I presented this abstract (PDF, 344 KB) as an oral short presentation at the 9th annual Ingham Institute for Applied Medical Research and South Western Sydney Local Health District (2014) Research & Teaching Showcase, held today at the Thomas & Rachel Moore Education Centre, Liverpool Hospital, Liverpool NSW Australia.
A recorded version of the presentation is available on YouTube:
Patient acceptability towards receiving alcohol enquiry from GPs – results from a mixed methods study
Tam C. W. M.1,2, Leong L.2, Zwar N.2, Hespe C.3
1 General Practice Unit, Fairfield Hospital, South Western Sydney Local Health District
2 School of Public Health and Community Medicine, UNSW Australia
3 School of Medicine, Sydney, The University of Notre Dame Australia
General practitioners (GPs) have expressed reservations to routine alcohol screening. Less is known about patient perspectives – consultation contexts are probably important, but these have not been well explored.
We sought to answer three questions regarding patient acceptability towards GP alcohol enquiry: (i) is it improved by asking within SNAP (smoking, nutrition, alcohol, physical activity)? (ii) how does it vary with the reason of encounter? and (iii) what are patient beliefs and attitudes?
We used quantitative and qualitative methods. All adult patients presenting to a general practice in a week in May 2014 were randomised to receive one of two postal questionnaires. The number of “acceptable” alcohol enquiry ratings to 20 short narrative scenarios was the primary outcome measure. The intervention group rated the acceptability of SNAP enquiry, while the control group only rated alcohol enquiry.
Acceptability scores between groups were analysed. Individual scenario acceptability was explored descriptively. Questionnaire respondents were recruited for semi-structured interviews. We used grounded theory method – purposive sampling, data coding, constructing an explanatory model.
144 questionnaires were returned (33% response). The difference between group means was 2.1 scenarios rated as acceptable (p = 0.016), a moderate effect (Cohen’s d = 0.40) favouring the intervention. There were large variations in acceptability between scenarios (range: 46 to 90%). Qualitative analysis suggests that acceptability may be mediated through three in-consultation factors – patient understanding of the “purpose” of alcohol enquiry, their sense of “control” over the dialogue, and their perception of being morally “judged”.
Patient acceptability towards receiving GP alcohol enquiry appears very sensitive to consultation contexts, and this can be understood through our model.