Skip to main content
Top
Published in: BMC Primary Care 1/2018

Open Access 01-12-2018 | Research article

Is problem alcohol use being detected and treated in Irish general practice?

Authors: Andrew O’Regan, Walter Cullen, Louise Hickey, David Meagher, Ailish Hannigan

Published in: BMC Primary Care | Issue 1/2018

Login to get access

Abstract

Background

The pattern of alcohol consumption in Ireland has serious societal and health consequences. General practice is well placed to screen for problem alcohol use and to carry out brief interventions. The aims of this study were to investigate the prevalence of documentation of problem alcohol use in patient records in Irish general practice, and to describe the documentation of its diagnosis and treatment.

Methods

General practitioners (GPs) affiliated with an Irish medical school were invited to participate in the study. One hundred patients were randomly selected from each participating practice using the practice software and the clinical records were reviewed for evidence of problem alcohol use. The following was recorded: patient demographics, whether problem alcohol use was documented, whether they had an intervention, a psychotropic medication or if a referral was made. Descriptive statistics and an estimate of the prevalence were calculated using SPSS and SAS software.

Results

Seventy one percent of the practices participated (n = 40), generating a sample of 3, 845 active patients. Only 57 patients (1.5%, 95% confidence interval 1 to 2%) were identified as having problem alcohol use in the previous two years. 29 (51%) of those with documented problem alcohol use were referred to other specialist services. 28 (49%) received a psychological intervention. 40 (70%) were prescribed psychotropic medications.

