Attitudes of Swedish general practitioners and nurses to working with lifestyle change, with special reference to alcohol consumption

AIMS: To explore the attitudes of Swedish general practitioners (GPs) and nurses to secondary alcohol prevention (early identification of, and intervention for, alcohol-related problems) and compare it to their attitudes to other important lifestyle behaviours such as smoking, stress, exercise, and overweight. METHODS: An adjusted version of The WHO Collaborative Study Questionnaire for General Practitioners was posted to all GPs and nurses in the County of Skaraborg, Sweden; 68 GPs and 193 nurses responded. RESULTS: The importance of drinking alcohol moderately, counselling skills on reducing alcohol consumption and perceived current effectiveness in helping patients change lifestyle behaviours ranked lower than working with all the other lifestyle behaviours. The nurses rated their potential effectiveness in helping patients change lifestyle higher than that of GPs for all the lifestyle behaviours. Nurses receiving more alcohol-related education had more positive attitudes than nurses with less education. For alcohol, the GPs assessed their role adequacy, role legitimacy and motivation higher than that of the nurses. The main obstacles for the GPs to carry out alcohol intervention were lack of training in counselling for reducing alcohol consumption, time constraints, and the fact that the doctors did not know how to identify problem drinkers who have no obvious symptoms of excess consumption. CONCLUSION: GPs and the nurses estimated their alcohol-related competence as lower than working with many other health-related lifestyles. These results can be explained by lack of practical skills, lack of training in suitable intervention techniques, and unsupportive working environments. All these elements must be considered when planning secondary alcohol prevention programs in primary health care.     

Changes in attitudes and practices in primary health care with regard to early intervention for problem drinkers.

During an intervention period of 1 to 2 months, a project team supported general practitioners (GPs) and nurses in four primary health care centres in Sweden in introducing new routines for detection and treatment of problem drinkers. After the implementation of the new methods, the GPs reported increased involvement in early detection and intervention significantly more often than the nurses did. A majority in both groups reported perceived improvement in skills. There was a significant positive change of the attitudes concerning working with alcohol-related problems in the nurses reaching the same level as the GPs. In the nurses, attitudes and self-perceived intervention skills were improved, but to a lesser extent than their practice. The results indicate that future efforts concerning improvement of primary health care staff involvement in alcohol interventions should focus on training, supervision, and giving positive examples, rather than on changing an already positive attitude towards alcohol intervention. The potential role of nurses is still uncertain and not utilized sufficiently.     

General practice nurses' knowledge of alcohol use and misuse: a questionnaire survey

Nurses in general practice (termed practice nurses) are an under-utilized resource for the detection and management of patients with alcohol misuse. However, little is known about their knowledge and attitudes towards alcohol use and misuse. We therefore conducted a postal questionnaire survey of 132 practice nurses in Liverpool (UK). The results of our survey (response rate 77%) show that a knowledge and skills gap exists in the delivery of effective advice on alcohol-related issues. Indeed, our results suggest that only one in two women and one in three men are receiving correct advice on sensible limits of alcohol consumption, this despite the fact that alcohol histories are taken. Further training was requested by most nurses to develop their screening and health promotion roles, and to become involved in the management of patients with alcohol-related problems in primary care. We suggest practice nurses should be encouraged to become involved in screening for, and management of, alcohol-related problems. However, it is important to ensure that the nurses receive appropriate training and have adequate back-up facilities from doctors and other workers involved in the care of patients with alcohol-related problems.     

Screening and managing cannabis use: comparing GP’s and nurses’ knowledge,beliefs, and behavior

ABSTRACT: BACKGROUND: General practitioners (GPs) and nurses are ideally placed to address the significant unmet demand for the treatment of cannabis-related problems given the numbers of people who regularly seek their care. The aim of this study was to evaluate differences between GPs and nurses' perceived knowledge, beliefs, and behaviors toward cannabis use and its screening and management. METHODS: This study involved 161 nurses and 503 GPs who completed a survey distributed via conference satchels to delegates of Healthed seminars focused on topics relevant to women and children's health. Differences between GPs and nurses were analyzed using chi2- tests and two-sample t-tests, while logistic regression examined predictors of service provision. RESULTS: GPs were more likely than nurses to have engaged in cannabis-related service provision, but also more frequently reported barriers related to time, interest, and having more important issues to address. Nurses reported less knowledge, skills, and role legitimacy. Perceived screening skills predicted screening and referral to alcohol and other drug (AOD) services, while knowing a regular user increased the likelihood of referrals only. CONCLUSIONS: Approaches to increase cannabis-related screening and intervention may be improved by involving nurses, and by leveraging the relationship between nurses and doctors, in primary care.     

