Early intervention for alcohol use: family physicians' motivations and perceived barriers.

objectiveTo elucidate family physicians' motivations concerning early intervention for alcohol use and their perceived barriers to such intervention.

designQualitative study with the use of focus groups and semistructured interviews.

settingCommunity-based, fee-for-service family-medicine practices in London, Ont.

participantsTwelve focus-group participants recruited through telephone contact by two family physicians on the project team. Participants were required to be physicians in family practice in London. Twelve interview participants recruited through a grand-rounds presentation at two local hospitals. Participants were required to be physicians in a community-based family practice in which primary care was not delivered by residents and to have agreed to participate in all phases (e.g., needs assessment, training and evaluation) of a training program on interventions to help patients reduce alcohol consumption or quit smoking.

main outcome measuresMotivations concerning early intervention for alcohol use and perceived barriers to such intervention, as identified by physicians.

resultsPhysicians in the focus groups and those interviewed endorsed their role in helping patients to reduce alcohol consumption and cited several reasons for the importance of that role. There was strong support for viewing alcohol use as a lifestyle issue to be dealt with in the context of a holistic approach to patient care. Participants cited many barriers to fulfilling their role and were particularly concerned about the appropriateness of asking all adolescent and adult patients about alcohol use, even at visits intended to discuss other issues and concerns. Physicians gave several motivations for improving their work in reduction of alcohol consumption, including their current frustration with the lack of a systematic strategy or tangible materials to help them identify and manage patients.

conclusionsInterventions with patients who use alcohol should be framed in the context of a holistic approach to family medicine. Qualitative knowledge of the motivations and barriers affecting physicians can inform future research and educational strategies in this area.