Patient Satisfaction as a Moderator of Risky Alcohol Consumers’ Attitude Towards Screening and Brief Intervention: A Cross Sectional Survey

Patient Satisfaction as a Moderator of Risky Alcohol Consumers’ Attitude Towards Screening and... Abstract Aims Although shown to be effective, General Practitioners (GPs) tend to refuse the implementation of Screening and Brief Intervention (SBI). Their expectation of negative response by patients seems to contrast with the positive attitude towards SBI of these patients. This discrepancy may be resolved by regarding moderators such as drinking status and patient satisfaction. We hypothesized that the attitude towards SBI will be more positive for abstainers or low-level consumers in comparison to high risk consumers especially in case of low patient satisfaction. Methods Ten GP offices in Germany received the questionnaires for a recruitment maximum of 30 patients each. Patient satisfaction was measured by the Koelner Questionnaire of Patient Satisfaction and drinking status was evaluated using the AUDIT-C. To assess the SBI attitude a pretested 8-item Likert scale was used. Results Questionnaires of 257 patients could be analyzed. Almost a third of patients were risky consumers (N = 78, 29.9%). They showed a more negative attitude towards SBI (M = 3.99, SD = 0.71) than abstainers or low-level consumers (M = 4.20, SD = 0.55). The main analysis revealed main effects for alcohol consumption, F(1, 252) = 4.31, P < 0.05, and patient satisfaction, F(1, 252) = 22.15, P < 0.001, as well as an interaction effect, F(1, 252) = 5.01, P < 0.05, showing that the SBI attitude of risky consumers was more negative than the SBI attitude of abstainers or low-level consumers only in case of low satisfaction. Conclusions Risky consumers show a more positive attitude towards SBI when they are satisfied with their GP. Our results thus suggest the use of a supportive consultation style for the intervention of risky consumers. Short Summary SBI attitude of general practice patients depends on their drinking status: abstainers or low-level consumers revealed a more positive attitude towards SBI than risky consumers. This effect is moderated by the patient’s satisfaction. Risky consumers show a more positive attitude towards SBI if they are satisfied with their GP. INTRODUCTION Preventive approaches such as screening and brief intervention (SBI) to reduce alcohol consumption in general practice patients have been shown to be effective (Kaner et al., 2007). However, General Practitioners (GPs) tend to refuse the implementation of SBI into their routine care (Heather, 2012). Several studies were conducted to identify the motivational barriers to SBI implementation held by GPs. They revealed a remarkable number of barriers such as organizational factors (e.g. lack of financial incentives), staff factors (e.g. lack of knowledge), or patient factors (e.g. negative reaction in terms of embarrassment or unease) (Johnson et al., 2011). Taking a critical look at these results one might suppose that these barriers would not all really affect the readiness of GPs to implement SBI. One could moreover speculate that socially desirable barriers, such as workload, were reported instead of less desirable barriers, such as the belief of being ineffective in treating patients with alcohol problems (Kaner et al., 1999). Concerns regarding ineffectiveness may be justified, however, because of experiences with patients rejecting alcohol-associated interventions (Hanschmidt et al. 2017). Accordingly, German GPs identified lack of adherence as the main source of frustration and low readiness when working with alcohol issues (Fankhänel et al., 2014a, b). In contrast to the GPs’ view, research investigating the patients’ acceptance of alcohol-associated interventions in general practice revealed a rather positive attitude towards interventions such as SBI (Nilsen et al., 2012). For instance, in one study conducted in Sweden, only 1.8% agreed completely that alcohol habits are peoples’ own business and not something health care providers should ask about (Nilsen et al., 2012). To solve this ostensible discrepancy between the patients’ and the GPs’ views the individual drinking status should be considered. Previous research showed for instance that risky and harmful consumers—the patients intended for receiving SBI—expressed a significantly greater reluctance than abstainers or low-level consumers (Nilsen et al., 2012). The positive influence of patient satisfaction has been shown for several aspects of health care such as quality of doctor–patient relationship or adherence to treatment (Norhayati et al., 2017). It may be expected hence that patient satisfaction may also have a moderating influence