Ketterer Frederic, Symons Linda, Lambrechts Marie-Claire, Mairiaux Philippe, Godderis Lode, Peremans Lieve, Remmen Roy, Vanmeerbeek Marc
Department of General Practice/Family Medicine, University of Liege, Avenue de l'Hôpital 3, CHU B23, Liege 4000, Belgium.
BMC Fam Pract. 2014 Jun 14;15:119. doi: 10.1186/1471-2296-15-119.
General practitioners (GPs) are considered to play a major role in detecting and managing substance abuse. However, little is known about how or why they decide to manage it. This study investigated the factors that influence GP behaviours with regard to the abuse of alcohol, illegal drugs, hypnotics, and tranquilisers among working Belgians.
Twenty Belgian GPs were interviewed. De Vries' Integrated Change Model was used to guide the interviews and qualitative data analyses.
GPs perceived higher levels of substance abuse in urban locations and among lower socioeconomic groups. Guidelines, if they existed, were primarily used in Flanders. Specific training was unevenly applied but considered useful. GPs who accepted abuse management cited strong interpersonal skills and available multidisciplinary networks as facilitators.GPs relied on their clinical common sense to detect abuse or initiate management. Specific patients' situations and their social, psychological, or professional dysfunctions were cited as cues to action.GPs were strongly influenced by their personal representations of abuse, which included the balance between their professional responsibilities toward their patients and the patients' responsibilities in managing their own health as well the GPs' abilities to cope with unsatisfying patient outcomes without reaching professional exhaustion. GPs perceived substance abuse along a continuum ranging from a chronic disease (whose management was part of their responsibility) to a moral failing of untrustworthy people. Alcohol and cannabis were more socially acceptable than other drugs. Personal experiences of emotional burdens (including those regarding substance abuse) increased feelings of empathy or rejection toward patients.Multidisciplinary practices and professional experiences were cited as important factors with regard to engaging GPs in substance abuse management. Time constraints and personal investments were cited as important barriers.Satisfaction with treatment was rare.
Motivational factors, including subjective beliefs not supported by the literature, were central in deciding whether to manage cases of substance abuse. A lack of theoretical knowledge and training were secondary to personal attitudes and motivation. Personal development, emotional health, self-awareness, and self-care should be taught to and fostered among GPs to help them maintain a patient-centred focus. Health authorities should support collaborative care.
全科医生（GPs）被认为在药物滥用的检测和管理中发挥着重要作用。然而，对于他们如何以及为何决定进行管理，我们知之甚少。本研究调查了影响比利时在职人员中全科医生对酒精、非法药物、催眠药和镇静剂滥用行为的因素。
对比利时20名全科医生进行了访谈。使用德弗里斯的综合变革模型来指导访谈和定性数据分析。
全科医生认为城市地区和社会经济地位较低群体中的药物滥用水平较高。指南（若存在）主要在佛兰德地区使用。特定培训的应用不均衡，但被认为是有用的。接受滥用管理的全科医生将强大的人际沟通技巧和可用的多学科网络视为促进因素。全科医生依靠他们的临床常识来检测滥用情况或启动管理。特定患者的情况及其社会、心理或职业功能障碍被视为行动线索。全科医生受到他们对滥用的个人认知的强烈影响，这包括他们对患者的专业责任与患者在管理自身健康方面的责任之间的平衡，以及全科医生在不导致职业倦怠的情况下应对不尽人意的患者结果的能力。全科医生将药物滥用视为一个连续体，范围从一种慢性病（其管理是他们职责的一部分）到不值得信任的人的道德失败。酒精和大麻在社会上比其他药物更容易被接受。情感负担的个人经历（包括与药物滥用有关的经历）增加了对患者的同理心或排斥感。多学科实践和专业经验被认为是促使全科医生参与药物滥用管理的重要因素。时间限制和个人投入被认为是重要障碍。对治疗的满意度很少见。
动机因素，包括文献中未支持的主观信念，在决定是否管理药物滥用病例方面至关重要。缺乏理论知识和培训相对于个人态度和动机而言是次要的。应向全科医生传授并培养个人发展、情绪健康、自我意识和自我护理，以帮助他们保持以患者为中心的关注。卫生当局应支持协作护理。