Opinions on alcohol-related issues among professionals in primary, occupational, and specialized health care

— The objective of this study was to analyse differencesin health care personnel's knowledge, skills, and attitudesin relation to alcohol-related matters by a postal questionnairebetween primary, occupational, and specialized health care.Heavy drinking was considered to be common among patients atall health care levels, and particularly in specialized healthcare. However, early recognition and treatment of heavy drinkerswas considered more appropriate in primary and occupationalhealth care, than in specialized health care. Alcohol consumptionwas found to be an easy subject to discuss at all health carelevels. In addition, 90% (165/183) of the respondents thoughtthat patients had a positive or neutral attitude towards questionson their alcohol consumption. Of the respondents, 32% (58/182)considered discussing alcohol-related matters unacceptable and81% (121/149) believed that they could not influence patients'drinking using brief intervention; there was no significantdifference between different settings. Additionally, motivationalskills of doctors and nurses were found to be poor at all healthcare levels. Our study shows that, although discussing alcoholconsumption is easy, better motivational skills and more positiveattitudes are needed in primary, occupational, and specializedhealth care. Professionals need further education at all healthcare levels, but particularly in specialized health care.     

Domestic violence and primary care. Attitudes, practices, and beliefs.

OBJECTIVE: To assess the attitudes and beliefs of the primary care provider team (physicians, physician assistants, nurses, and medical assistants) toward the identification and management of abused patients and perpetrators of domestic violence (DV). DESIGN: Survey of the health care team using a confidential questionnaire. SETTING AND SUBJECTS: Five primary care clinics with 240 providers at a large urban health maintenance organization. RESULTS: The response rate was 86% (206 respondents). Fifty percent of clinicians and 70% of nurses/assistants believed that the prevalence of DV in their practice was 1% or loss; 1 in 10 clinicians and nearly half of nurses/assistants had never identified an abused person; 45% of clinicians never or seldom asked about DV when examining injured patients; and all participants were much less confident in asking about DV than about smoking or consuming alcohol. Twenty-five percent believed the abused person's personality led to the violence; 28% believed they did not have strategies to help abused persons; and 20% were concerned for their personal safety in discussing DV. Only 10% believed they had management information, but 77% had not attended any educational programs on DV in the past year. CONCLUSIONS: This study provides important information about current knowledge, attitudes, and beliefs of health care providers toward the diagnosis and management of DV. This information should prove useful to all who attempt to design clinical strategies and educational programs to address this issue.     

Factors influencing GPs' decisions regarding screening for high alcohol consumption: a focus group study in Swedish primary care

OBJECTIVE: The aim of this study was to explore factors that influence general practitioners' (GPs') decisions regarding screening for high alcohol consumption. METHODS: GPs working at three primary healthcare centres in Sweden participated in focus group interviews. The interviews were recorded and transcribed verbatim, and a deductive framework approach was used for the analysis. RESULTS: The majority of the participating GPs did not believe in asking all patients about their alcohol consumption. Reported factors that influenced how many and which patients were questioned about alcohol consumption were time, age of the patient, consultation setting, patient-physician relationship, what symptoms the patient presented with, and knowledge of measures if patients appear to have a high alcohol consumption. Thus, alcohol screening and intervention were not performed in all patient groups as was originally intended, but were performed in limited groups of patients such as those with alcohol-related symptoms. CONCLUSIONS: Although the number of participants in this study was small and the conclusions cannot be generalized, the results provide some valuable insights into why GPs are hesitant to engage in screening for high alcohol consumption. Since prevention of alcohol-related health problems is an important public health issue, many different screening and intervention strategies have to be formulated and evaluated in order to reach patients with both hazardous and harmful alcohol consumption within the healthcare system. Screening all consecutive patients for a limited period or screening patient groups known to include a fairly high frequency of high alcohol consumers are two ways of limiting the time requirements and increasing role legitimacy. Still, there is a need for a broader public health strategy involving many players in the community in alcohol preventive measures, especially in more primary preventive approaches.     

Attitudes to cardiovascular health promotion among GPs and practice nurses.

