Article in English.
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Abstract:
Screening and brief intervention (BI) for alcohol problems has been difficult to implement among general practitioners (GPs) in Norway. The aim of this article is to sum up the efforts and reflect on the relatively limited achievements so far.
In the 1980’s, data for the identification (AUDIT) part of the WHO-project was collected from GPs and general hospitals in Norway. Also high risk patients were recruited for BI from health centres and GPs in the Bergen area. The recruitment of candidates turned out to be difficult, as few patients met the inclusion criteria; their alcohol risk was not high enough. Another problem has been that not many GPs are interested in using new BI technology.
In a survey we found that Norwegian GPs felt more competent to give advice on smoking than on alcohol. The most important obstacles for better alcohol counseling were lack of time and BI competence. The doctors also preferred to use BI selectively - only on patients with symptoms of high risk consumption. General screening was regarded as an intrusion of patient autonomy.
A policy document by the Norwegian College of GPs clearly states that “the extent of preventive work must be balanced with other core duties, as the GP’s primary task is to offer health care for the sick". In other words, many preventive interventions compete for the GP’s time and attention.