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An online survey of Irish general practitioner experience of and attitude toward managing problem alcohol use.

ABSTRACT: BACKGROUND:In the general practice setting screening, brief intervention and counselling have been shown to be effective in the reduction of problem alcohol use. This study aimed to explore Irish general practitioners' (GPs) current practice of and attitudes towards the management of problem alcohol use. METHODS:An online survey was emailed, with one email reminder, to 1750 general/family practitioners who were members of the Irish College of General Practitioners (ICGP) and for whom an active email address was available. Overall, 476 completed questionnaires were received representing a 27.2% response rate. RESULTS:Two-thirds of the respondents reported that they have managed patients for problem alcohol use and related issues in the past year. The majority, 96%, of respondents indicated that they initiate conversations around alcohol even when the patient does not do so. Almost two thirds of GPs stated that they use structured brief intervention when talking to patients about their alcohol intake and circa 85% reported that they provide some form of counselling in relation to reducing alcohol consumption. While more than two out of three GPs felt prepared when counselling patients in relation to alcohol consumption, almost half considered they are ineffective in helping patients to reduce alcohol consumption. One third of GPs advised that they did not have access to an addiction counsellor. CONCLUSIONS:GPs in this survey reported widespread experience of screening and intervention, however, many still felt ineffective. In order to maximise the potential impact of GPs, a clearer understanding is required of what interventions are effective in different scenarios. Furthermore, GPs are only part of the solution in terms of addressing alcohol consumption. The services available in the broader health care system and Government alcohol related policy needs to further support GPs and patients.

SUBMITTER: Collins C

PROVIDER: S-EPMC6297939 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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An online survey of Irish general practitioner experience of and attitude toward managing problem alcohol use.

Collins Claire C Finegan Pearse P O'Riordan Margaret M

BMC family practice 20181218 1

<h4>Background</h4>In the general practice setting screening, brief intervention and counselling have been shown to be effective in the reduction of problem alcohol use. This study aimed to explore Irish general practitioners' (GPs) current practice of and attitudes towards the management of problem alcohol use.<h4>Methods</h4>An online survey was emailed, with one email reminder, to 1750 general/family practitioners who were members of the Irish College of General Practitioners (ICGP) and for w ...[more]

PMID: 30563475

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Project description:BackgroundGeneral Practitioners (GPs) are involved in preconception, pregnancy, and postnatal care. Overall, mental health remains a significant contributor to disease burden affecting 1 in 4 pregnant women. Psychotropic medication prescribing occurs in almost 1 in 12 pregnancies, and appears to be increasing, along with the prevalence of mental health disorders in women of reproductive age. Perinatal mental health management is therefore not an unlikely scenario within their clinical practice. This scoping review aims to map current research related to GPs perceptions and experiences of managing perinatal mental health.MethodA comprehensive search strategy using nine electronic databases, and grey literature was undertaken between December 2021 and February 2023. Relevant studies were sourced from peer review databases using key terms related to perinatal mental health and general practitioners. Search results were screened on title, abstract and full text to assess those meeting inclusion criteria and relevance to the research question.ResultsAfter screening, 16 articles were included in the scoping review. The majority focused on perinatal depression. Findings support that GPs express confidence with diagnosing perinatal depression but report issues of stigma navigating a diagnosis. Over the last two decades, prescribing confidence in perinatal mental health remains variable with concerns for the safety profile of medication, low level of confidence in providing information and a strong reliance on personal experience. Despite the establishment of perinatal guidelines by countries, the utilisation of these and other existing resources by GPs appears from current literature to be infrequent. Many challenges exist for GPs around time pressures, a lack of information and resources, and difficulty accessing referral to services.ConclusionRecommendations following this scoping review include targeted perinatal education programs specific for GPs and embedded within training programs and the development of practice guidelines and resources specific to general practice that recognises time, services, and funding limitations. To achieve this future research is first needed on how guidelines and resources can be developed and best delivered to optimise GP engagement to improve knowledge and enhance patient care.

