Can Doctors Be Divided Into Groups Based on Their Attitudes to Addressing Alcohol Issues in Their Patients? Analyses From a Survey of Portuguese General Practitioners

Relationship Between Primary Care Providers' Perceptions of Alcohol Use Disorder And Pharmacotherapy Prescribing Rates

AIMS

Acamprosate, naltrexone and disulfiram are underprescribed for alcohol use disorder (AUD) with marked variability among primary care providers (PCPs). We aimed to identify differences between high and low prescribers of medications for AUD (MAUD) with regard to knowledge, experiences, prioritization and attitudes.

METHODS

We surveyed PCPs from a large healthcare system with at least 20 patients with AUD. Prescribing rates were obtained from the electronic health record (EHR). Survey responses were scored from strongly disagree (1) to strongly agree (5). Multiple imputation was used to generate attitude scores for 7 missing subjects. PCPs were divided into groups by the median prescribing rate and attitude. Comparisons were made using Wilcoxon rank-sum and regression.

RESULTS

Of the 182 eligible PCPs, 68 (37.4%) completed the survey. Most indicated willingness to attend an educational course (57.4%). Compared with low prescribers, high prescribers viewed the effectiveness of medications more favorably (short term 4.0 vs 3.7, P = 0.02; long term 3.5 vs 3.2, P = 0.04) and were more likely to view prescribing as part of their job (3.9 vs 3.4, P = 0.04). PCPs with positive attitudes (72.4%, CI 60.9-83.8%) had a prescribing rate of 5.0% (CI 3.5-6.5%) compared to 1.9% (CI 0.5-3.4%) among those with negative attitudes (P = 0.028). When stratified by attitude, belief in effectiveness was associated with higher prescribing among PCPs with positive attitudes but not those with negative attitudes.

CONCLUSIONS

PCPs indicated an interest in learning to prescribe MAUD. However, education alone may not be effective unless physicians have positive attitudes towards patients with AUD.

Examining the Attitudes of Non-Psychiatric Practicing Healthcare Workers Towards Patients With Alcohol Problems in General Hospital Setting

BACKGROUND AND OBJECTIVES

Problematic alcohol-use affect the physical and mental well-being of hospitalised individuals and may receive screening and brief-intervention during treatment. Non-psychiatric doctors and nurses might respond inadequately due to negative attitudes and beliefs. This study aimed to examine these attitudes of non-psychiatric workers in the medical and surgical wards.

METHODS

A total of 457 doctors and 1643 nurses were recruited from the medical, surgical and orthopaedic disciplines over a period of 4 months. Three questionnaires were administered: demographics, Alcohol & Alcohol-Problems Perceptions Questionnaire (AAPPQ) and Staff Perception of Alcohol Treatment Resources.

RESULTS

About 128 doctors and 785 nurses responded. Around 75.5% doctors and 51.9% nurses endorsed role-legitimacy in the AAPPQ. Both the doctor (86.7%) and nurse (77.6%) groups agreed on the importance to initiate intervention for patients with problematic alcohol-use in daily work. Both groups were sceptical and negative towards these patients endorsing low-level role-adequacy (41.2%), role-support (36.9%), motivation (36.5%), task-specific self-esteem (25.1) as well as work satisfaction (20.5%).

CONCLUSION/DISCUSSION

Doctors and nurses demonstrated low levels of therapeutic commitments towards patients with problematic alcohol-use thereby necessitating the introduction of in-house programmes to educate, empower and emphasise the importance of therapeutic contact with patients for alcohol intervention.

SCIENTIFIC SIGNIFICANCE

The prompt identification and treatment of patients with alcohol problems are contingent on the workers' attitudes towards them. This study's results should spark a nation-wide interest to improve the training and recognition of such patients and providing adequate educational resources.

Implementing alcohol screening and brief interventions in primary health care: study protocol for a pilot cluster randomized controlled trial

BACKGROUND

Alcohol is one of the most important risk factors contributing to the global burden of disease. Screening and brief interventions in primary care settings are effective in reducing alcohol consumption. However, implementation of such interventions in routine practice has been proven difficult. Most programmes in practice and research have lacked a theoretical rationale for how they would change practitioner behaviour.

OBJECTIVE

To determine whether a theory-based behaviour change intervention delivered to primary care practices significantly increases delivery of alcohol screening.

METHODS

We will conduct a two-arm, cluster-randomized controlled, parallel, open trial. Twelve primary care practices will be randomized to one of two groups: training and support; and waiting-list control. Family physicians, nurses and receptionists will be eligible to participate. The intervention will be a training and support programme. The intervention will be tailored to the barriers and facilitators for implementing alcohol screening and brief interventions following the principles of the Behaviour Change Wheel approach. The primary outcome will be the proportion of patients screened with the Alcohol Use Disorders Identification Test.

CONCLUSION

This study will test whether a theory-driven implementation programme increases alcohol screening rates in primary care. Results from this trial will provide a useful addition to existing evidence by informing implementation researchers what areas of behaviour change are critical to increasing alcohol screening rates.

TRIAL REGISTRATION

clinicaltrials.gov NCT02968186.

The Issue of Burnout and Work Satisfaction in Younger GPs-A Cluster Analysis Utilizing the HaMEdSi Study

The shortage of general practitioners (GPs) in Germany has become a relevant problem. Therefore, it is important to find the determinants that make primary care more attractive, and which support GPs remaining in practice. Our aim in this exploratory study was to search for relevant GP subgroups and their characteristics in order to find starting points for improvements or interventions. We attempted a comprehensive survey of all GPs in the German region of Siegen-Wittgenstein with about 280,000 inhabitants. There were 158 GPs in the total population; 85 of these (53.8%) took part in the study. There were 64 male GPs (75.3%) in our sample. The mean age of the participants was 53.5 years (SD 8.93). The questionnaire was composed of demographic questions, questions regarding future perspectives, the Motivation for Medical Education Questionnaire (MoME-Q), the Maslach Burnout Inventory (MBI), and the Work Satisfaction Questionnaire. K-means cluster analyses were used for subgrouping. A 2-cluster solution had good statistical quality criteria. Cluster 1 was characterised by elderly GPs who more frequently had a resident physician in their practices. These GPs had low burnout scores and high work satisfaction scores. Cluster 2 consisted of younger GPs who less frequently had a resident in their practices. They had average burnout scores according to published norms and lower work satisfaction scores. There seems to be an age cohort effect regarding burnout and work satisfaction. Having a resident physician seems to be protective. Interventions should be designed for younger GPs, especially members of generation Y, to reduce burnout and improve work satisfaction.