BACKGROUND: Cardiovascular health promotion is an important element of national health strategy, but doubts have been raised about current methods, and attitudes among general practice staff are ambivalent. OBJECTIVES: We aimed to assess attitudes to cardiovascular health promotion, opinions about efficacy and perceptions of skills in lifestyle counselling in GPs and nurses from the same practices. METHOD: A questionnaire survey of 107 GPs and 58 practice nurses from 19 group practices (100% response rate). RESULTS: Practice nurses were seen to have the main responsibility for cardiovascular health promotion. Although attitudes to health promotion were generally positive, lack of training in lifestyle counselling was perceived to be a problem. Few responders believed that they were very influential in helping people change their lifestyles. Beliefs about the effectiveness of lifestyle counselling were mixed, with cigarette smoking, physical inactivity and obesity being seen as difficult to change. Beliefs in the effectiveness of lifestyle counselling were associated with positive attitudes towards health promotion and greater confidence in training. No association between personal health behaviour and attitudes towards health promotion were observed. CONCLUSIONS: It is recognized that health promotion involves more than the provision of simple information and advice, but GPs and practice nurses lack confidence in lifestyle counselling skills. The attitudes of health professionals are crucial to the implementation of prevention strategies and require regular review.     

Nurses’ knowledge and attitudes regarding nutrition in the elderly

Background-aims  Nurses in the community are in contact with the elderly at different levels of care. The aim of this study was to assess nurses’ knowledge and attitudes regarding nutritional-care for the elderly, and the impact of their attitude on the quality of assessment-care they provide to this growing population in need of nutritional-care. Methods  A structured questionnaire was distributed by mail to 600 nurses working in Maccabi-Health-Care-Services (MHS). The questionnaire assessed different aspects of elderly nutrition. Results  The vast majority (91%) of the participants reported treating elderly in their practice. Religious nurses and the nurses with an individual orientation specialty reported more positive attitudes about nutritional-care for the elderly than others did (p=0.05). Nurses with a bachelor’s degree had better attitudes than registered nurses about the importance of nutrition for the elderly (p< 0.01). Younger nurses were found to be more knowledgeable than older ones (p< 0.04). The nurses perceived nutrition as influencing different health conditions, and 85% pointed to the importance of feeding at the end of life. Conclusions  Nurses working in the community recognize the impact of proper nutrition on elderly patients’ health, but need more training in screening for nutritional problems in the elderly.     

Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial

Background  

Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-based Dementia Training Program (DTP) aimed at stimulating collaboration in dementia primary care. We expect this program to increase the number of cognitive assessments and dementia diagnoses and to improve attitudes and knowledge of GPs and nurses.     

Differences in tobacco assessment and intervention practices: a regional snapshot

BACKGROUND: This research describes tobacco attitudes and practices of health care providers in the Upper Midwest. A baseline measure of preventive practices by providers was needed to plan effective tobacco intervention education programs. METHODS: Health care providers in a 16-county region received a mailed survey regarding tobacco assessment practices, intervention practices, attitudes, skills/knowledge, barriers, and desire for tobacco education. The survey was sent to all chiropractors, dentists, nurse practitioners/physician assistants, physicians (primary care and specialist), and public health nurses in the region. A total of 51.9% (n = 614) of all providers returned usable surveys. RESULTS: Significant differences were found between provider groups on all measured concepts. Primary care physicians, nurse practitioners/physician assistants, and public health nurses were more likely than specialist physicians, dentists, and chiropractors to assess, intervene, be supportive of tobacco cessation, have skills/knowledge about cessation, perceive fewer barriers, and want further education. CONCLUSIONS: In this region, provider groups differed in tobacco use assessment and treatment. All provider groups desired education regarding tobacco intervention. Region-wide tobacco cessation educational initiatives need to take into account differences between provider groups.     

Implementation and dissemination of methods for prevention of alcohol problems in primary health care: a feasibility study

Secondary prevention of alcohol problems in health care has been proved efficacious in many studies, yet its implementation remains scarce, and its effectiveness in regular health care remains unknown. This article reports results from a feasibility study of dissemination of alcohol prevention methods in primary health care in Stockholm. Initial interviews with general practitioners (GPs) and district health nurses indicated that few raised the issue of alcohol with patients, made notes about alcohol in patient charts or found working with alcohol issues rewarding. The impact of a training session, where a project nurse visited all willing GPs and nurses, was limited. Although the uptake of the prevention package was high, follow-up at 3 months indicated that little use was made of the materials. Specifically, screening rates were low. In the future, secondary prevention of alcohol problems will require better adaptation to the realities of primary care.     

