Department of Health Sciences, University of York, York, UK.
Centre for Primary Health and Social Care, School of Social Professions, London Metropolitan University, London, UK.
Addict Sci Clin Pract. 2023 Mar 30;18(1):22. doi: 10.1186/s13722-023-00378-x.
Attempts to routinely embed brief interventions in health systems have long been challenging, with healthcare professionals concerned about role adequacy, legitimacy, and support. This is the first study to explore clinical pharmacists' experiences of discussing alcohol with patients in their new role in UK primary care, in developing a novel approach to brief intervention. It investigates their confidence with the subject of alcohol in routine practice and explores views on a new approach, integrating alcohol into the medication review as another drug directly linked to the patient's health conditions and medicines, rather than a separated 'healthy living' issue. The study forms part of wider efforts to repurpose and reimagine the potential application of brief interventions and to rework their contents.
Longitudinal qualitative study of 10 recruits to the new clinical pharmacist role in English primary care, involving three semi-structured interviews over approximately 16 months, supplemented by 10 one-off interviews with pharmacists already established in general practice.
When raised at all, enquiring about alcohol in medication reviews was described in terms of calculating dose and level of consumption, leading to crude advice to reduce drinking. The idea was that those who appeared dependent should be referred to specialist services, though few such referrals were recalled. Pharmacists acknowledged that they were not currently considering alcohol as a drug in their practice and were interested in learning more about this concept and the approach it entailed, particularly in relation to polypharmacy. Some recognised a linked need to enhance consultation skills.
Alcohol complicates routine clinical care and adversely impacts patient outcomes, even for those drinking at seemingly unremarkable levels. Changing clinical practice on alcohol requires engaging with, and supportively challenging, routine practices and entrenched ideas of different kinds. Framing alcohol as a drug may help shift the focus from patients with alcohol problems to problems caused for patients by alcohol. This is less stigmatising and provides role legitimacy for pharmacists to address alcohol clinically in medication reviews, thus providing one element in the formation of a new prevention paradigm. This approach invites further innovations tailored to other healthcare professional roles.
长期以来，试图将简短干预措施常规纳入卫生系统一直具有挑战性，医护人员对角色的充分性、合法性和支持感到担忧。这是第一项研究，探讨了英国初级保健中临床药师在新角色中与患者讨论酒精的经验，以开发一种新的简短干预方法。它调查了他们在常规实践中对酒精主题的信心，并探讨了对新方法的看法，即将酒精纳入药物审查中，作为与患者健康状况和药物直接相关的另一种药物，而不是作为一个单独的“健康生活”问题。该研究是更广泛努力的一部分，旨在重新利用和重新构想简短干预措施的潜在应用，并重新设计其内容。
对英国初级保健中新临床药师角色的 10 名新兵进行了纵向定性研究，涉及大约 16 个月内的 3 次半结构化访谈，并辅以 10 次对已在普通实践中建立的药剂师的一次性访谈。
在进行药物审查时，询问酒精问题被描述为计算剂量和饮酒量，从而导致减少饮酒的粗略建议。想法是，那些看起来依赖酒精的人应该被转介到专科服务机构，但很少有人记得这样的转介。药剂师承认，他们目前在实践中并未将酒精视为一种药物，并且有兴趣更多地了解这一概念及其所涉及的方法，特别是与多药治疗相关的方法。一些人认识到需要增强咨询技能。
酒精会使常规临床护理复杂化，并对患者的结果产生不利影响，即使是那些看似不明显的饮酒水平的患者也是如此。改变酒精方面的临床实践需要与常规实践和各种根深蒂固的观念进行接触，并给予支持性挑战。将酒精定义为一种药物可能有助于将焦点从有酒精问题的患者转移到酒精给患者带来的问题上。这减少了污名化，并为药剂师在药物审查中从临床角度解决酒精问题提供了角色合法性，从而为新的预防范式的形成提供了一个要素。这种方法邀请进一步创新，以适应其他医疗保健专业人员的角色。
