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Published in: BMC Primary Care 1/2020

Open Access 01-12-2020 | Research article

Financial reimbursement - irrelevant for GPs’ readiness to implement brief intervention to reduce alcohol consumption? A cross-sectional vignette study

Authors: Thomas Fankhaenel, Katrin Schulz, Lars-Eric Petersen, Andreas Klement, Thomas Frese

Published in: BMC Primary Care | Issue 1/2020

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Abstract

Background

General Practitioners’ (GPs) readiness to implement screening and brief intervention (SBI) to treat patients with excessive alcohol consumption is low. Several studies identified crucial barriers such as insufficient financial reimbursement. In contrast to the barriers-account, we assume that low implementation readiness of GPs may be less attributed to external barriers but rather more so to inherent characteristics of SBI. To test our assumption, we conducted a vignette study assessing the GPs’ readiness to implement SBI in comparison to a pharmacological intervention also designed for the treatment of excessive drinkers in relation to standard or above-standard financial reimbursement. According to our hypothesis GPs should be less ready to implement SBI regardless of financial reimbursement.

Methods

A convenience sample of GPs was recruited to answer the questionnaire. To assess the GPs’ implementation readiness a 4-item 6-point Likert scale was developed and pretested.

Results

One hundred forty GPs completed the questionnaire. GPs were more ready to implement the pharmacological intervention than SBI, F(1,132) = 27.58, p < .001 (main effect).
We found no effect for financial reimbursement, F(1,132) = 3.60, ns, and no interaction effect, F(1,132) = 2.20, ns.

