Primary Care Clinician Attitudes Have Little Effect on Alcohol Screening Implementation

Despite evidence-based recommendations for alcohol screening and advice for hazardous drinking in primary care, few patients receive these services. Clinician role security and therapeutic commitment have been hypothesized to affect implementation. Researchers surveyed 746 clinicians across a range of backgrounds, in 120 European primary care practices that had agreed to participate in a trial of alcohol screening and advice implementation. They asked the clinicians about their role security (e.g., can appropriately advise patients; believe they have the right to ask) and therapeutic commitment (e.g., find it rewarding; self-esteem about success) to working with patients with alcohol use disorders. They asked clinicians to document screening and advice.

• Of 179,954 patients seen in a 4-week period, 5% were screened; 74% of those who screened positive were reportedly given brief advice.
• Role security (score range 4–28) was associated with screening at higher than the median rate among psychologists, social workers, and nurse aides (adjusted* odds ratio 1.39), but not among physicians and nurses; it was not associated with advice.
• Therapeutic commitment was not associated with screening or advice.

Comments:

Clinician attitudes did not appear to affect screening and advice rates much in this study, and the high proportion screening positive suggests they only screened people at high risk. The study, however, asked about alcohol use disorders (not hazardous use where there is evidence to support advice), did not report survey response rate (making it impossible to judge selection bias), and included clinicians who had very positive attitudes and were in practices that agreed to an implementation study, participants who are therefore unlikely to be representative of practicing clinicians. Nonetheless, it is likely that practical barriers (time, skill, incentives, practice support) are more important than attitudes for implementing alcohol screening and advice and will need to be addressed.

Richard Saitz, MD, MPH

Reference:

Bendtsen P, Anderson P, Wojnar M, et al. Professional’s attitudes do not influence screening and brief interventions rates for hazardous and harmful drinkers: results from ODHIN study. Alcohol Alcohol. 2015 [Epub ahead of print]. doi: 10.1093/alcalc/agv020.