Exploring the views of primary care paramedics on the screening of addictive disorders

Maxime Pautrat

Keywords: Screening - substance use disorders - allied health occupations

Background:
Early screening for substance use disorders is recommended as part of primary care. The objective of the evolution of the European health system is to include allied health professionals in this identification. The appropriation of their new role has not yet been explored.

Research questions:
To explore the viewpoint of allied health professionals in primary care on the screenning of substance use disorders.

Method:
This qualitative study inspired by grounded theory was conducted between August 2018 and July 2019. It included 13 semi-structured individual interviews and 4 focus groups of primary care health professionals (physical therapist, nurse, midwife, pharmacist, and dentist) recruited at their practice settings.

Results:
Paramedics described the advantages of their profession for addiction screening: home visits, prescription history, familiarity with intimate topics, close consultations, .... Despite daily observation positions, they sometimes remained silent witnesses "I suspected an addiction but I told myself 'there's no point in bringing it up'"; for fear of dropping a bomb "I got 'What are you meddling with?' " and resigned: "You try and then you don't try anymore". Their habits of centered-prescription practice "it's fine with them that we just come in for the care. Their feeling of powerlessness was a barrier to their screening process. They felt closer to the patients to talk about intimate subjects and yet less legitimate than the doctor to talk about addictions. Finally, their desire for multidisciplinarity was limited by the fear of disturbing the doctor and the confusion between betrayal and medical secret.

Conclusions:
Paramedical professionals claimed to have a complementary role to play in the identification of addictions. Their reluctance echoes the concept of self-censorship already described in the studies with addictologists and patients.

Points for discussion:
How to include specific contributions from paramedic practice on screening for substance use disorders?

how to optimize the practice of family medicine in these new interprofessional settings?