Phan T, Yana J, Fabre J, Yana L, Renard V, Ferrat E
Département Universitaire d'Enseignement et de Recherche en Médecine Générale, Faculté de santé, université Paris-Est-Créteil (UPEC), 94010 Créteil, France; Maison de Santé Pluridisciplinaire Universitaire de Fontainebleau, 77300 Fontainebleau, France.
Département Universitaire d'Enseignement et de Recherche en Médecine Générale, Faculté de santé, université Paris-Est-Créteil (UPEC), 94010 Créteil, France.
Rev Epidemiol Sante Publique. 2020 Aug;68(4):215-225. doi: 10.1016/j.respe.2020.06.003. Epub 2020 Jul 8.
The screening of patients who are at-risk drinkers, which means exceeding the thresholds defined by health authorities or associated with a specific situation (taking psychotropic drugs, having an organic pathology, driving a vehicle, drinking during pregnancy), represents a major issue in primary care. Few studies have offered perspective from the patients' standpoint. The main purpose of this study was to describe general practitioners at-risk drinking screening from their patients point of view. The secondary objective was to identify the factors associated with perception of satisfactory general practitioner knowledge about alcohol consumption.
A quantitative cross-sectional study was launched in 9 general practitioner offices over 6 months. Patients older than 18 were recruited to answer a questionnaire blinded from their general practitioner, indicating the level of their alcohol consumption and their perception regarding their general practitioner's screening methods. Descriptive, univariate and multivariate logistic regression analyses were performed.
All in all, 445 patients were analyzed. Sixty-two at-risk drinkers were screened (13.9 %). Most of the patients declared they had not been interviewed about their alcohol consumption by their general practitioner either during initial consultations (86.1 %) or over time (83.3 %). Only 4.2 % of patients had previously initiated discussion about their consumption. Patients were not ashamed to talk about alcohol (99.2 %) and found their general practitioner to be competent on this topic (100 %). In multivariate analysis, independent factors associated with a good general practitioner knowledge about their patients' current consumption were the questions put forward by their general practitioner about alcohol consumption during their first visit (P<0.001) and during subsequent visits (P<0.001).
This study showed a low general practitioner screening rate of their patients' at-risk drinking. Only a minority of patients, including at-risk drinkers, declared that their general practitioner was aware of their level of alcohol consumption. Screening could be improved by being systematized during initial consultations and regularly scheduled during subsequent visits, especially in at-risk situations.
对高危饮酒者进行筛查是初级保健中的一个重大问题，高危饮酒者是指饮酒量超过卫生当局规定的阈值或与特定情况相关的人群（服用精神药物、患有器质性疾病、驾驶车辆、孕期饮酒）。很少有研究从患者的角度提供相关观点。本研究的主要目的是从患者的角度描述全科医生对高危饮酒的筛查情况。次要目标是确定与患者认为全科医生对饮酒知识了解满意相关的因素。
在6个月内，对9个全科医生诊所开展了一项定量横断面研究。招募18岁以上的患者回答一份对其全科医生保密的问卷，问卷内容包括他们的饮酒水平以及对全科医生筛查方法的看法。进行了描述性、单变量和多变量逻辑回归分析。
总共分析了445名患者。筛查出62名高危饮酒者（13.9%）。大多数患者表示，他们在初次就诊时（86.1%）或随时间推移（83.3%）都没有被全科医生询问过饮酒情况。只有4.2%的患者之前主动提及过自己的饮酒情况。患者并不羞于谈论饮酒（99.2%），并且认为他们的全科医生在这个话题上很有能力（100%）。在多变量分析中，与全科医生对患者当前饮酒情况有良好了解相关的独立因素是全科医生在首次就诊时（P<0.001）和后续就诊时（P<0.001）提出的关于饮酒的问题。
本研究表明全科医生对患者高危饮酒的筛查率较低。只有少数患者，包括高危饮酒者，表示他们的全科医生了解他们的饮酒水平。可以通过在初次就诊时系统化筛查，并在后续就诊时定期安排筛查来改善，尤其是在高危情况下。
