[Re: https://www.hifa.org/dgroups-rss/alcohol-use-disorders-153-unanswered-qu... ]
Dear Neil,
It is true that Primary Care health professionals have little time, but they are in an excellent position to identify AUDs early.
I have not found evidence of the existence of a very brief advice for alcohol, as there is for tobacco.
In any case, I believe that the first thing that should be promoted among these professionals is a change in attitude.
According to a 2016 study (https://academic.oup.com/alcalc/article/51/4/422/1739927) , which recruited 120 primary health care units from Catalonia, England, the Netherlands, Poland and Sweden, only 1.4% of patients were asked and advised about their alcohol consumption. Which implies that screening and brief interventions are rarely implemented in current PHC.
Why are screening and brief interventions not implemented in routine primary health care? There are multiple reasons including: lack of education and financial reimbursement, fear of losing patients because they don't like being asked about alcohol, and also, as we have acknowledged, limited time.
We have already talked about the need to systematically train and motivate all first-level health professionals to intervene early.
The issue is how the “system” can help these busy, time-poor professionals perform this important function.
Perhaps the Health System could start with:
- including screening tests (e.g. AUDIT), routinely, for comorbid conditions such as hypertension, insomnia, depression or anxiety disorder. Addressing it routinely would reduce stigma.
Or, make the screening broader:
- The nurse or the receptionist could give all patients who attend a Primary Care consultation the AUDIT form to complete before entering the office. The doctor, according to the observed score, could give brief advice (of at least one minute and relating it to the reason for the consultation, if applicable) and eventually indicate to the patient that he would like to address this topic in a future consultation (if the problem is not severe) or refer he/she to a program or specialist (if the score is high).
- A simple message could be: “If you allow me, as your doctor, I must tell you that your test score was high and I am concerned about the impact that your alcohol consumption may have on your health.”
If we could get these simple steps implemented, I think it could be helpful, or at least a first step.
These are just a few ideas to promote discussion.
What do others think?
Kind regards,
Eduardo
Dr. Eduardo Bianco
Director, Addiction Training Program (ATP)
Email: ebianco@nextgenu.org
Web: NextGenU.org
HIFA profile: Eduardo Bianco is a medical doctor and Cardiologist, Certified Tobacco Cessation Expert with a Masters in Prevention and Treatment of Addictive Disorders. Currently, he is Chair of the World Heart Federation Tobacco Expert Group. Dr. Biancos research examines tobacco control and cessation, and he is a prominent member of several organizations that address tobacco control in Latin America. Dr. Bianco has worked for 25 years in Uruguay and Latin America to promote and train in smoking cessation treatment and tobacco control policies. He is also the former Regional Coordinator for the Americas of the Framework Convention Alliance and former Technical Director of the MOH Center for International Cooperation for Tobacco. ebianco AT nextgenu.org
