Multiple barriers to ‘brief interventions’ for alcohol in primary care

Alcohol is the most widely used social drug in Australia, and overconsumption is an issue.
 
In 2019, 25% of people aged 14 and over consumed more than four standard drinks in one sitting at least monthly, with people in their 50s consuming 11 or more standard drinks in one session.
 
The costs associated with alcohol and counselling services can be significant, particularly for low-income patients. But there is evidence to suggest that primary care is accessible and can play an important role in reducing weekly alcohol intake through brief interventions (BIs).
 
According to recent research published in Oxford Academic, however, BIs are not always routinely offered – and this is due to a number of barriers within the healthcare system and the community.
 
Researchers interviewed GPs, practice nurses and patients to explore their perspectives on BIs and identified a lack of time, limitation of clinical software, and patient resources as key factors.
 
The research, conducted as part of the REACH Project and funded by VicHealth, was led by Dr Liz Sturgiss, a Senior Research Fellow in the School of Primary and Allied Health Care at Monash University and a member of the RACGP’s Specific Interests Addiction Medicine.
 
She told newsGP that when it comes to BIs or other preventive health measures in general practice, the focus is often on ‘why the GP isn’t doing what they’re meant to be doing’ – but that is not the case here.
 
‘Our research has actually shown that at multiple levels of the system, there are things happening that are not supporting conversations to happen between GPs and patients about alcohol,’ Dr Sturgiss said.
 
In addition to barriers within the health system, the findings also identified Australian drinking norms and low community awareness of alcohol harms to be key factors, and that alcohol BIs in primary care could be further supported by community public health messages about alcohol use.
 
While undertaking the research, clinicians contrast the public health efforts made to educate the community about the associated risks of smoking with efforts around alcohol, where they often feel that they are ‘starting at square one’ with the patient.
 
‘[Participants] said there’s not a single patient that enters [their] consultation room who doesn’t understand that smoking is very harmful for your health,’ Dr Sturgiss said. ‘And that message has really been supported by public health messaging.
 
‘Compare that to alcohol.
 
‘There’s little bits and pieces on packaging now with alcohol, but often people aren’t aware of the health harms.’
 

When it comes to brief interventions for alcohol, Dr Liz Sturgiss says ensuring GPs are supported with education and resources is vital. 

The Melbourne GP also believes social media has a for a significant role.
 
She says headlines amplifying research that suggests limited alcohol intake can be good for health has added to the misinformation in this area and added to the challenge for clinicians.
 
‘That really explains why sometimes these conversations are even more difficult in that general practice consultation room because you’re starting not even from square one, but perhaps behind the blocks, trying to undo some of this misinformation that people have hooked onto,’ Dr Sturgiss said.
 
‘So we need strong public health messaging to combat that.’
 
Lack of adequate time was raised as a factor by all GPs. While that can be hard to overcome in the short term, Dr Sturgiss suggests GPs think about the impact they can make over the course of many consultations, rather than just that one.
 
‘When general practice is working as it should and working to its capacity, we care for people over years and decades,’ she said.
 
‘So I really encourage GPs that even though it feels like, “I can’t do everything in this exact moment”, thinking about it in terms of continuity of care – we can have a big impact on our patients’ lives.’
 
The role of GPs and BIs is expected to be even more important in the months ahead, with evidence suggesting the pandemic has led to increased alcohol intake.
 
Research conducted by Monash University in August found ambulance attendances for alcohol-related harms to homes increased by 9% in 2020, with people from socioeconomically advantaged areas most affected.
 
Dr Sturgiss says it is important to be mindful of how to approach the conversation, given the stigma that exists regarding alcohol dependence. 
 
‘Alcohol is a weird one,’ she said. ‘Even though it is a very accepted part of community and celebrations, alcohol dependence is a highly stigmatised condition.’
 
To assist GPs, a series of free resources have been developed and available online for use in the waiting room, as well as during consultations to facilitate discussions. They include a clinic waiting room poster and lifestyle questionnaire, and BI flowchart and standard drinks guide.
 
The resources are also available in Arabic and Chinese, and some have been specifically designed to be very visual for patients who have difficulty reading.
 
‘That’s the main outcome for this work, which is exciting,’ Dr Sturgiss said.
 
‘When we started out the project, we really noticed that there were very limited resources available to help GPs have those discussions with patients. That’s why we developed the resources.
 
‘We’ve also developed a visual diagram for GPs to talk with their patients about cancer risk and alcohol because that’s something that people tend to be quite invested in, and it can be a little bit of a hook.’
 
Log in below to join the conversation.

alcohol and other drugs alcohol use brief intervention drinking general practice resources