How primary care providers talk to patients about alcohol - A qualitative study
How primary care providers talk to patients about alcohol - A qualitative study
复制标题
DOI：
10.1007/bf02743146
复制
发表时间：
2006-09-01
影响因子：
5.7
通讯作者：
Bradley, Katharine A.
中科院分区：
文献类型：
--
作者：
McCormick, Kinsey A.;Cochran, Nancy E.;Bradley, Katharine A.
背景：酒精滥用是一种常见的和有充分证据的发病率和死亡率的来源。简短的初级保健酒精咨询已被证明对酒精滥用患者有益。目的：描述初级保健提供者和酒精滥用筛查阳性患者之间与酒精相关的讨论。对含有酒精使用讨论的初级保健访问录音进行探索性定性分析。参与者：参与者是29名退伍军人事务（VA）普通内科诊所的男性门诊患者，他们的酒精滥用筛查呈阳性，以及他们的14名初级保健提供者，他们都参加了一项更大的质量改进试验。测量方法：使用扎根理论和谈话分析这两种定性研究技术，对任何与酒精有关的谈话录音进行转录和编码。结果：确定了三个主题：(1)患者披露了有关酒精使用的信息，但提供者通常不会探索这些披露；(2)与吸烟相关的建议相比，关于饮酒的建议通常是模糊和/或试探性的，吸烟相关的建议更常见，通常更明确和坚定；(3)在与酒精有关的讨论中，提供者的不适是显而易见的。局限性：该单点VA研究结果的普遍性尚不清楚。结论：这项单站点研究的结果表明，提供者的不适和回避是基于证据的简短酒精咨询的重要障碍。需要对当前的酒精咨询实践进行进一步调查，以确定这些模式是否延伸到其他初级保健机构，并为未来的教育工作提供信息。
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.