Sturgiss Elizabeth, Lam Tina, Russell Grant, Ball Lauren, Gunatillaka Nilakshi, Barton Chris, Tam Chun Wah Michael, O'Donnell Renee, Chacko Elizabeth, Skouteris Helen, Mazza Danielle, Nielsen Suzanne
Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia.
Fam Pract. 2022 Mar 24;39(2):275-281. doi: 10.1093/fampra/cmab091.
Brief interventions (BIs) delivered in primary care can reduce harmful alcohol consumption. Yet, clinicians do not routinely offer BIs to reduce harmful alcohol use.
We explored the perspectives of clinicians and patients about the use of alcohol BIs during consultations in Australian primary care.
Semi-structured interviews and focus groups (face-to-face and virtual) were undertaken with 34 general practitioners, eight practice nurses and 17 patients. Field notes were made from audio-recordings and themes were identified using a descriptive qualitative approach with the field notes as the point of data analysis.
Participants identified barriers within the consultation, practice setting and wider healthcare system plus across the community which reduce the delivery of BIs in primary care including: Australian drinking norms; inconsistent public health messaging around alcohol harm; primary care not recognized as a place to go for help; community stigma towards alcohol use; practice team culture towards preventive health, including systems for recording alcohol histories; limitations of clinical software and current patient resources.
Multiple layers of the healthcare system influence the use of BIs in primary care. Identified facilitators for embedding BIs in primary care included: (i) raising community and clinician awareness of the health harms of alcohol, (ii) reinforcing a primary care culture that promotes prevention and, (iii) supportive resources to facilitate discussion about alcohol use and strategies to reduce intake. Alcohol BIs in primary care could be further supported by community public health messages about alcohol use.
在初级保健中提供的简短干预措施（BIs）可以减少有害饮酒。然而，临床医生并不常规提供BIs来减少有害饮酒。
我们探讨了澳大利亚初级保健咨询期间临床医生和患者对使用酒精简短干预措施的看法。
对34名全科医生、8名执业护士和17名患者进行了半结构化访谈和焦点小组讨论（面对面和虚拟形式）。根据录音制作了现场笔记，并采用描述性定性方法以现场笔记作为数据分析点来确定主题。
参与者指出了咨询过程、诊所环境、更广泛的医疗保健系统以及整个社区中存在的障碍，这些障碍减少了初级保健中BIs的提供，包括：澳大利亚的饮酒规范；关于酒精危害的公共卫生信息不一致；初级保健未被视为寻求帮助的地方；社区对饮酒的污名化；诊所团队对预防保健的文化，包括记录饮酒史的系统；临床软件的局限性和当前的患者资源。
医疗保健系统的多个层面影响着初级保健中BIs的使用。确定的将BIs纳入初级保健的促进因素包括：（i）提高社区和临床医生对酒精健康危害的认识，（ii）强化促进预防的初级保健文化，以及（iii）提供支持性资源以促进关于饮酒和减少饮酒摄入量策略的讨论。关于饮酒的社区公共卫生信息可以进一步支持初级保健中的酒精简短干预措施。