Project description:BackgroundSecond medical opinions (SOs) can assist patients in making informed treatment decisions and improve the understanding of their diagnosis. In Germany, there are different approaches to obtain a structured SO procedure: SO programs by health insurers and SOs according to the SO Directive. Through a direct survey of the population, we aimed to assess how structured SOs should be provided to fulfil patients' needs.MethodsA stratified sample of 9990 adults (≥18 years) living in the federal states of Berlin and Brandenburg (Germany) were initially contacted by post in April and sent a reminder in May 2020. The survey results were analyzed descriptively.ResultsAmong 1349 participants (response rate 14%), 56% were female and the median age was 58 years (interquartile range (IQR) 44-69). Participants wanted to be informed directly and personally about the possibility of obtaining an SO (89%; 1201/1349). They preferred to be informed by their physician (93%; 1249/1349). A majority of participants would consider it important to obtain an SO for oncological indications (78%; 1049/1349). Only a subset of the participants would seek an SO via their health insurer or via an online portal (43%; 577/1349 and 16%; 221/1349). A personally delivered SO was the preferred route of SO delivery, as 97% (1305/1349) would (tend to) consider this way of obtaining an SO. Participants were asked to imagine having moderate knee pain for years, resulting in a treatment recommendation for knee joint replacement. They were requested to rate potential qualification criteria for a physician providing the SO. The criteria rated to be most important were experience with the recommended diagnosis/treatment (criterion (very) important for 93%; 1257/1349) and knowledge of the current state of research (criterion (very) important for 86%; 1158/1349). Participants were willing to travel 60 min (median; IQR 60-120) and wait 4 weeks (median; IQR 2-4) for their SO in the hypothetical case of knee pain.ConclusionIn general, SOs were viewed positively. We found that participants have clear preferences regarding SOs. We propose that these preferences should be taken into account in the future design and development of SO programs.

Project description:BackgroundGeneral practitioners (GPs) increasingly manage patients with multimorbidity but report challenges in doing so. Patients describe poor experiences with health care systems that treat each of their health conditions separately, resulting in fragmented, uncoordinated care. For GPs to provide the patient-centred, coordinated care patients need and want, research agendas and health system structures and policies will need to adapt to address this epidemiologic transition. This systematic review seeks to understand if and how multimorbidity impacts on the work of GPs, the strategies they employ to manage challenges, and what they believe still needs addressing to ensure quality patient care.MethodsSystematic review and thematic synthesis of qualitative studies reporting GP experiences of managing patients with multimorbidity. The search included nine major databases, grey literature sources, Google and Google Scholar, a hand search of Journal of Comorbidity, and the reference lists of included studies.ResultsThirty-three studies from fourteen countries were included. Three major challenges were identified: practising without supportive evidence; working within a fragmented health care system whose policies and structures remain organised around single condition care and specialisation; and the clinical uncertainty associated with multimorbidity complexity and general practitioner perceptions of decisional risk. GPs revealed three approaches to mitigating these challenges: prioritising patient-centredness and relational continuity; relying on knowledge of patient preferences and unique circumstances to individualise care; and structuring the consultation to create a sense of time and minimise patient risk.ConclusionsGPs described an ongoing tension between applying single condition guidelines to patients with multimorbidity as security against uncertainty or penalty, and potentially causing patients harm. Above all, they chose to prioritise their long-term relationships for the numerous gains this brought such as mutual trust, deeper insight into a patient's unique circumstances, and useable knowledge of each individual's capacity for the work of illness and goals for life. GPs described a need for better multimorbidity management guidance. Perhaps more than this, they require policies and models of practice that provide remunerated time and space for nurturing trustful therapeutic partnerships.