Alcohol-related knowledge, beliefs and attitudes among health and clerical personnel

Health personnel has been thought to pay too little attention to alcohol-related problems. Knowledge, attitudes and beliefs related to alcohol were studied among 225 physicians, 296 nurses, and 279 clerical employees. Knowledge scores were constructed by giving one point for every correct answer. For knowledge on alcoholic beverages and biological facts (11 questions), the mean scores were: physicians 7.7, nurses 6.7, and clerical employees 6.5. For etiologic knowledge (12 items), the means were: physicians 8.6, nurses 6.9, and clerical employees 6.3. The respective scores for prognostic knowledge (9 items) were: physicians 6.8, nurses 6.3, clerical employees 5.5. For knowledge on prevention and treatment the mean scores were: physicians 2.7, nurses 2.2 and clerical personnel 2.3. Physicians had more permissive attitudes towards alcohol use in various social situations and were less likely to recommend compulsory treatment than nurses or clerical employees. With respect to the prevention of alcohol problems, all groups considered face-to-face health education to be the most effective approach, followed by radio and TV education, and then voluntary treatment. Beverage price increases were regarded to be the least effective approach by nurses and clerical employees, while physicians felt that the press was the least likely source of enlightenment. Knowledge was only remotely related to age, marital status and permissive attitudes. Health personnel knew more about alcohol-related problems than lay people, but there is room for further improvement.     

Usefulness, length and content of alcohol-related discussions in primary health care: the exit poll survey

AIMS: To evaluate patients' opinions of the usefulness of alcohol-related discussions with general practitioners (GPs), the time used for the discussion and its main content. METHODS: Exit poll survey to 2000 consecutive patients right after GP consultations. RESULTS: The response rate was 60.2% (1203/2000). Of the patients 11.6% (139/1203) reported that they were asked and/or advised about alcohol during the consultation. The time used for discussion about alcohol was mostly <4 min; longer for heavy than for non-heavy drinkers. Main topics of the discussion dealt with quantities consumed and harm caused by alcohol. The majority of the patients (81%) reported that discussions concerning alcohol were useful. In that respect heavy drinkers did not differ from non-heavy drinkers. CONCLUSIONS: Discussions about alcohol in primary health care were rare and short, but patients' opinions about their usefulness were mainly positive.     

Genetics Education for Primary Care Providers in Community Health Settings

Patients who are in need of genetic services are often inappropriately managed, in part due to inadequate knowledge of genetic issues among primary health care providers. The purpose of this study was to determine the effect of a genetics education program on the knowledge and attitudes of primary care providers in community health settings. A total of one hundred twenty-one primary care providers who work in Texas Public Health Region VIII participated in an educational program designed to provide basic genetics information. A one-group pretest-posttest design was used to assess knowledge and attitudes of subjects, and comparisons were made pre and post intervention. Pretest assessment revealed less than adequate knowledge about basic genetic principles and relatively positive attitudes among the subjects. Following the program, there were statistically significant increases in both knowledge about genetic conditions (P = .001) and attitudes toward provision of genetic services (P = .001). These results indicate that primary health care providers, motivated to learn complex materials and new skills in order to assist their patients, can do so in a relatively short time period.     

A strategy to increase the palliative care capacity of rural primary health care providers

OBJECTIVE: To pilot and evaluate an intervention aimed at increasing the palliative care capacity of primary health care providers in rural and remote communities. DESIGN: Pre- and post-workshop, and three months follow-up questionnaires. SETTING: Four locations in Far North Queensland. SUBJECTS: One hundred and forty-nine primary health care providers ranging from personal care workers to general practitioners (GPs). INTERVENTIONS: Fourteen workshops were conducted. These were tailored to local palliative case loads facilitated by a specialist palliative care team from the Mt Olivet Hospice Service. Workshop content consisted of introductory didactic teaching based on participant-nominated topics, small group case management discussions and a session devoted to psychosocial and counselling inputs. MAIN OUTCOME MEASURES: Cost, GP reach, evaluation of educational and clinical objectives. RESULTS: Average cost per participant--excluding wages--was 271 dollars. Thirty-two per cent of local GPs attended the workshops and 93.2% of participants reported that the workshops had satisfied their educational learning objectives. Evaluation of GP clinical performance revealed significant improvements in confidence regarding palliative care knowledge and skill levels as well as the management of common palliative symptoms. Evaluation of other primary health care providers' clinical performance showed significant improvements in skills, management and rated knowledge. CONCLUSIONS: This intervention is relatively inexpensive, has reasonable reach and is effective as measured by educational and clinical outcomes.     

