Alcohol screening and brief interventions in primary care - Evidence and a pragmatic practice-based approach.
BACKGROUND
Risky alcohol drinking is a common problem in adults presenting in Australian general practice. Preventive health guidelines recommend routine delivery of alcohol screening and brief intervention (ASBI) by general practitioners (GPs). However, ASBIs have rarely been implemented successfully in a sustainable manner.


OBJECTIVE
In this article, we explain the current state of empirical evidence for the effectiveness of ASBI in primary care and describe a pragmatic interpretation of how this evidence applies to routine care.


CONCLUSIONS
The empirical evidence surrounding ASBIs is complex. ASBIs are efficacious in research settings, but their effectiveness when compared with control interventions in real-world practice is less certain. Alcohol assessment within therapeutic doctor-patient relationships, rather than the specific formal tools, may be the 'active ingredient'. A pragmatic, practice-based approach to early detection of risky drinking is to focus on strategies that allow asking patients about their drinking more regularly, documenting it, and using quality improvement methodology to improve alcohol recording data completeness for the practice population.
BSc (Med) MBBS MMH (GP) FRACGP, Staff Specialist in General Practice, General Practice Unit, South Western Sydney Local Health District; Conjoint Senior Lecturer, University of New South Wales, Sydney, NSW; RACGP National Research and Evaluation Ethics Committee, NSW.
C W Michael
CW
Tam
Andrew
A
Knight
Siaw-Teng
ST
Liaw
D000328:Adult; D000428:Alcohol Drinking / Q000523:psychology / Q000628:therapy*; D001315:Australia; D003142:Communication; D058005:General Practitioners; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D012309:Risk-Taking