Effectiveness of a training program for the management of risky alcohol use in primary care professionals based on motivational interviewing.

OBJECTIVE: To assess the effectiveness of a training program for Primary Care (PC) professionals developed to increase knowledge, attitudes, and skills for managing patients with risky alcohol use and in the motivational interview. DESIGN: Multicenter, two-arm parallel, randomized, open-label controlled clinical trial. SETTING: PC of the Andalusian Health Service. PARTICIPANTS: The study was completed by 80 healthcare professionals from 31 PC centers. INTERVENTIONS: In both experimental and control groups, a workshop on managing patients with risky alcohol consumption and the resolution of two videotaped clinical cases with standardized patients were conducted. The experimental group attended a workshop on motivational interviewing. MAIN MEASUREMENTS: Knowledge about managing risky alcohol use, clinical performance in patients with this health problem, and assessment of the motivational interview. RESULTS: Mean age was 39.50±13.06 - SD - (95% CI: 36.59-42.41); 71.3% (95% CI: 61.1-80.9%) were women. The average score of both groups in the knowledge questionnaire before the training program was 15.10±4.66, becoming 21.99±3.93 points after the training (95% CI: 5.70-7.92; p<0.001). The experimental group showed an average score of 18.53±13.23 before the intervention with the motivational interview and 28.33±11.86 after this intervention (p=0.002). In contrast, no significant variation was found in the score of the control group. CONCLUSIONS: A training program aimed at PC professionals designed to increase knowledge on how to manage risky alcohol use and acquire communication skills in motivational interviewing is effective.

Patient participation in the discussions of options in Spanish primary care consultations.

OBJECTIVES: To determine patients' participation in the discussion of options in primary care consultations. Identify the patients' wish to participate and their perceptions of their participation and explore the potential factors that may influence these. DESIGN: Cross-sectional study. Setting. Ninety-seven general practices. Participants. six hundred and fifty-eight patients who went to their doctors for unselected reasons. Measurements. All the encounters were videoed, patient participation in decision making (DM) was assessed with two tools. After the consultation, GPs completed a questionnaire about biomedical and relational information. Patients' preferences and perception of participation was explored with different type of questions. RESULTS: Encounters successfully videoed: 638. Of these, only 90 interviews clearly showed patient participation. In 161 other interviews, patient participation was considered possible. Questionnaires collected: 645. In 60% of the situations (390 encounters), patients wished they could have stated their views about the proposed option(s), but they perceived this did not happen. The degree of participation at the consultation did not relate significantly with the physician's ideas about the type of problem, evolution and treatment. Neither did any of the considered variables influence either the patients' wish to participate in the discussion of the suggested option or their perception of this. CONCLUSIONS: GPs ask patients for their opinion and promote discussion about the suggested plan in few encounters. Patients perceive this, including many patients that previously had declared not to be interested in being involved in decisions. These results revealed an important mismatch between what patients wish and what they perceive.

Diagnostic usefulness of the Alcohol Use Disorders Identification Test (AUDIT) questionnaire for the detection of hazardous drinking and dependence on alcohol among Spanish patients.

OBJECTIVE: To check the validity of the Alcohol Use Disorders Identification Test (AUDIT) among Spanish adult citizens. METHODS: This is a descriptive observational study. The surveyed group comprised patients aged 18-80 years who went to their doctors' surgeries at two primary care centres located in Cordoba (Spain). We examined the psychometric properties of AUDIT and its capacity to correctly diagnose alcohol abuse or dependence, as defined by DSM-IV, ICD-10, and hazardous drinking. RESULTS: Six hundred and fourteen patients were studied (mean age 43+/-1.43 years). At a cut-off value of 7 points, the sensitivity of AUDIT in detecting hazardous drinking was 91.7%, and its specificity 91.9%; the area below the curve was 0.95 (95% confidence interval [CI] 0.937-0.975). To detect possible dependence, the optimum cut-off value was 6 points. According to ICD-10, sensitivity was 81.6%, specificity 82.3%, and the area under the curve 0.885 (95% CI 0.848-0.923; p<0.001), whereas according to DSM-IV criteria, sensitivity was 88.3%, specificity 83.1%, and the area under the curve 0.918 (95% CI 0.885-0.951). CONCLUSION: The high criterion-related validity of AUDIT was proven, regardless of the gold standard used.