How Primary Care Providers Talk to Patients About Alcohol: a Qualitative Study

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2006 Aug 22

PMID 16918743

Citations 68

Authors

Kinsey A McCormick

Nancy E Cochran

Anthony L Back

Joseph O Merrill

Emily C Williams

Katharine A Bradley

Affiliations

Soon will be listed here.

Abstract

Background: Alcohol misuse is a common and well-documented source of morbidity and mortality. Brief primary care alcohol counseling has been shown to benefit patients with alcohol misuse.

Objective: To describe alcohol-related discussions between primary care providers and patients who screened positive for alcohol misuse.

Design: An exploratory, qualitative analysis of audiotaped primary care visits containing discussions of alcohol use.

Participants: Participants were 29 male outpatients at a Veterans Affairs (VA) General Internal Medicine Clinic who screened positive for alcohol misuse and their 14 primary care providers, all of whom were participating in a larger quality improvement trial.

Measurements: Audiotaped visits with any alcohol-related discussion were transcribed and coded using grounded theory and conversation analysis, both qualitative research techniques.

Results: Three themes were identified: (1) patients disclosed information regarding their alcohol use, but providers often did not explore these disclosures; (2) advice about alcohol use was typically vague and/or tentative in contrast to smoking-related advice, which was more common and usually more clear and firm; and (3) discomfort on the part of the provider was evident during alcohol-related discussions.

Limitations: Generalizability of findings from this single-site VA study is unknown.

Conclusion: Findings from this single site study suggest that provider discomfort and avoidance are important barriers to evidence-based brief alcohol counseling. Further investigation into current alcohol counseling practices is needed to determine whether these patterns extend to other primary care settings, and to inform future educational efforts.

Citing Articles

Implementation of Alcohol Use Disorder Training Curriculum Improves Perceived Confidence in Treating Alcohol-Related Liver Disorder Amongst Gastroenterology Fellows.

Jagdish B, Murone J, Venkat D Dig Dis Sci. 2025; .

PMID: 39826068 DOI: 10.1007/s10620-025-08846-x.

Barriers to Alcohol Use Disorder Treatment in Patients with Alcohol-Associated Liver Disease.

Leko A, Leggio L Clin Liver Dis. 2024; 28(4):779-791.

PMID: 39362721 PMC: 11458136. DOI: 10.1016/j.cld.2024.06.012.

Provider perceptions of young people living with HIV and unhealthy alcohol use in Southwestern Uganda: a qualitative study.

Odokonyero R, Nakasujja N, Turiho A, Sanyu N, Muyindike W, Nansera D Addict Sci Clin Pract. 2024; 19(1):62.

PMID: 39223677 PMC: 11370108. DOI: 10.1186/s13722-024-00495-1.

Missing Opportunities in the Screening of Alcohol Use and Problematic Use, and the Provision of Brief Advice and Treatment Information Among Individuals With Alcohol Use Disorder.

Sharma V, Falise A, Bittencourt L, Zafaranian A, Hai A, Lopez-Quintero C J Addict Med. 2024; 18(4):408-417.

PMID: 38587310 PMC: 11290991. DOI: 10.1097/ADM.0000000000001301.

Perspectives of clinical stakeholders and patients from four VA liver clinics to tailor practice facilitation for implementing evidence-based alcohol-related care.

Soyer E, Frost M, Fletcher O, Ioannou G, Tsui J, Edelman E Addict Sci Clin Pract. 2024; 19(1):3.

PMID: 38200496 PMC: 10782537. DOI: 10.1186/s13722-023-00429-3.

