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Are Brief Alcohol Interventions Adequately Embedded in UK Primary Care? A Qualitative Study Utilising Normalisation
1Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4AX, UK. amy.odonnell@newcastle.ac.uk.
Summary
General practitioners (GPs) in England showed limited progress in adopting alcohol screening and brief interventions (ASBI) despite incentives. Implementation challenges, including delegation and lack of personal investment, hindered embedding these preventative alcohol care pathways.
Area of Science:
- Public Health
- Primary Care Medicine
- Health Services Research
Background:
- Alcohol screening and brief interventions (ASBI) are evidence-based but inconsistently adopted in primary care.
- Financial incentives were implemented in England (2008-2015) to promote ASBI delivery.
- Understanding implementation barriers and facilitators is crucial for improving preventative care.
Purpose of the Study:
- To explore general practitioners' (GPs) experiences implementing alcohol screening and brief interventions (ASBI) in primary care.
- To identify barriers and facilitators to the routine adoption of ASBI using Normalisation Process Theory.
- To assess progress towards embedding a preventative alcohol care pathway in English primary care.
Main Methods:
- Qualitative study employing Normalisation Process Theory-informed interviews.
- 14 general practitioners (GPs) in England participated.
- Interviews focused on experiences during the period of financial incentives for ASBI delivery.
Main Results:
- GPs acknowledged the importance of ASBI (coherence) but lacked personal investment (cognitive participation).
- ASBI implementation was often delegated to nurses, with GPs reverting to usual care for problem drinking (collective action and reflexive monitoring).
- Limited progress was observed in embedding a comprehensive preventative alcohol care pathway.
Conclusions:
- Despite awareness and incentives, ASBI adoption in English primary care remains suboptimal.
- Future strategies should target high-risk patients and improve GP training for effective ASBI integration.
- Enhanced screening prioritization and GP skill development are needed to embed best practices in alcohol care.
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