title: When general practitioners talk about alcohol: exploring facilitating and hampering factors for pragmatic case finding.
abstract: BACKGROUND
  The aim was to explore individual and system factors facilitating or hampering pragmatic case finding, an identification strategy based on clinical signs and targeted screening.
  
  
  METHODS
  Two focus groups with general practitioners were interviewed twice, in the context of a four-session seminar on alcohol and complex drug problems, and an additional focus group interview with general practitioners not attending the seminar. Interviews focused mainly on conditions for talking about alcohol, views on collaboration with colleagues, how they deal with complex issues, and strategies for learning and quality improvement.
  
  
  RESULTS
  The participants presented many deliberate strategies for quality improvement and learning together, but there was a tendency to avoid discussing complex case stories or potentially controversial topics with colleagues. Possible barriers to change were presented. The majority of their stories on talking about alcohol coincided well with the concept of pragmatic case finding. The duality between shame and normality, time constraints and a need for structure were the most important individual barriers to an open and respectful conversation about alcohol with patients.
  
  
  CONCLUSIONS
  Our study supports pragmatic case finding as a relevant and viable strategy for talking about alcohol in general practice, and as an alternative to screening and brief intervention. Quality improvement in practice is strengthened when it is adapted to the clinical setting, and builds on and stimulates the GPS' and staff's own strategies for learning and quality work.
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway Research Unit for General Practice, Uni health, Uni Research, Bergen, Norway Centre for Alcohol and Drug Research, Stavanger University Hospital, Norway giljelid@gmail.com.
authors.forename: Torgeir Gilje
authors.initials: TG
authors.lastname: Lid
authors.affiliation: Centre for Alcohol and Drug Research, Stavanger University Hospital, Norway.
authors.forename: Sverre
authors.initials: S
authors.lastname: Nesvåg
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Norway.
authors.forename: Eivind
authors.initials: E
authors.lastname: Meland
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D019973:Alcohol-Related Disorders / Q000517:prevention & control; D003142:Communication; D005260:Female; D017144:Focus Groups; D058006:General Practice; D058005:General Practitioners / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D036301:Qualitative Research; D058996:Quality Improvement
keywords: Alcohol-related health problems; communities of practice; focus groups; general practice; quality improvement