Detection and management of alcohol use disorders in German primary care influenced by non-clinical factors.

AIMS: The primary objective was to assess the proportion of detected and correctly referred patients in German primary care. The secondary objective was to identify patient and practitioner characteristics that predict detection and correct referral. METHODS: In this clustered cross-sectional survey in German primary care, 3003 patients were consecutively invited to participate, and were asked to fill in a standardized health questionnaire. They were then screened for problematic alcohol consumption using the Alcohol Use Disorders Identification Test. The physicians recorded their assessment of the presence of any alcohol use disorder and documented the treatment course of all identified patients for 3 months. RESULTS: Correctly identified problem drinkers were 38.6% in a per-protocol analysis and 33.6% using a worst-case scenario. Referral behaviour of physicians was in conformity with current practice guidelines in 64.6% of the documented cases and 27.0% in a worst-case scenario. Several patient (e.g. sex, age) and practitioner characteristics (e.g. age), which influence the diagnosis and referral of patients, could be identified. CONCLUSIONS: There is a clear need to increase the special diagnostic and therapeutic skills of general practitioners so that they may be able to indicate and perform secondary prevention. Further research should focus on the likely effects of the implementation of these diagnostic and management tools.

An adherence typology: coping, quality of life, and physical symptoms of people living with HIV/AIDS and their adherence to antiretroviral treatment.

BACKGROUND: Research has found that patient adherence to antiretroviral therapy is crucial to treatment success, but this research did not investigate the patient's viewpoint. This study examined relationships between types of adherence and coping, psychosocial factors, quality of life (QoL), and physical symptoms from the perspective of people living with HIV/AIDS. MATERIAL/METHODS: The quantitative study involved 100 HIV-positive participants. Questionnaires comprised the Trier Scales on Coping with Physical Illness, Medical-Outcomes-Study HIV Health-Survey QoL, Social Factors of Antiretroviral Therapy, and the HIV/AIDS Physical Symptom-Checklist. A sub-sample of 41 participants underwent semi-standardized interviews eliciting the type of adherence. Grounded Theory was the method of qualitative analyses. RESULTS: Maladaptive coping (rumination) related to poor mental health (p<0.001), concealing the HIV-infection (p<0.01), and being treatment-naive (p<0.01). Spiritual coping was more likely in women (p<0.001). Overall, QoL was worse in participants with more physical symptoms (p<0.001) and in those seeking mental health care (p<0.001). Working and maintaining a regular daily routine were associated with better adherence (p<0.05). Four adherence types were identified: 'Traditional Adherence' (with indifferent, faithful, and anxious subtypes), 'Traditional Non-Adherence', 'Critical Adherence', and 'Critical Non-Adherence'. The traditional types underscored a paternalistic medical model, while critical types emphasized 'autonomous patients'. Critical types were less frequent (39%), although superior to traditional types (p<0.001) in internal locus of control, optimal social support, and adaptive coping. CONCLUSIONS: Critical adherence is superior to traditional adherence with respect to physical and psychosocial factors. Strategies to improve adherence should therefore target empowerment and autonomy rather than patient obedience.