Screening and brief alcohol intervention in primary health care
Alcohol is a major cause of social, health and economic problems in the United Kingdom. Thus reduction in excessive drinking was one of the targets included in the White Paper, "Saving Lives: Our Healthier Nation" and is the subject of a National Harm Reduction Strategy. However alcohol problems are responsive to brief intervention (5-10 minutes of structured advice accompanied by written material). A number of randomised controlled trials have shown that, in comparison with controls, excessive drinkers receiving brief advice will reduce their alcohol consumption by around 25%. General practice is a particularly valuable point of contact for the delivery of brief intervention for excessive alcohol use because of the large proportion (70%) of the population who access their general practice each year. Excessive drinkers present twice as often as other patients and may constitute 20% of patients on a practice list. However, the potential of both General Practitioners and primary health care nurses to reduce the prevalence of alcohol related problems contrasts sharply with current practice. This Doctorate of Philosophy by published work is based on a programme of research, using the principles of social marketing, to disseminate and implement screening and brief alcohol intervention in primary health care. The submission includes a series of papers, published in a variety of peer-reviewed journals. Although the papers included in this thesis address different research questions and report a range of research techniques each makes a contribution to the field of screening and brief alcohol intervention. Publications reveal that General Practitioners remain unaware of the evidence for screening and brief alcohol intervention. While effective dissemination and implementation strategies are available, General Practitioners exhibit selective provision of screening and brief alcohol intervention. This is also the case for primary health care nurses. Although health professionals often cite negative patient reactions, patients consider screening and brief alcohol intervention appropriate when carried out under suitable conditions.