Call to better screen problem drinking

A new survey of patients linked to 40 different GP clinics found that just 1.5% were identified as having problem alcohol use in the previous two years, prompting calls for better screening levels.

This is despite a recent World Health Organisation report showing that almost half of Irish drinkers engage in heavy drinking on a regular basis, placing Ireland’s binge drinking rates at the second highest of 174 countries studied

The study — the first large-scale study of patient records in general practice in Ireland looking at documentation of screening and treatment of problem alcohol use — suggests the possibility that “the high rates of alcohol abuse and dependence among physicians may be a contributory factor in the reluctance to ask about alcohol problems in the general practice population”.

The research, published in the BMC Family Practice journal, involved a sample of 3,845 active patients linked with 40 doctors’ practices, all affiliated with the University of Limerick Graduate Entry Medical School.

Ultimately, just 57 patients were identified as having problem alcohol use documented in the previous two years. Fourteen practices had no patients in their sample with documented problem alcohol use, while 10 had between 2% and 8% of their sample with documented problem alcohol use.

The analysis found that patients with problem alcohol use are more likely to be male, and are also more likely to be eligible for free GP care, as well as having been referred or attended secondary care in the past year.

The same patients also attend the GP more frequently, typically five visits a year as opposed to two, and 72% of those with problem alcohol use were identified from free text in consultation notes.

Just six patients had a diagnostic code entered for problem alcohol use, while four patients were identified from referral letters; four from both referral letters and consultation notes; one from a ‘past history’ page; and one from a psychological assessment.

The report said time constraints should no longer restrict a GP’s ability to screen their patients, and suggests that “there may be deeper underlying deterrents for GPs in documenting problem alcohol use, including protection of their patients”.

“GPs frequently answer questionnaires for health insurance companies relating to mortgage protection and employment suitability with their patients’ permission.

“It may pose a dilemma for a GP on whether to include documented ‘high-risk activities’ such as binge drinking or alcohol addiction, so not documenting the finding may be an easier approach.

“Possibly, the high rates of alcohol abuse and dependence among physicians may be a contributory factor.”

Highlighting “the current lack of documentation of alcohol problems in patient records and the need for training and discussion to improve confidence and reinforce positive attitudes among GPs in relation to preventive work”, the report said GPs are ideally placed “to detect and intervene due to frequent contact with problem alcohol use and the relationship they have with their patients”.