title: How primary care providers talk to patients about alcohol: a qualitative study.
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.
  
  
  METHODS
  An exploratory, qualitative analysis of audiotaped primary care visits containing discussions of alcohol use.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Generalizability of findings from this single-site VA study is unknown.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, Seattle, WA, USA. kamc@u.washington.edu
authors.forename: Kinsey A
authors.initials: KA
authors.lastname: McCormick
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Cochran
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Back
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Merrill
authors.forename: Emily C
authors.initials: EC
authors.lastname: Williams
authors.forename: Katharine A
authors.initials: KA
authors.lastname: Bradley
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000523:psychology*; D001291:Attitude of Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D036301:Qualitative Research; D013637:Tape Recording