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Implementing pragmatic case finding to address alcohol use in general practice: a mixed methods feasibility study.

Sebastian Potthoff1,2, Håvar Brendryen1,3, Haris Bosnic1,4

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PubMed
Summary

Educational outreach visits (EOVs) effectively embed pragmatic case finding (PCF) for alcohol use in primary care. GPs found EOVs feasible and acceptable, improving their confidence and skills in addressing patient alcohol consumption.

Keywords:
Pragmatic case findingalcohol interventionsgeneral practiceprimary caretailored implementation

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Area of Science:

  • Primary Care Medicine
  • Public Health
  • Behavioral Science

Background:

  • Screening and brief interventions (SBIs) for alcohol use are effective but difficult to implement in primary care.
  • Universal screening is resource-intensive and may not fit general practitioners' (GPs) roles.
  • Pragmatic case finding (PCF) offers a feasible alternative by integrating alcohol discussions into relevant clinical contexts.

Purpose of the Study:

  • To assess the feasibility and acceptability of tailored, theory-based educational outreach visits (EOVs) for embedding PCF in primary care.
  • To explore the influence of EOVs on professional practice regarding alcohol use.
  • To examine changes in GP behavior determinants before and after EOV implementation.

Main Methods:

  • A mixed-methods feasibility study involving four EOVs in Norwegian GP clinics.
  • Utilized semi-structured group interviews with GPs and support staff.
  • Employed the Determinants of Implementation Behaviour Questionnaire (DIBQ) for quantitative assessment.

Main Results:

  • GPs (n=10) found EOVs feasible and acceptable, preferring in-person delivery.
  • Key themes included increased awareness of alcohol's health impacts, managing hidden cases, reducing stigma, and addressing behavioral change challenges.
  • Survey data (n=19) indicated a positive shift in GPs' knowledge, skills, and intentions regarding alcohol discussions.

Conclusions:

  • EOVs are a feasible and acceptable method for integrating PCF into primary care.
  • EOVs show potential to enhance GPs' capacity to address alcohol use in routine consultations.
  • Further research is needed on fidelity, sustainability, and patient-level outcomes.