Project description:The rapid advancement of artificial intelligence (AI) has generated an increasing demand for tools that can assess public attitudes toward AI. This study proposes the development and the validation of the AI Attitude Scale (AIAS), a concise self-report instrument designed to evaluate public perceptions of AI technology. The first version of the AIAS that the present manuscript proposes comprises five items, including one reverse-scored item, which aims to gauge individuals' beliefs about AI's influence on their lives, careers, and humanity overall. The scale is designed to capture attitudes toward AI, focusing on the perceived utility and potential impact of technology on society and humanity. The psychometric properties of the scale were investigated using diverse samples in two separate studies. An exploratory factor analysis was initially conducted on a preliminary 5-item version of the scale. Such exploratory validation study revealed the need to divide the scale into two factors. While the results demonstrated satisfactory internal consistency for the overall scale and its correlation with related psychometric measures, separate analyses for each factor showed robust internal consistency for Factor 1 but insufficient internal consistency for Factor 2. As a result, a second version of the scale is developed and validated, omitting the item that displayed weak correlation with the remaining items in the questionnaire. The refined final 1-factor, 4-item AIAS demonstrated superior overall internal consistency compared to the initial 5-item scale and the proposed factors. Further confirmatory factor analyses, performed on a different sample of participants, confirmed that the 1-factor model (4-items) of the AIAS exhibited an adequate fit to the data, providing additional evidence for the scale's structural validity and generalizability across diverse populations. In conclusion, the analyses reported in this article suggest that the developed and validated 4-items AIAS can be a valuable instrument for researchers and professionals working on AI development who seek to understand and study users' general attitudes toward AI.

Project description:ContextThe use of ethnic identifiers in health systems is recommended in several European countries as a means to identify and address heath inequities. There are barriers to implementation that have not been researched.ObjectiveThis study examines whether and how ethnicity data can be collected in Irish general practices in a meaningful and acceptable way.MethodsQualitative case study data generation was informed by Normalization Process Theory (NPT) constructs about 'sense' making and 'engagement'. It consisted of individual interviews and focus group discussions based on visual participatory techniques. There were 70 informants, including 62 general practitioner (GP) users of diverse ethnic backgrounds recruited through community organisations and eight GPs identified through an inter-agency steering group. Data were analysed according to principles of thematic analysis using NPT.ResultsThe link between ethnicity and health was often considered relevant because GP users grasped connections with genetic (skin colour, lactose intolerance), geographic (prevalence of disease, early years exposure), behavioural (culture/food) and social determinant (housing) factors. The link was less clear with religion. There was some scepticism and questions about how the collection of data would benefit GP consultations and concerns regarding confidentiality and the actual uses of these data (e.g. risk of discrimination, social control). For GPs, the main theme discussed was relevance: what added value would it bring to their consultations and was it was their role to collect these data? Their biggest concern was about data protection issues in light of the European Union (EU) General Data Protection Regulation (GDPR). The difficulty in explaining a complex concept such as 'ethnicity' in the limited time available in consultations was also worrying.ConclusionsImplementation of an ethnicity identifier in Irish general practices will require a strong rationale that makes sense to GP users, and specific measures to ensure that its benefits outweigh any potential harm. This is in line with both our participants' views and the EU GDPR.

Project description:Background and aimsProblem gambling and unhealthy alcohol use often co-occur. The current trial sought to establish whether adding a brief online intervention for unhealthy alcohol use to an online problem gambling intervention would lead to improvements in gambling and drinking among those with both of these concerns.MethodsParticipants were recruited from across Canada using an advertisement targeting those concerned about their gambling who were interested in online help. No mention of unhealthy alcohol use was made in the advertisement. Participants meeting criteria for problem gambling were randomized to either receive just an online intervention for gambling (G-only) or to receive an online gambling intervention plus a brief personalized feedback intervention for unhealthy alcohol use (G + A). Participants were followed up at 3 and 6 months.ResultsA total of 282 participants were recruited for the trial. Follow-up rates were good (80% and 84% at 3 and 6 months). There were significant reductions in gambling (p < .001) across time but no significant differences (p > .05) between those who received either the G-only or G + A interventions. Further, for those with unhealthy alcohol use (41% of the sample), there were no significant reductions in alcohol consumption (p > .05) across time or differences between condition.Discussion and conclusionThe addition of a brief intervention for unhealthy alcohol use to an online intervention for gambling did not appear to improve either gambling or drinking outcomes among people concerned about their gambling. Further research is merited to examine whether a combined intervention (with gambling and drinking components integrated) might result in improved outcomes and whether such an intervention might benefit the subgroup of participants who would specifically seek help for both gambling and alcohol concerns.Trial registration:ClinicalTrials.govNCT03323606; Registration date: October 24, 2017.

Dataset Information

An online survey of Irish general practitioner experience of and attitude toward managing problem alcohol use.

Publications

An online survey of Irish general practitioner experience of and attitude toward managing problem alcohol use.

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