Dear Eduardo,
"It is true that Primary Care health professionals have little time, but they are in an excellent position to identify AUDs early."
Yes this makes it all the more important to meet the information needs of primary health workers.
"I have not found evidence of the existence of a very brief advice for alcohol, as there is for tobacco."
This is a very important observation. 'Very Brief Advice on smoking is a proven 30-second clinical intervention, which identifies smokers, advises them on the best method of quitting, and supports subsequent quit attempts.'
https://www.plymouth.ac.uk/research/primarycare/global-health-research/v...
By contrast, there appears to be no parallel Very Brief Advice on alcohol. The guidance you previously cited talks of 'a brief intervention may be delivered over several sessions (for example, 5–30 minutes)' (WHO alcohol brief intervention training manual for primary care) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA)'s The Healthcare Professional’s Core Resource on Alcohol' (which requires 10 hours of continuing professional development input, and is written from a US perspective that may not be ideal for worldwide use).
Previous discussions on the information needs of primary health workers in low- and middle-income countries repeatedly emphasise the time element. Many if not most primary health workers in LMICs, unlike their counterparts in high-income countries, simply do not have the opportunity to schedule 'several sessions' with every patient who may have an alcohol use disorder, nor do they have time to invest in a 10-hour training programme.
It would be interesting to know if anyone has ever done an information needs assessment of, say, community health workers (or other cadres of primary health worker) with regards to alcohol.
I would predict that such assessment would emphasise the need for Very Brief Advice on alcohol, just as we already have for tobacco.
"The nurse or the receptionist could give all patients who attend a Primary Care consultation the AUDIT form to complete before entering the office."
In my understanding, this would not be feasible in most primary care consultations in LMICs. It would be interesting to understand better the scope of primary care consultations and the implications for what is and what isn't feasible. Many consultations are done in the home or community, by community health workers and other health professionals. Even if we talk of primary care facility consultations, screening for alcohol use disorders might not be seen as a priority. The mainstay of alcohol 'screening' by primary health workers in the UK is simply to ask how much the patient drinks.
"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.'"
This is the kind of message that could be considered for inclusion in Very Brief Advice. As with Very Brief Advice on tobacco, there is a need for health professionals and health communicators to work together to outline, say, the three most important points that a health professional should share with a patient who is drinking more than the recommended maximum.
As I wrote yesterday in the context of Cardiovascular-Kidney-Metabolic Syndrome (and it applies to every area of health): "Our primary responsibility is to ensure that every person has access to the information they need to protect their own health and the health of others. Such information should be not only accurate, but also in the right format, language and technical level to be understandable and useful. Where such information is not readily available, and where there is misinformation, people will continue to be poorly informed and more likely to make poor choices. 'Every patient deserves the chance to fail'"
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org
