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Research Summary

Alcohol and Other Drug Discussions in Primary Care: Not Rare, but Numerous Challenges

With the current focus on routine integration of screening for alcohol and other drug (AOD) use in primary care, little is known about the content of physician-patient interactions when AOD conversations do occur. Investigators in New Zealand used 171 video-recorded patient visits with 15 general practitioners (GPs) and subsequent interviews with GPs to examine promoters and inhibiters of AOD discussions. Substances discussed included alcohol, tobacco, caffeine, anxiolytics, sleep aides, and analgesics.

  • Topics related to AOD occurred in 56 visits (33%); more than a single question or comment occurred in 42 visits.
  • Promoting factors included use of open-ended questions and nonverbal communication to encourage patient disclosure.
  • Uncomfortable body language may have led patients to give defensive or socially acceptable answers.
  • Acceptance of patient answers served as a “face-saving” strategy both for physicians and patients to avoid discussion of difficult topics.
  • Interviews with GPs revealed time pressures and the desire to manage the presenting complaint as barriers to addressing AOD topics.

Comments:

This qualitative study highlights the distance still left to travel in effectively using primary care as a vehicle to prevent and counsel patients about AOD use. Although routine screening for AOD use in primary care holds promise for case finding and prevention, stigma, competing priorities, and time pressures remain barriers to effective counseling about risky behaviors. Hillary Kunins, MD, MPH, MS

Reference:

Moriarty HJ, Stubbe MH, Chen L, et al. Challenges to alcohol and other drug discussions in the general practice consultation. Fam Pract. 2012;29(2):213–222.

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