title: Australian general practitioner perceptions of the detection and screening of at-risk drinking, and the role of the AUDIT-C: a qualitative study.
abstract: BACKGROUND
  At-risk drinking is common in Australia. Validated screening tools such as the AUDIT-C have been promoted to general practitioners (GPs), but appear rarely used and detection of at-risk drinking in primary care remains low. We sought to describe Australian GP perceptions of the detection and screening of at-risk drinking; to understand their low uptake of alcohol screening questionnaires, and in particular, their attitude to the adoption of the AUDIT-C.
  
  
  METHODS
  Semi-structured focus group interviews of four groups of GPs and GP trainees were conducted in metropolitan Sydney between August and October 2011. Audio recordings were transcribed and analysed using grounded theory methodology.
  
  
  RESULTS
  We identified four main themes: there was consensus that detecting at-risk drinking is important but difficult to do, social and cultural attitudes to alcohol consumption affect willingness to ask questions about its use, the dynamics of patient-doctor interactions are important, and alcohol screening questionnaires lack practical utility. Analysis suggests that the conceptual barriers to detecting at-risk drinking were: community stigma and stereotypes of "problem drinking", GP perceptions of unreliable patient alcohol use histories, and the perceived threat to the patient-doctor relationship.
  
  
  CONCLUSIONS
  This small exploratory study found that the practice of, and barriers to, detecting at-risk drinking appear to be inextricably linked to the sociocultural beliefs surrounding alcohol use. Screening questionnaires such as the AUDIT-C are not designed to address these issues. In the current context, it is unlikely that approaches that focus on the use of these tools will be effective at improving detection of at-risk drinking by GPs.
authors: School of Public Health and Community Medicine, The University of New South Wales, Level 3 Samuels Building, UNSW Sydney, NSW 2052, Australia. m.tam@unsw.edu.au.
authors: Chun Wah Michael
authors: CW
authors: Tam
authors: Nicholas
authors: N
authors: Zwar
authors: Roslyn
authors: R
authors: Markham
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D000437:Alcoholism / Q000175:diagnosis*; D001291:Attitude of Health Personnel; D001315:Australia; D005260:Female; D017144:Focus Groups; D058005:General Practitioners; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D057545:Social Stigma; D015813:Substance Abuse Detection / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires / Q000706:statistics & numerical data
references: Alcohol Alcohol. 2011 Jan-Feb;46(1):52-60
references: 21059696
references: J Stud Alcohol. 1980 May;41(5):417-28
references: 7412295
references: Br J Addict. 1986 Jun;81(3):405-18
references: 3461849
references: Br Med J (Clin Res Ed). 1986 Sep 20;293(6549):735-7
references: 3094634
references: JAMA. 1984 Oct 12;252(14):1905-7
references: 6471323
references: Fam Pract. 1995 Dec;12(4):419-22
references: 8826058
references: Drug Alcohol Depend. 2003 Jan 24;69(1):9-14
references: 12536061
references: J Fam Pract. 1999 Nov;48(11):899-902
references: 10907628
references: J Stud Alcohol. 1992 May;53(3):197-202
references: 1583898
references: Nurse Res. 2010;17(4):18-28
references: 20712231
references: Soc Sci Med. 2006 Nov;63(9):2418-28
references: 16814441
references: J Public Health (Oxf). 2011 Sep;33(3):412-21
references: 21169370
references: Arch Intern Med. 1998 Sep 14;158(16):1789-95
references: 9738608
references: Aust Fam Physician. 2011 Aug;40(8):570-4
references: 21814650
references: Drug Alcohol Rev. 2009 May;28(3):301-23
references: 19489992
references: Med Care. 2005 Mar;43(3):229-36
references: 15725979
references: Drug Alcohol Depend. 2002 Mar 1;66(1):39-43
references: 11850134
references: Qual Health Res. 2010 May;20(5):607-16
references: 19926797
references: Alcohol Alcohol. 2007 Jul-Aug;42(4):308-16
references: 17510102
references: Alcohol Alcohol. 2010 Mar-Apr;45(2):207-12
references: 20100927
references: BMJ. 2002 Oct 19;325(7369):870
references: 12386040
references: Alcohol Alcohol. 2000 Sep-Oct;35(5):525-30
references: 11022028
references: Fam Pract. 2012 Apr;29(2):213-22
references: 21987374