Conclusion

This is the first large scale study of patient records in general practice in Ireland looking at documentation of screening and treatment of problem alcohol use. It highlights the current lack of documentation of alcohol problems and the need to re-inforce positive attitudes among GPs in relation to preventive work.
Literature
1.
go back to reference WHO: Global status report on alcohol and health, 2014. In.: World Health Organisation; 2014. WHO: Global status report on alcohol and health, 2014. In.: World Health Organisation; 2014.
2.
go back to reference OECD: Health Statistics. In.: Organisation for Economic Co-operation and Development; 2014. OECD: Health Statistics. In.: Organisation for Economic Co-operation and Development; 2014.
3.
go back to reference Smyth BP, Kelly A, Cox G. Decline in age of drinking onset in Ireland, gender and per capita alcohol consumption. Alcohol Alcohol. 2011;46(4):478–84.CrossRefPubMed Smyth BP, Kelly A, Cox G. Decline in age of drinking onset in Ireland, gender and per capita alcohol consumption. Alcohol Alcohol. 2011;46(4):478–84.CrossRefPubMed
4.
go back to reference Hibell B, Guttormsson U, Ahlström S, Balakireva O, Bjarnason T, Kokkevi A, Kraus L: The 2011 ESPAD Report. Substance Use among Students in 2012, 36:123–134. Hibell B, Guttormsson U, Ahlström S, Balakireva O, Bjarnason T, Kokkevi A, Kraus L: The 2011 ESPAD Report. Substance Use among Students in 2012, 36:123–134.
5.
go back to reference Davoren MP, Shiely F, Byrne M, Perry IJ. Hazardous alcohol consumption among university students in Ireland: a cross-sectional study. BMJ Open. 2015;5(1):e006045.CrossRefPubMedPubMedCentral Davoren MP, Shiely F, Byrne M, Perry IJ. Hazardous alcohol consumption among university students in Ireland: a cross-sectional study. BMJ Open. 2015;5(1):e006045.CrossRefPubMedPubMedCentral
6.
go back to reference DeWit DJ, Adlaf EM, Offord DR, Ogborne AC. Age at first alcohol use: a risk factor for the development of alcohol disorders. Am J Psychiatr. 2000;157(5):745–50.CrossRefPubMed DeWit DJ, Adlaf EM, Offord DR, Ogborne AC. Age at first alcohol use: a risk factor for the development of alcohol disorders. Am J Psychiatr. 2000;157(5):745–50.CrossRefPubMed
7.
go back to reference Byrne S: Costs to society of problem alcohol use in Ireland. Dublin: Health Service Executive 2010. Byrne S: Costs to society of problem alcohol use in Ireland. Dublin: Health Service Executive 2010.
8.
go back to reference Rundle K, Leigh C, McGee H, Layte R. Irish contraception and crisis pregnancy [ICCP] study. A survey of the general Population. 2004; Rundle K, Leigh C, McGee H, Layte R. Irish contraception and crisis pregnancy [ICCP] study. A survey of the general Population. 2004;
9.
go back to reference McGee H, Garavan R, de Barra M, Byrne J, Conroy R: The SAVI report: sexual abuse and violence in Ireland. 2002. McGee H, Garavan R, de Barra M, Byrne J, Conroy R: The SAVI report: sexual abuse and violence in Ireland. 2002.
10.
go back to reference Health Do: Department of Health. Steering Group Report on a National Substance Abuse Strategy. In.: Department of Health; 2012. Health Do: Department of Health. Steering Group Report on a National Substance Abuse Strategy. In.: Department of Health; 2012.
11.
go back to reference Foster T, Gillespie K, McClelland R, Patterson C. Risk factors for suicide independent of DSM-III-R Axis I disorder. Case-control psychological autopsy study in Northern Ireland. Br J Psychiatry. 1999;175(2):175–9.CrossRefPubMed Foster T, Gillespie K, McClelland R, Patterson C. Risk factors for suicide independent of DSM-III-R Axis I disorder. Case-control psychological autopsy study in Northern Ireland. Br J Psychiatry. 1999;175(2):175–9.CrossRefPubMed
12.
go back to reference Bedford D, O'Farrell A, Howell F. Blood alcohol levels in persons who died from accidents and suicide. Ir Med J. 2006;99(3):80–3.PubMed Bedford D, O'Farrell A, Howell F. Blood alcohol levels in persons who died from accidents and suicide. Ir Med J. 2006;99(3):80–3.PubMed
13.
go back to reference WHO: Global Status Report on Alcohol and Health. In. Geneva: World Health Organisation; 2011. WHO: Global Status Report on Alcohol and Health. In. Geneva: World Health Organisation; 2011.
14.
go back to reference Martin J, Barry J, Goggin D, Morgan K, Ward M, O’Suilleabhain T. Alcohol-attributable mortality in Ireland. Alcohol Alcohol. 2010;45(4):379–86.CrossRefPubMed Martin J, Barry J, Goggin D, Morgan K, Ward M, O’Suilleabhain T. Alcohol-attributable mortality in Ireland. Alcohol Alcohol. 2010;45(4):379–86.CrossRefPubMed
15.
go back to reference Mongan D: Health-related consequences of problem alcohol use. -3759 2007. Mongan D: Health-related consequences of problem alcohol use. -3759 2007.
