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Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care

BACKGROUND: Attempts to routinely embed brief interventions in health systems have long been challenging, with healthcare professionals concerned about role adequacy, legitimacy, and support. This is the first study to explore clinical pharmacists’ experiences of discussing alcohol with patients in...

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Autores principales: Madden, Mary, Stewart, Duncan, Mills, Thomas, McCambridge, Jim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10062268/
https://www.ncbi.nlm.nih.gov/pubmed/36998099
http://dx.doi.org/10.1186/s13722-023-00378-x
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author Madden, Mary
Stewart, Duncan
Mills, Thomas
McCambridge, Jim
author_facet Madden, Mary
Stewart, Duncan
Mills, Thomas
McCambridge, Jim
author_sort Madden, Mary
collection PubMed
description BACKGROUND: Attempts to routinely embed brief interventions in health systems have long been challenging, with healthcare professionals concerned about role adequacy, legitimacy, and support. This is the first study to explore clinical pharmacists’ experiences of discussing alcohol with patients in their new role in UK primary care, in developing a novel approach to brief intervention. It investigates their confidence with the subject of alcohol in routine practice and explores views on a new approach, integrating alcohol into the medication review as another drug directly linked to the patient’s health conditions and medicines, rather than a separated ‘healthy living’ issue. The study forms part of wider efforts to repurpose and reimagine the potential application of brief interventions and to rework their contents. METHODS: Longitudinal qualitative study of 10 recruits to the new clinical pharmacist role in English primary care, involving three semi-structured interviews over approximately 16 months, supplemented by 10 one-off interviews with pharmacists already established in general practice. RESULTS: When raised at all, enquiring about alcohol in medication reviews was described in terms of calculating dose and level of consumption, leading to crude advice to reduce drinking. The idea was that those who appeared dependent should be referred to specialist services, though few such referrals were recalled. Pharmacists acknowledged that they were not currently considering alcohol as a drug in their practice and were interested in learning more about this concept and the approach it entailed, particularly in relation to polypharmacy. Some recognised a linked need to enhance consultation skills. CONCLUSIONS: Alcohol complicates routine clinical care and adversely impacts patient outcomes, even for those drinking at seemingly unremarkable levels. Changing clinical practice on alcohol requires engaging with, and supportively challenging, routine practices and entrenched ideas of different kinds. Framing alcohol as a drug may help shift the focus from patients with alcohol problems to problems caused for patients by alcohol. This is less stigmatising and provides role legitimacy for pharmacists to address alcohol clinically in medication reviews, thus providing one element in the formation of a new prevention paradigm. This approach invites further innovations tailored to other healthcare professional roles. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13722-023-00378-x.
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spelling pubmed-100622682023-03-31 Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care Madden, Mary Stewart, Duncan Mills, Thomas McCambridge, Jim Addict Sci Clin Pract Research BACKGROUND: Attempts to routinely embed brief interventions in health systems have long been challenging, with healthcare professionals concerned about role adequacy, legitimacy, and support. This is the first study to explore clinical pharmacists’ experiences of discussing alcohol with patients in their new role in UK primary care, in developing a novel approach to brief intervention. It investigates their confidence with the subject of alcohol in routine practice and explores views on a new approach, integrating alcohol into the medication review as another drug directly linked to the patient’s health conditions and medicines, rather than a separated ‘healthy living’ issue. The study forms part of wider efforts to repurpose and reimagine the potential application of brief interventions and to rework their contents. METHODS: Longitudinal qualitative study of 10 recruits to the new clinical pharmacist role in English primary care, involving three semi-structured interviews over approximately 16 months, supplemented by 10 one-off interviews with pharmacists already established in general practice. RESULTS: When raised at all, enquiring about alcohol in medication reviews was described in terms of calculating dose and level of consumption, leading to crude advice to reduce drinking. The idea was that those who appeared dependent should be referred to specialist services, though few such referrals were recalled. Pharmacists acknowledged that they were not currently considering alcohol as a drug in their practice and were interested in learning more about this concept and the approach it entailed, particularly in relation to polypharmacy. Some recognised a linked need to enhance consultation skills. CONCLUSIONS: Alcohol complicates routine clinical care and adversely impacts patient outcomes, even for those drinking at seemingly unremarkable levels. Changing clinical practice on alcohol requires engaging with, and supportively challenging, routine practices and entrenched ideas of different kinds. Framing alcohol as a drug may help shift the focus from patients with alcohol problems to problems caused for patients by alcohol. This is less stigmatising and provides role legitimacy for pharmacists to address alcohol clinically in medication reviews, thus providing one element in the formation of a new prevention paradigm. This approach invites further innovations tailored to other healthcare professional roles. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13722-023-00378-x. BioMed Central 2023-03-30 2023 /pmc/articles/PMC10062268/ /pubmed/36998099 http://dx.doi.org/10.1186/s13722-023-00378-x Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Madden, Mary
Stewart, Duncan
Mills, Thomas
McCambridge, Jim
Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care
title Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care
title_full Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care
title_fullStr Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care
title_full_unstemmed Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care
title_short Alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care
title_sort alcohol, the overlooked drug: clinical pharmacist perspectives on addressing alcohol in primary care
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10062268/
https://www.ncbi.nlm.nih.gov/pubmed/36998099
http://dx.doi.org/10.1186/s13722-023-00378-x
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