Conclusions

Further research should investigate more thoroughly the crucial characteristics of SBI to initiate a modification process finally leading to more effective primary care dependency prevention.
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Literature
2.
go back to reference Grothues JM, Bischof G, Reinhardt S, Meyer C, John U, Rumpf HJ. Effectiveness of brief alcohol interventions for general practice patients with problematic drinking behavior and comorbid anxiety or depressive disorders. Drug Alcohol Depend. 2008;94(1–3):214–20.CrossRef Grothues JM, Bischof G, Reinhardt S, Meyer C, John U, Rumpf HJ. Effectiveness of brief alcohol interventions for general practice patients with problematic drinking behavior and comorbid anxiety or depressive disorders. Drug Alcohol Depend. 2008;94(1–3):214–20.CrossRef
3.
go back to reference Babor TF, Higgins-Biddle J, Saunders J, Monteiro M. AUDIT The Alcohol Use Disorders Identification Test: Guidelines for use in primary care. Second ed. Geneva: World Health Organisation; 2001. Babor TF, Higgins-Biddle J, Saunders J, Monteiro M. AUDIT The Alcohol Use Disorders Identification Test: Guidelines for use in primary care. Second ed. Geneva: World Health Organisation; 2001.
4.
go back to reference Beich A, Gannik D, Malterud K. Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners. BMJ. 2002;325(7369):870.CrossRef Beich A, Gannik D, Malterud K. Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners. BMJ. 2002;325(7369):870.CrossRef
5.
go back to reference Heather N. Can screening and brief intervention lead to population-level reductions in alcohol-related harm? Addict Sci Clin Pract. 2012;7(1):15.CrossRef Heather N. Can screening and brief intervention lead to population-level reductions in alcohol-related harm? Addict Sci Clin Pract. 2012;7(1):15.CrossRef
6.
go back to reference O'Regan A, Cullen W, Hickey L, Meagher D, Hannigan A. Is problem alcohol use being detected and treated in Irish general practice? BMC Fam Pract. 2018;19(1):30.CrossRef O'Regan A, Cullen W, Hickey L, Meagher D, Hannigan A. Is problem alcohol use being detected and treated in Irish general practice? BMC Fam Pract. 2018;19(1):30.CrossRef
7.
go back to reference Sebo P, Cerutti B, Fournier JP, Rat C, Rougerie F, Senn N, et al. How do general practitioners put preventive care recommendations into practice? A cross-sectional study in Switzerland and France. BMJ Open. 2017;7(10):e017958.CrossRef Sebo P, Cerutti B, Fournier JP, Rat C, Rougerie F, Senn N, et al. How do general practitioners put preventive care recommendations into practice? A cross-sectional study in Switzerland and France. BMJ Open. 2017;7(10):e017958.CrossRef
8.
go back to reference Aalto M, Pekuri P, Seppa K. Obstacles to carrying out brief intervention for heavy drinkers in primary health care: a focus group study. Drug Alcohol Rev. 2003;22(2):169–73.CrossRef Aalto M, Pekuri P, Seppa K. Obstacles to carrying out brief intervention for heavy drinkers in primary health care: a focus group study. Drug Alcohol Rev. 2003;22(2):169–73.CrossRef
9.
go back to reference Anderson P, Kaner E, Wutzke S, Funk M, Heather N, Wensing M, et al. Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study. Alcohol Alcohol. 2004;39(4):351–6.CrossRef Anderson P, Kaner E, Wutzke S, Funk M, Heather N, Wensing M, et al. Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study. Alcohol Alcohol. 2004;39(4):351–6.CrossRef
10.
go back to reference Fankhänel T, Lenz J, Papert S, Voigt K, Klement A. Screening und Brief Intervention in der Hausarztpraxis: Barrieren gegen eine Frühintervention bei Patienten mit Alkoholmissbrauch. Psychother Psychosom Med Psychol. 2014;64(9/10):373–7.CrossRef Fankhänel T, Lenz J, Papert S, Voigt K, Klement A. Screening und Brief Intervention in der Hausarztpraxis: Barrieren gegen eine Frühintervention bei Patienten mit Alkoholmissbrauch. Psychother Psychosom Med Psychol. 2014;64(9/10):373–7.CrossRef
11.
go back to reference Johnson M, Jackson R, Guillaume L, Meier P, Goyder E. Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. J Public Health (Oxf). 2011;33(3):412–21.CrossRef Johnson M, Jackson R, Guillaume L, Meier P, Goyder E. Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. J Public Health (Oxf). 2011;33(3):412–21.CrossRef
12.
go back to reference Keurhorst MN, Anderson P, Spak F, Bendtsen P, Segura L, Colom J, et al. Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): study protocol for a cluster randomized factorial trial. Implementation Sci : IS. 2013;8:11.CrossRef Keurhorst MN, Anderson P, Spak F, Bendtsen P, Segura L, Colom J, et al. Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): study protocol for a cluster randomized factorial trial. Implementation Sci : IS. 2013;8:11.CrossRef
13.
go back to reference Nilsen P. Brief alcohol intervention--where to from here? Challenges remain for research and practice. Addiction. 2010;105(6):954–9.CrossRef Nilsen P. Brief alcohol intervention--where to from here? Challenges remain for research and practice. Addiction. 2010;105(6):954–9.CrossRef
14.
go back to reference Nygaard P, Paschall MJ, Aasland OG, Lund KE. Use and barriers to use of screening and brief interventions for alcohol problems among Norwegian general practitioners. Alcohol Alcohol. 2010;45(2):207–12.CrossRef Nygaard P, Paschall MJ, Aasland OG, Lund KE. Use and barriers to use of screening and brief interventions for alcohol problems among Norwegian general practitioners. Alcohol Alcohol. 2010;45(2):207–12.CrossRef
15.
go back to reference Rapley T, May C, Frances KE. Still a difficult business? Negotiating alcohol-related problems in general practice consultations. Soc Sci Med. 2006;63(9):2418–28.CrossRef Rapley T, May C, Frances KE. Still a difficult business? Negotiating alcohol-related problems in general practice consultations. Soc Sci Med. 2006;63(9):2418–28.CrossRef
16.
