Miller Emma R, Ramsey Imogen J, Tran Ly Thi, Tsourtos George, Baratiny Genevieve, Manocha Ramesh, Olver Ian N
Department of Public Health, Flinders University, Adelaide, South Australia, Australia.
University of Southern Queensland, Toowoomba, Queensland, Australia.
BMJ Open. 2016 Dec 1;6(12):e013921. doi: 10.1136/bmjopen-2016-013921.
This study aimed to investigate factors that inhibit and facilitate discussion about alcohol between general practitioners (GPs) and patients.
Data analysis from a cross-sectional survey.
894 GP delegates of a national health seminar series held in five capital cities of Australia in 2014.
Likelihood of routine alcohol enquiry; self-assessed confidence in assessing and managing alcohol issues in primary healthcare.
Most GPs (87%) reported that they were likely to routinely ask patients about their alcohol consumption and had sufficient skills to manage alcohol issues (74%). Potential barriers to enquiring about alcohol included perceptions that patients are not always honest about alcohol intake (84%) and communication difficulties (44%). 'I usually ask about alcohol' was ranked by 36% as the number one presentation likely to prompt alcohol discussion. Altered liver function test results followed by suspected clinical depression were most frequently ranked in the top three presentations. Suspicious or frequent injuries, frequent requests for sickness certificates and long-term unemployment were ranked in the top three presentations by 20% or less. Confidence in managing alcohol issues independently predicted likelihood to 'routinely ask' about alcohol consumption. Lack of time emerged as the single most important barrier to routinely asking about alcohol. Lack of time was predicted by perceptions of competing health issues in patients, fear of eliciting negative responses and lower confidence in ability to manage alcohol-related issues.
Improving GPs' confidence and ability to identify, assess and manage at-risk drinking through relevant education may facilitate greater uptake of alcohol-related enquiries in general practice settings. Routine establishment of brief alcohol assessments might improve confidence in managing alcohol issues, reduce the time burden in risk assessment, decrease potential stigma associated with raising alcohol issues and reduce the potential for negative responses from patients.
本研究旨在调查全科医生（GP）与患者之间抑制和促进酒精问题讨论的因素。
横断面调查的数据分析。
2014年在澳大利亚五个首府城市举办的全国健康研讨会系列的894名全科医生代表。
常规酒精询问的可能性；自我评估在初级医疗保健中评估和管理酒精问题的信心。
大多数全科医生（87%）报告称他们可能会常规询问患者的饮酒情况，并且有足够的技能来管理酒精问题（74%）。询问酒精问题的潜在障碍包括认为患者在饮酒量方面并不总是诚实（84%）以及沟通困难（44%）。“我通常会询问饮酒情况”被36%的人列为最有可能引发酒精问题讨论的首要陈述。其次是肝功能检查结果异常，然后是疑似临床抑郁症，这两项最常被列为前三项陈述。可疑或频繁受伤、频繁开具病假证明的请求以及长期失业被列为前三项陈述的比例为20%或更低。独立管理酒精问题的信心预测了“常规询问”饮酒情况的可能性。时间不足成为常规询问酒精问题的唯一最重要障碍。时间不足是由对患者存在其他健康问题的认知、担心引发负面反应以及对管理与酒精相关问题的能力信心较低所预测的。
通过相关教育提高全科医生识别、评估和管理危险饮酒的信心和能力，可能会促进在全科医疗环境中更多地进行与酒精相关的询问。常规开展简短的酒精评估可能会提高管理酒精问题的信心，减轻风险评估中的时间负担，减少与提出酒精问题相关的潜在污名，并降低患者产生负面反应的可能性。