16.
go back to reference Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the US preventive services task force. Ann Intern Med. 2004;140(7):557–68.CrossRefPubMed Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the US preventive services task force. Ann Intern Med. 2004;140(7):557–68.CrossRefPubMed
17.
go back to reference Anderson P. Effectiveness of general practice interventions for patients with harmful alcohol consumption. Br J Gen Pract. 1993;43(374):386–9.PubMedPubMedCentral Anderson P. Effectiveness of general practice interventions for patients with harmful alcohol consumption. Br J Gen Pract. 1993;43(374):386–9.PubMedPubMedCentral
18.
19.
go back to reference Cullen W, O'Brien S, O'Carroll A, D O'Kelly F, Bury G. Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care. BMC Fam Pract. 2009;10(1):1.CrossRef Cullen W, O'Brien S, O'Carroll A, D O'Kelly F, Bury G. Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care. BMC Fam Pract. 2009;10(1):1.CrossRef
20.
go back to reference Thomson S, Figueras J, Evetovits T, Jowett M, Mladovsky P, Maresso A, Cylus J, Karanikolos M, Kluge H: Economic crisis, health systems and health in Europe: impact and implications for policy: WHO regional Office for Europe; 2014. Thomson S, Figueras J, Evetovits T, Jowett M, Mladovsky P, Maresso A, Cylus J, Karanikolos M, Kluge H: Economic crisis, health systems and health in Europe: impact and implications for policy: WHO regional Office for Europe; 2014.
21.
go back to reference Structure of General Practice in Ireland 1982–2015. Structure of General Practice in Ireland 1982–2015.
22.
go back to reference Hiddema-Van de Wal A, Smith R, van der Werf G, Meyboom-de Jong B. Towards improvement of the accuracy and completeness of medication registration with the use of an electronic medical record (EMR). Fam Pract. 2001;18(3):288–91.CrossRefPubMed Hiddema-Van de Wal A, Smith R, van der Werf G, Meyboom-de Jong B. Towards improvement of the accuracy and completeness of medication registration with the use of an electronic medical record (EMR). Fam Pract. 2001;18(3):288–91.CrossRefPubMed
23.
go back to reference Ngwakongnwi E, Hemmelgarn B, Quan H. Documentation of preventive screening interventions by general practitioners: a retrospective chart audit. BMC Fam Pract. 2010;11(1):21.CrossRefPubMedPubMedCentral Ngwakongnwi E, Hemmelgarn B, Quan H. Documentation of preventive screening interventions by general practitioners: a retrospective chart audit. BMC Fam Pract. 2010;11(1):21.CrossRefPubMedPubMedCentral
24.
go back to reference Edwards ST, Neri PM, Volk LA, Schiff GD, Bates DW. Association of note quality and quality of care: a cross-sectional study. BMJ quality & safety. 2014;23(5):406–13.CrossRef Edwards ST, Neri PM, Volk LA, Schiff GD, Bates DW. Association of note quality and quality of care: a cross-sectional study. BMJ quality & safety. 2014;23(5):406–13.CrossRef
25.
go back to reference Kaner E, Heather N, Brodie J, Lock CA, McAvoy BR. Patient and practitioner characteristics predict brief alcohol intervention in primary care. Br J Gen Pract. 2001;51(471):822–7.PubMedPubMedCentral Kaner E, Heather N, Brodie J, Lock CA, McAvoy BR. Patient and practitioner characteristics predict brief alcohol intervention in primary care. Br J Gen Pract. 2001;51(471):822–7.PubMedPubMedCentral
26.
go back to reference Fiellin DA, Reid MC, O'Connor PG. Screening for alcohol problems in primary care: a systematic review. Arch Intern Med. 2000;160(13):1977–89.CrossRefPubMed Fiellin DA, Reid MC, O'Connor PG. Screening for alcohol problems in primary care: a systematic review. Arch Intern Med. 2000;160(13):1977–89.CrossRefPubMed
27.
go back to reference Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on alcohol and related conditions. Arch Gen Psychiatry. 2007;64(7):830–42.CrossRefPubMed Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on alcohol and related conditions. Arch Gen Psychiatry. 2007;64(7):830–42.CrossRefPubMed
28.
go back to reference Nkire N, Udoh G, Elahi M, Cotter D, MacHale S. Screening and recording of patients’ alcohol-use habit by clinicians in a tertiary accident and emergency unit in Ireland. Annals of medical and health sciences research. 2014;4(4):590–3.CrossRefPubMedPubMedCentral Nkire N, Udoh G, Elahi M, Cotter D, MacHale S. Screening and recording of patients’ alcohol-use habit by clinicians in a tertiary accident and emergency unit in Ireland. Annals of medical and health sciences research. 2014;4(4):590–3.CrossRefPubMedPubMedCentral
29.