Health workers and AIDS: knowledge, attitudes and experiences as determinants of anxiety

The objective of the study was to measure the level of HIV/AIDS related anxiety among health care workers and identify its determinants. Data were obtained by means of a mailed, anonymous, self-administered questionnaire distributed to 2561 Danish medical doctors, nurses and nursing aides drawn randomly from the lists of members of the respective national associations. The data were analysed on the basis of a pre-study model including 12 variables hypothesizing a hierarchy of causal dependencies with anxiety at the top. 44% of the participants expressed HIV/AIDS related anxiety--hospital workers more than primary care workers, the older less than the younger. Anxiety was significantly associated with negative/restrictive attitudes towards HIV positives and gay men and with low levels of knowledge about HIV transmission and less education about HIV/AIDS. Negative/restrictive attitudes towards HIV positives were associated both with less knowledge regarding HIV transmission and fewer contacts with HIV positives. Similar associations were found regarding gay men. It is suggested that new kinds of training programmes be established which focus much more on attitudes and norms concerning HIV/AIDS--especially among health care workers with only occasional contact with HIV patients.     

General practitioners,primary care and support for carers in England: can training make a difference?

As a part of the national carers' strategy, the Department of Health commissioned six pilot workshops spread across England for General Practitioners (GPs) and other primary healthcare workers. The six workshops were held during September and October 2009, arranged by the Royal College of General Practitioners and planned in consultation with the Princess Royal Trust for Carers. The workshops were delivered by one of two GPs and by a carer. The Department of Health commissioned an evaluation of the workshop programme. This paper reports on the attitudes towards and knowledge of carers by GPs and other primary care workers, such as community matrons, practice nurses, healthcare assistants, practice managers and receptionists. It also tracks changes over time from the questionnaire responses pre- and post-workshop and 3 months later in the GPs' and other primary care workers' response to carers. Prior to the workshops, GPs and other primary care workers saw primary care as having a significant role in directly assisting carers, especially with emotional support and in signposting to other services. However, there was a lack of knowledge about issues facing carers, limited confidence in assisting carers and few services within the primary care teams directly focussed on carers. The workshops were regarded positively by those who attended, and the evaluation found that there was a positive impact with GPs and other primary care workers reporting specific actions they had taken post-workshop to assist carers, greater confidence and awareness in working with carers, and increased knowledge about carers. The paper concludes by recommending how the pilot programme might be rolled out more widely.     

新医改视域下北京市基层护士对失能失智老年照护的知信行现状与发展需求分析

目的 了解北京市基层护士对失能失智老年照护的知信行现状及发展需求,为改善基层医院失能失智老年照护策略及政府相关政策的提出提供实证依据.方法 采用自制《基层护士老年失能失智照护知信行及需求调查问卷》对北京市232名基层护士进行老年失能失智照护知识、行为、态度以及需求的调查.结果 北京市基层护士失能失智老年照护知信行总分为...     

Knowledge and attitudes of primary care physicians regarding battered women. Comparison between specialists in family medicine and GPs

BACKGROUND: Domestic violence is a widespread public health problem and an important part of primary care practice. OBJECTIVE: To evaluate the approach of primary care physicians (family physicians and GPs) to the care of battered women. METHODS: A self-report questionnaire containing items about experience, knowledge and attitudes regarding the care of battered women was mailed to a random sample of 300 primary care physicians employed by the two major health management organizations in Israel. The population included family physicians, who have 4 years of residency training in primary care, and GPs, who do not undergo specialization after completing their medical studies. RESULTS: A total of 236 physicians (130 family physicians and 106 GPs) responded. In general, the physicians had had very little exposure to the problem and estimated its prevalence in the community as less than half that indicated in the medical literature. Compared with the GPs, however, the family physicians reported more exposure to the subject (P < 0.001) and had better knowledge of its prevalence and risk factors (P < 0.001). They also showed a greater tendency to view the problem as universal (P < 0.05) and as part of their professional responsibilities. However, both groups tended not to include the care of battered women with no physical injury within their professional duties. CONCLUSIONS: Physicians should be made more aware of the problem of battered women within the context of their routine professional practice and of the importance of keeping abreast of the subject. Educators should place more emphasis on imparting knowledge and skills in the management of battered women, especially for GPs.