Alcohol Interventions in General Practice

Pragmatic case finding – addressing alcohol in primary care

High alcohol consumption is an important risk factor for many health problems, as well as social problems and premature death.

Alcohol screening and brief interventions (SBI) delivered in primary care is effective at reducing alcohol consumption, but routine implementation remains problematic. Screening all patients for excessive drinking (universal screening) is resource-intensive and not compatible with general practitioners’ (GPs’) perceived professional role, nor with the work load in general practice. Pragmatic case finding is developed in general practice, and is based on the clinical relevance for alcohol for many common health problems (https://pubmed.ncbi.nlm.nih.gov/22643149/; https://pubmed.ncbi.nlm.nih.gov/25564115/). 

Pragmatic case finding is a strategy aimed at enabling the doctor and the patient to include alcohol as a relevant factor for the patient’s health problem. If you see your doctor with a health problem where alcohol may be relevant (e.g. sleeping problem or hypertension) and the doctor starts talking about alcohol, the patient may perceive this as a shift in focus from the health problem to alcohol. By framing the discussion based on the health problem, the patient and the GP can explore whether alcohol is relevant. In addition, drinking less may then be a strategy to alleviate the health problem, or to test whether alcohol was relevant. This approach will likely strengthen the patient-doctor collaboration.

We have developed a tailored four-session training intervention to improve addressing alcohol in general practice based on pragmatic case finding, to strengthen GPs’ ability to address alcohol. The training intervention includes training in the app Endre, a supplement to support patients’ change processes, see ENDRE 2.0 (helse-stavanger.no). The tailored intervention was informed by findings from four focus group interviews with GPs and 55 free text questionnaires from GPs in training (see Pragmatic approaches for addressing alcohol in general practice: Development of a tailored implementation intervention (frontiersin.org)). 

Important topics in the training intervention were the operationalisation of pragmatic case finding, clinical evidence on the link between alcohol use and many health problems, opening up the conversation on alcohol use, managing barriers for addressing alcohol and following-up and maintaining change. 

We have explored GPs’ experiences with addressing alcohol before and after the training intervention with questionnaires and focus group interviews. Four larger GP clinics with a total of 36 GPs and interns participated in the study.  Analyses of the data are ongoing, and the findings will be published in scientific articles. This work highlights the value of a pragmatic, relevance-based clinical approach, as opposed to universal screening approaches, to addressing alcohol in primary care. A pragmatic approach is more in line with GPs’ existing clinical skill set and holds the potential to improve widespread uptake and implementation of SBI in routine primary care.

Visit the comprehensive Norwegian project site that includes information materials for users, course materials, tools and other resourses: Alkoholvaner og helse i allmennpraksis (helse-stavanger.no)

Please contact us at KORFOR if you need information from the Norwegian site to be provided in English.