Journal of General Internal Medicine

, Volume 21, Issue 9, pp 966–972

How primary care providers talk to patients about alcohol a qualitative study

  • Kinsey A. McCormick
  • Nancy E. Cochran
  • Anthony L. Back
  • Joseph O. Merrill
  • Emily C. Williams
  • Katharine A. Bradley
Original Articles

Abstract

BACKGROUND: Alcohol misuse is a common and well-documented source of morbidity and mortality. Brief primary care alcohol counseling has been shown to benefit patients with alcohol misuse.

OBJECTIVE: To describe alcohol-related discussions between primary care providers and patients who screened positive for alcohol misuse.

DESIGN: An exploratory, qualitative analysis of audiotaped primary care visits containing discussions of alcohol use.

PARTICIPANTS: Participants were 29 male outpatients at a Veterans Affairs (VA) General Internal Medicine Clinic who screened positive for alcohol misuse and their 14 primary care providers, all of whom were participating in a larger quality improvement trial.

MEASUREMENTS: Audiotaped visits with any alcohol-related discussion were transcribed and coded using grounded theory and conversation analysis, both qualitative research techniques.

RESULTS: Three themes were identified: (1) patients disclosed information regarding their alcohol use, but providers often did not explore these disclosures; (2) advice about alcohol use was typically vague and/or tentative in contrast to smoking-related advice, which was more common and usually more clear and firm; and (3) discomfort on the part of the provider was evident during alcohol-related discussions.

LIMITATIONS: Generalizability of findings from this single-site VA study is unknown.

CONCLUSION: Findings from this single site study suggest that provider discomfort and avoidance are important barriers to evidence-based brief alcohol counseling. Further investigation into current alcohol counseling practices is needed to determine whether these patterns extend to other primary care settings, and to inform future educational efforts.

Key words

alcohol drinking primary care communication physician-patient relations 

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Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Kinsey A. McCormick
    • 1
    • 2
  • Nancy E. Cochran
    • 3
    • 4
  • Anthony L. Back
    • 2
  • Joseph O. Merrill
    • 2
    • 5
  • Emily C. Williams
    • 2
    • 6
  • Katharine A. Bradley
    • 1
    • 2
    • 6
    • 7
    • 8
  1. 1.Northwest Health Services Research and Development Center of ExcellenceVA Puget Sound Health Care SystemSeattleUSA
  2. 2.Department of MedicineUniversity of WashingtonSeattleUSA
  3. 3.White River Junction VA Hospital, White RiverJunctionUSA
  4. 4.Department of Medicine and Community and Family MedicineDartmouth Medical SchoolHanoverUSA
  5. 5.Harborview Medical CenterSeattleUSA
  6. 6.Center of Excellence in Substance Abuse Treatment and EducationVA Puget Sound Health Care SystemSeattleUSA
  7. 7.Primary and Specialty Medical Care ServiceVA Puget Sound Health Care SystemSeattleUSA
  8. 8.Department of Health ServicesUniversity of WashingtonSeattleUSA
  9. 9.VA Puget Sound Health Services Research and DevelopmentSeattle

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