go back to reference Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WW, Locke BZ. The NIMH epidemiologic catchment area program: historical context, major objectives, and study population characteristics. Arch Gen Psychiatry. 1984;41(10):934.CrossRefPubMed Regier DA, Myers JK, Kramer M, Robins LN, Blazer DG, Hough RL, Eaton WW, Locke BZ. The NIMH epidemiologic catchment area program: historical context, major objectives, and study population characteristics. Arch Gen Psychiatry. 1984;41(10):934.CrossRefPubMed
30.
go back to reference Kaner E, Bland M, Cassidy P, Coulton S, Dale V, Deluca P, Gilvarry E, Godfrey C, Heather N, Myles J. Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. BMJ. 2013;346:e8501.CrossRefPubMedPubMedCentral Kaner E, Bland M, Cassidy P, Coulton S, Dale V, Deluca P, Gilvarry E, Godfrey C, Heather N, Myles J. Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. BMJ. 2013;346:e8501.CrossRefPubMedPubMedCentral
31.
go back to reference Spandorfer JM, Israel Y, Turner BJ: Primary care physicians' views on screening and management of alcohol abuse inconsistencies with national guidelines. J Fam Pract 1999, 48(11):899–899. Spandorfer JM, Israel Y, Turner BJ: Primary care physicians' views on screening and management of alcohol abuse inconsistencies with national guidelines. J Fam Pract 1999, 48(11):899–899.
32.
go back to reference Anderson P, Kaner E, Wutzke S, Funk M, Heather N, Wensing M, Grol R, Gual A, Pas L. 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.CrossRefPubMed Anderson P, Kaner E, Wutzke S, Funk M, Heather N, Wensing M, Grol R, Gual A, Pas L. 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.CrossRefPubMed
33.
go back to reference Wilson GB, Lock CA, Heather N, Cassidy P, Christie MM, Kaner EF. Intervention against excessive alcohol consumption in primary health care: a survey of GPs' attitudes and practices in England 10 years on. Alcohol Alcohol. 2011;46(5):570–7.CrossRefPubMedPubMedCentral Wilson GB, Lock CA, Heather N, Cassidy P, Christie MM, Kaner EF. Intervention against excessive alcohol consumption in primary health care: a survey of GPs' attitudes and practices in England 10 years on. Alcohol Alcohol. 2011;46(5):570–7.CrossRefPubMedPubMedCentral
34.
go back to reference Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. Primary care validation of a single-question alcohol screening test. J Gen Intern Med. 2009;24(7):783–8.CrossRefPubMedPubMedCentral Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. Primary care validation of a single-question alcohol screening test. J Gen Intern Med. 2009;24(7):783–8.CrossRefPubMedPubMedCentral
35.
go back to reference Oreskovich MR, Shanafelt T, Dyrbye LN, Tan L, Sotile W, Satele D, West CP, Sloan J, Boone S. The prevalence of substance use disorders in American physicians. Am J Addict. 2015;24(1):30–8.CrossRefPubMed Oreskovich MR, Shanafelt T, Dyrbye LN, Tan L, Sotile W, Satele D, West CP, Sloan J, Boone S. The prevalence of substance use disorders in American physicians. Am J Addict. 2015;24(1):30–8.CrossRefPubMed
36.
go back to reference Anderson R. Alcohol abuse and the Irish. Forum Clinical Focus. 2012;12(5):4–8. Anderson R. Alcohol abuse and the Irish. Forum Clinical Focus. 2012;12(5):4–8.
37.
go back to reference Bhattarai N, Charlton J, Rudisill C, Gulliford MC. Coding, recording and incidence of different forms of coronary heart disease in primary care. PLoS One. 2012;7(1):e29776.CrossRefPubMedPubMedCentral Bhattarai N, Charlton J, Rudisill C, Gulliford MC. Coding, recording and incidence of different forms of coronary heart disease in primary care. PLoS One. 2012;7(1):e29776.CrossRefPubMedPubMedCentral
39.
go back to reference Field CA, Klimas J, Barry J, Bury G, Keenan E, Smyth BP, Cullen W. Problem alcohol use among problem drug users in primary care: a qualitative study of what patients think about screening and treatment. BMC Fam Pract. 2013;14(1):1.CrossRef Field CA, Klimas J, Barry J, Bury G, Keenan E, Smyth BP, Cullen W. Problem alcohol use among problem drug users in primary care: a qualitative study of what patients think about screening and treatment. BMC Fam Pract. 2013;14(1):1.CrossRef
40.
go back to reference Anderson RM, Joseph; Aherin, Adrian; Finegan, Pearse; Farren, Conor: Helping Patients with Alcohol Problems. In.: Irish College of General Practitioners; 2014. Anderson RM, Joseph; Aherin, Adrian; Finegan, Pearse; Farren, Conor: Helping Patients with Alcohol Problems. In.: Irish College of General Practitioners; 2014.
Metadata
Title
Is problem alcohol use being detected and treated in Irish general practice?
Authors
Andrew O’Regan
Walter Cullen
Louise Hickey
David Meagher
Ailish Hannigan
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2018
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-018-0718-5

Other articles of this Issue 1/2018

BMC Primary Care 1/2018 Go to the issue