go back to reference Anderson P, Coulton S, Kaner E, Bendtsen P, Kloda K, Reynolds J, et al. Delivery of brief interventions for heavy drinking in primary care: outcomes of the ODHIN 5-country cluster randomized trial. Ann Fam Med. 2017;15(4):335–40.CrossRef Anderson P, Coulton S, Kaner E, Bendtsen P, Kloda K, Reynolds J, et al. Delivery of brief interventions for heavy drinking in primary care: outcomes of the ODHIN 5-country cluster randomized trial. Ann Fam Med. 2017;15(4):335–40.CrossRef
17.
go back to reference Coleman AL, Seitzman RL, Cummings SR, Yu F, Cauley JA, Ensrud KE, et al. The association of smoking and alcohol use with age-related macular degeneration in the oldest old: the study of osteoporotic fractures. Am J Ophthalmol. 2010;149(1):160–9.CrossRef Coleman AL, Seitzman RL, Cummings SR, Yu F, Cauley JA, Ensrud KE, et al. The association of smoking and alcohol use with age-related macular degeneration in the oldest old: the study of osteoporotic fractures. Am J Ophthalmol. 2010;149(1):160–9.CrossRef
18.
go back to reference Town R, Kane R, Johnson P, Butler M. Economic incentives and physicians' delivery of preventive care: a systematic review. Am J Prev Med. 2005;28(2):234–40.CrossRef Town R, Kane R, Johnson P, Butler M. Economic incentives and physicians' delivery of preventive care: a systematic review. Am J Prev Med. 2005;28(2):234–40.CrossRef
19.
go back to reference Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71(5):843–61.CrossRef Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71(5):843–61.CrossRef
20.
go back to reference Palpacuer C, Duprez R, Huneau A, Locher C, Boussageon R, Laviolle B, et al. Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate. Addiction. 2018;113(2):220–37.CrossRef Palpacuer C, Duprez R, Huneau A, Locher C, Boussageon R, Laviolle B, et al. Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate. Addiction. 2018;113(2):220–37.CrossRef
21.
go back to reference Mann K, Hoch E, Batra A. S3-Leitlinie Screening, Diagnose und Behandlung alkoholbezogener Störungen. Berlin, Heidelberg: Springer Verlag; 2016. Mann K, Hoch E, Batra A. S3-Leitlinie Screening, Diagnose und Behandlung alkoholbezogener Störungen. Berlin, Heidelberg: Springer Verlag; 2016.
22.
go back to reference Johansen KGV, Tarp S, Astrup A, Lund H, Pagsberg AK, Christensen R. Harms associated with taking nalmefene for substance use and impulse control disorders: a systematic review and meta-analysis of randomised controlled trials. PLoS One. 2017;12(8):e0183821.CrossRef Johansen KGV, Tarp S, Astrup A, Lund H, Pagsberg AK, Christensen R. Harms associated with taking nalmefene for substance use and impulse control disorders: a systematic review and meta-analysis of randomised controlled trials. PLoS One. 2017;12(8):e0183821.CrossRef
23.
go back to reference Einheitlicher Bewertungsmaßstab (EBM) (2018). Einheitlicher Bewertungsmaßstab (EBM) (2018).
24.
go back to reference Anderson P, Clement S. The AAPPQ revisited: the measurement of general practitioners' attitudes to alcohol problems. Br J Addict. 1987;82(7):753–9.CrossRef Anderson P, Clement S. The AAPPQ revisited: the measurement of general practitioners' attitudes to alcohol problems. Br J Addict. 1987;82(7):753–9.CrossRef
25.
go back to reference Gunzerath L, Faden V, Zakhari S, Warren K. National Institute on Alcohol Abuse and Alcoholism report on moderate drinking. Alcohol Clin Exp Res. 2004;28(6):829–47.CrossRef Gunzerath L, Faden V, Zakhari S, Warren K. National Institute on Alcohol Abuse and Alcoholism report on moderate drinking. Alcohol Clin Exp Res. 2004;28(6):829–47.CrossRef
26.
go back to reference Abidi L, Nilsen P, Karlsson N, Skagerström J, O'Donnell A. Conversations about alcohol in healthcare - cross-sectional surveys in the Netherlands and Sweden. BMC Public Health. 2020;4;20(1):283. Abidi L, Nilsen P, Karlsson N, Skagerström J, O'Donnell A. Conversations about alcohol in healthcare - cross-sectional surveys in the Netherlands and Sweden. BMC Public Health. 2020;4;20(1):283.
27.
go back to reference Dzidowska M, Lee KSK, Wylie C, Bailie J, Percival N, Conigrave JH, et al. A systematic review of approaches to improve practice, detection and treatment of unhealthy alcohol use in primary health care: a role for continuous quality improvement. BMC Fam Pract. 2020;13;21(1):33. Dzidowska M, Lee KSK, Wylie C, Bailie J, Percival N, Conigrave JH, et al. A systematic review of approaches to improve practice, detection and treatment of unhealthy alcohol use in primary health care: a role for continuous quality improvement. BMC Fam Pract. 2020;13;21(1):33.
28.
go back to reference Verplanken B. Beyond frequency: habit as mental construct. Br J Soc Psychol. 2006;45(Pt 3):639–56.CrossRef Verplanken B. Beyond frequency: habit as mental construct. Br J Soc Psychol. 2006;45(Pt 3):639–56.CrossRef
29.
go back to reference Glasman LR, Albarracin D. Forming attitudes that predict future behavior: a meta-analysis of the attitude-behavior relation. Psychol Bull. 2006;132(5):778–822.CrossRef Glasman LR, Albarracin D. Forming attitudes that predict future behavior: a meta-analysis of the attitude-behavior relation. Psychol Bull. 2006;132(5):778–822.CrossRef
30.
go back to reference Kathiresan J, Patro BK. Case vignette: a promising complement to clinical case presentations in teaching. Educ Health. 2013;26(1):21–4.CrossRef Kathiresan J, Patro BK. Case vignette: a promising complement to clinical case presentations in teaching. Educ Health. 2013;26(1):21–4.CrossRef
Metadata
Title
Financial reimbursement - irrelevant for GPs’ readiness to implement brief intervention to reduce alcohol consumption? A cross-sectional vignette study
Authors
Thomas Fankhaenel
Katrin Schulz
Lars-Eric Petersen
Andreas Klement
Thomas Frese
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2020
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-020-01231-9

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