The GPs' low readiness to treat excessive consumers with brief intervention to reduce their alcohol consumption: A problem of the health problem?

Thomas Fankhaenel, Benjamin Panic, Marcus Schwarz, Katrin Schulz, Thomas Frese

Keywords: general practitioner, alcohol consumption, brief intervention, seriousness of the health problem

In Germany 18% of men and 14% of women are excessive alcohol consumers. General Practitioners' (GPs) readiness to implement brief intervention (BI) to reduce alcohol consumption of excessive consumers is low. Although several barriers were identified by past research, improving these conditions has not led to improved implementation. Based on Expectancy Value Theory of Achievement Motivation we assume that low seriousness of the health problem in association with the treatment of excessive consumers may be considered as crucial barrier too.

Research questions:
Does low seriousness of the health problem associated with excessive alcohol consumption also have a negative effect on the GPs' readiness to implement BI like the crucial barriers insufficient financial reimbursement and low patient adherence?

The questionnaire was developed by an interdisciplinary team of GPs, social scientists, and psychologists. In order to manipulate the seriousness of the health problem GPs were confronted with three different fictitious patients with either excessive consumption (low seriousness), or binge drinking, or even harmful consumption (both high seriousness). GPs were also informed that that the fictitious patient responds affirmatively or not affirmatively (adherence manipulation). GPs were finally informed that they would receive a financial reimbursement of 18 Euro or 36 Euro (reimbursement manipulation).

Questionnaires of 185 GPs were analyzed. As hypothesized GPs were less ready to treat patients with excessive consumption in comparison to patients with harmful consumption, t(184)=5.51, p<.001, d=.40, and binge drinking, t(184)=6.14, p<.001, d=.43. Their readiness was higher in case of high adherence, F(1,181)=17.35, p<.001, ή²=.09.

GPs' readiness to implement a BI was influenced by the seriousness of the health problem and patient adherence. No such effect was found for financial reimbursement.

Points for discussion:
Are risky consumers the appropriate target group for a brief intervention?

How can the readiness of general practitioners to carry out a brief intervention be improved?