References

Fleming M, Barry K, Manwell L, Johnson K, London R . Brief physician advice for problem alcohol drinkers. A randomized controlled trial in community-based primary care practices. JAMA. 1997; 277(13):1039-45. View

Thom B, Tellez C . A difficult business: detecting and managing alcohol problems in general practice. Br J Addict. 1986; 81(3):405-18. DOI: 10.1111/j.1360-0443.1986.tb00347.x. View

. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004; 140(7):554-6. DOI: 10.7326/0003-4819-140-7-200404060-00016. View

Arborelius E, Damstrom Thakker K . Why is it so difficult for general practitioners to discuss alcohol with patients?. Fam Pract. 1995; 12(4):419-22. DOI: 10.1093/fampra/12.4.419. View

Wallace P, Cutler S, Haines A . Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. BMJ. 1988; 297(6649):663-8. PMC: 1834369. DOI: 10.1136/bmj.297.6649.663. View

Whitlock E, Polen M, Green C, Orleans T, Klein J . Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004; 140(7):557-68. DOI: 10.7326/0003-4819-140-7-200404060-00017. View

DAmico E, Paddock S, Burnam A, Kung F . Identification of and guidance for problem drinking by general medical providers: results from a national survey. Med Care. 2005; 43(3):229-36. DOI: 10.1097/00005650-200503000-00005. View

Bradley K, Bush K, McDonell M, Malone T, Fihn S . Screening for problem drinking : Comparison of CAGE and AUDIT. J Gen Intern Med. 2007; 13(6):379-88. DOI: 10.1046/j.1525-1497.1998.00118.x. View

Bradley K, Kivlahan D, Bush K, McDonell And M, Fihn S . Variations on the CAGE alcohol screening questionnaire: strengths and limitations in VA general medical patients. Alcohol Clin Exp Res. 2001; 25(10):1472-8. DOI: 10.1097/00000374-200110000-00010. View

10.

Russell N, Roter D . Health promotion counseling of chronic-disease patients during primary care visits. Am J Public Health. 1993; 83(7):979-82. PMC: 1694773. DOI: 10.2105/ajph.83.7.979. View

11.

Wenrich M, Paauw D, Carline J, Curtis J, Ramsey P . Do primary care physicians screen patients about alcohol intake using the CAGE questions?. J Gen Intern Med. 1995; 10(11):631-4. DOI: 10.1007/BF02602748. View

12.

Funk M, Wutzke S, Kaner E, Anderson P, Pas L, McCormick R . A multicountry controlled trial of strategies to promote dissemination and implementation of brief alcohol intervention in primary health care: findings of a World Health Organization collaborative study. J Stud Alcohol. 2005; 66(3):379-88. DOI: 10.15288/jsa.2005.66.379. View

13.

Maynard D, Heritage J . Conversation analysis, doctor-patient interaction and medical communication. Med Educ. 2005; 39(4):428-35. DOI: 10.1111/j.1365-2929.2005.02111.x. View

14.

Cornuz J, Ghali W, Di Carlantonio D, Pecoud A, Paccaud F . Physicians' attitudes towards prevention: importance of intervention-specific barriers and physicians' health habits. Fam Pract. 2000; 17(6):535-40. DOI: 10.1093/fampra/17.6.535. View

15.

Fleming M, Mundt M, French M, Baier Manwell L, Stauffacher E, Barry K . Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis. Alcohol Clin Exp Res. 2002; 26(1):36-43. View

16.

Anderson P, Kaner E, Wutzke S, Funk M, Heather N, Wensing M . Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study. Alcohol Alcohol. 2004; 39(4):351-6. DOI: 10.1093/alcalc/agh072. View

17.

Green C, Perrin N, Polen M . Gender differences in the relationships between multiple measures of alcohol consumption and physical and mental health. Alcohol Clin Exp Res. 2004; 28(5):754-64. DOI: 10.1097/01.alc.0000125342.28367.a1. View

18.

Larsson U, Saljo R, Aronsson K . Patient-doctor communication on smoking and drinking: lifestyle in medical consultations. Soc Sci Med. 1987; 25(10):1129-37. DOI: 10.1016/0277-9536(87)90354-6. View

19.

Klatsky A, Armstrong M, Friedman G . Alcohol and mortality. Ann Intern Med. 1992; 117(8):646-54. DOI: 10.7326/0003-4819-117-8-646. View

20.

Bertholet N, Daeppen J, Wietlisbach V, Fleming M, Burnand B . Reduction of alcohol consumption by brief alcohol intervention in primary care: systematic review and meta-analysis. Arch Intern Med. 2005; 165(9):986-95. DOI: 10.1001/archinte.165.9.986. View