Training health providers to address unhealthy alcohol use in primary care: a cross-sectional, multicenter study

Effectiveness of a training program for the management of risky alcohol use in primary care professionals based on motivational interviewing

OBJECTIVE

To assess the effectiveness of a training program for Primary Care (PC) professionals developed to increase knowledge, attitudes, and skills for managing patients with risky alcohol use and in the motivational interview.

DESIGN

Multicenter, two-arm parallel, randomized, open-label controlled clinical trial.

SETTING

PC of the Andalusian Health Service.

PARTICIPANTS

The study was completed by 80 healthcare professionals from 31 PC centers.

INTERVENTIONS

In both experimental and control groups, a workshop on managing patients with risky alcohol consumption and the resolution of two videotaped clinical cases with standardized patients were conducted. The experimental group attended a workshop on motivational interviewing.

MAIN MEASUREMENTS

Knowledge about managing risky alcohol use, clinical performance in patients with this health problem, and assessment of the motivational interview.

RESULTS

Mean age was 39.50±13.06 - SD - (95% CI: 36.59-42.41); 71.3% (95% CI: 61.1-80.9%) were women. The average score of both groups in the knowledge questionnaire before the training program was 15.10±4.66, becoming 21.99±3.93 points after the training (95% CI: 5.70-7.92; p<0.001). The experimental group showed an average score of 18.53±13.23 before the intervention with the motivational interview and 28.33±11.86 after this intervention (p=0.002). In contrast, no significant variation was found in the score of the control group.

CONCLUSIONS

A training program aimed at PC professionals designed to increase knowledge on how to manage risky alcohol use and acquire communication skills in motivational interviewing is effective.

Screening for alcohol use in primary care: assessing French general practitioner practices

Alcohol use is a leading risk factor for premature death and disability. To tackle this issue, more systematic and accurate screening for at-risk consumption is needed in healthcare systems, especially by general practitioners (GPs). We assessed the frequency of at-risk consumption screening by GPs in France. We also identified characteristics associated with more frequent screening and greater use of validated screening tools by these healthcare providers. A cross-sectional survey was conducted among a representative sample of French GPs. Multinomial logistic regressions were used to identify factors associated with more frequent screening and greater use of validated screening tools. Response rate was of 73%. Of the 2412 participants, 42.8% screened all their patients systematically and repeatedly, while 48.0% never used standardized tools to screen potentially at-risk patients. Among other characteristics, being aware of and using the "early identification and brief intervention" screening strategy, and feeling absolutely comfortable talking with patients about reducing or stopping their alcohol use, were both associated with more frequent screening and use of standardized tools. Our results on at-risk alcohol use screening highlight an improvement over data from previous studies. Nevertheless, better training of French GPs in good alcohol screening practices-specifically, increased screening frequency and greater use of standardized tools-may improve identification of at-risk patients.

Assessment of the Teaching on Alcohol Use and Management in Current Health Professional Curricula in India

Alcohol consumption is globally a serious public health challenge, and it is rampant across all parts of India. The COVID-19 pandemic has added to the overall burden of alcoholism due to long working hours, increased mental stress, depression, and so on. Primary care physicians have an important role in assessing risk and providing counselling, intervention and treatment of alcohol misuse. Studies have demonstrated primary health care facilities to be ideally suited for alcohol prevention and cessation interventions as most patients with alcohol use disorders (AUDs) seek treatment from facilities in the primary care setting in India. Thus, the training of healthcare professionals is vital in addressing AUDs in India. The Indian government is setting up Health and Wellness Centres across the country intended to address long-term care and holistic health promotion. At the same time, healthcare providers have expressed their limited competence in cessation and counselling practices related to AUDs. One of the attributing factors for these limitations is the paucity of exposure during the formative years. With this background, a review was undertaken of the current prescribed undergraduate professional curricula (medical, nursing, dentistry and physiotherapy) in India to assess its current status and preparedness in addressing alcohol misuse. The study findings emphasise the need to bolster the continuing education of health professionals aimed at health promotion and preventive strategies by hands-on training, brief workshops, supervised clinical experience by extramural faculty such as addiction psychiatrists, use of standardised patients, role play, and other similar methods.