe1, Nathanael Wells1 and Liz Sturgiss1

Author institutions:

1Department of General Practice, Monash University, Australia, 2Monash Addiction Research Centre, Monash University, Australia, 3Health and Social Care Unit, HiPP CRE, Monash University, Australia, 4Warwick Business School, Warwick University, UK, 5Healthy Primary Care Team, Griffith University, Australia, 6Monash Health, Australia, 7Academic Primary and Integrated Care Unit, UNSW, Australia

Problem

Alcohol is a major source of harm, contributing to 3 million deaths and 132.6 million Disability Adjusted Life Years (DALYs) annually in Australia. The burden of harm from alcohol use falls disproportionately on low-income communities. Alcohol Brief Interventions (ABIs) involve assessing a person’s alcohol use and offering individualised advice to reduce health risks. Despite their demonstrated effectiveness, ABIs are infrequently implemented in primary care.Our team explored factors that influence the uptake of ABIs from the perspective of primary care clinicians and patients in Australian general practice.

Approach

Our qualitative study used semi-structured interviews and focus groups of primary care clinicians working in the greater Melbourne metropolitan region and patients from across Australia. Interview guides were based on published literature. General practices were recruited via a mail-out, newsletters and social media platforms including Twitter and GP-specific Facebook groups. Patients from low-income groups were engaged via social media conversations, and advertisements on social media and peer-to-peer alcohol support groups. Transcripts of audio recordings and field notes were used to identify themes using a matrix based on the question structure.

Findings

Participants (17 patients, 42 clinicians) reported multiple barriers and facilitators to the uptake of ABIs in primary care. We were able to use system levels to organise these into an ecological model from the wider community through to the individual patient and clinician. At the community level, we found barriers to adoption of ABIs through: existing community norms of excessive alcohol use, limited awareness of the alcohol-related harms, and limited recognition that GPs could provide support for alcohol use. Within the healthcare system, limited referral options into tertiary care for alcohol dependence discouraged clinicians from conducting ABIs. Clinicians reported that ABIs could be supported by practice culture, including practice systems and teamwork to collect alcohol histories. However, clinicians continued to experience tension between asking about alcohol use routinely or as a direct response to another clinical issue . Within consultation barriers included time constraints, limitations in clinical software, and lack of appropriate resources to support conversations.Patients experiencing stigma surrounding alcohol use and those with limited knowledge about alcohol harms were less likely to engage with ABIs. Clinician’ knowledge gaps in standard drink sizes, medications for alcohol dependence, motivational interviewing skills and perceived stigma as barriers to conducting ABIs.

Consequences

We have outlined factors at multiple levels of the healthcare system and broader community that influence the implementation of ABIs in Australian general practice. The multiple factors imply that a successful implementation strategy will have several targets, and likely benefit from a cohesive public health and primary care approach. Findings have been used to inform an intervention to increase clinician uptake of ABIs in general practice.

Submitted by:

Nilakshi Gunatillaka

Funding acknowledgement:

This project is funded by the Victorian Health Promotion Foundation (VicHealth)