on the patients’ attitude towards alcohol-associated activities by the GP. Because of perceiving their GP as more benevolent or supportive, more satisfied patients may be more approachable in relation to alcohol-associated interventions. In the present study, we tested for the moderating effect of patient satisfaction on the patients’ attitude towards SBI in relation to the individual drinking status of the patient. We hypothesized an interaction effect between risky alcohol use and patient satisfaction with regard to acceptance of SBI. In particular, the attitude towards SBI will be more positive for the abstainers or low-level consumers in comparison to high risk consumers. However, this gap is hypothesized to be smaller among individuals with higher patient satisfaction. MATERIALS A convenience sample of 10 GP offices in Germany was asked to participate by personal communication. On site, the practice nurse was informed about the study and asked about inviting their GP to participate. When the GP agreed to participate, study information, consent forms, and questionnaires were handed over to the practice nurse. She was instructed to administer the questionnaire to 30 consecutive patients visiting the GP office for any reason during the daytime from Monday to Friday. The study took place during a 6-month period from April to September 2016. Study protocol and research materials were approved by the Ethics Committee of the University of Halle. The questionnaire started with information about the WHO recommendation stating that each patient should be screened and—in case of risky consumption—treated by brief intervention (Babor et al., 2001). To assess the SBI attitude of patients an 8-item Likert scale was developed and pretested by eight members of the research team. The scale development was based on research results showing that attitudes should be conceptualized as one-dimensional constructs indicating a general liking or disliking for a certain object or behavior (Eagly & Chaiken, 1993). Since no elaborate belief system regarding GP alcohol-associated activities was expected, a one-dimensional measure was developed to assess a generalized attitude including self-related and social aspects of SBI. After answering the questionnaire, the research team members discussed construct validity, comprehensibility and unambiguousness during a common debriefing session and decided about the final scale design (Cronbach’s alpha = 0.73). Patient satisfaction with the GP was measured by the following four GP-related subscales of the KPF (Koelner Questionnaire of Patient Satisfaction (Pfaff et al., 2004)): (1) professional competence, (2) neglect by the GP, (3) confidence in the GP and (4) support by the GP (Cronbach’s’ alpha = 0.92). Alcohol consumption was assessed by the AUDIT-C (Bush et al., 1998), which is a three-item screening test to detect alcohol misuse among general practice patients (Bradley et al., 2007). As recommended by previous researchers different cut points were used for women (risky consumption ≥3) and men (risky consumption ≥4) (Rumpf et al., 2002; Dawson et al., 2005; Bradley et al., 2007). The AUDIT-C was scored only if all questions were answered. Patient demographic data and practice information were also gathered. To test for the moderating effect of patient satisfaction, the sample was divided into patients with high and low patient satisfaction based on median split (Median = 3.73). Then we computed an ANCOVA with alcohol consumption (abstinence or low-level consumption/risky consumption) and patient satisfaction (high/low) as between-subjects factors, age as covariate and SBI attitude as the dependent variable. SPSS statistical software, version 22.0, was used to calculate means as well as standard deviations and to run all further analyses. A statistically significant difference was stated for P < 0.05. RESULTS Ten GPs agreed to participate in the study, each of whom was running an urban single practice in the city of Halle or Dresden. The GP offices each provided between 21 and 30 questionnaires (M = 28.8, SD = 2.72). Because of missing data in the AUDIT-C, 28 questionnaires had to be excluded from the analysis (9.8%). Finally, 257 questionnaires were analyzed. Mean age of patients was 45 years (SD = 16.94), ranging from 15 to 89 years. Almost half of the patients were women (N = 120, 46%). The patients’ SBI attitude was measured by an 8-item Likert scale. The patients reported a mean SBI attitude of M = 4.14 (SD = 0.60). Mean patient satisfaction was M = 3.62 (SD = 0.41). Older patients showed a more positive SBI attitude (r = 0.15, P < 0.05) than younger patients (see Table 1). Older patients were also more satisfied with their GP than younger patients (r = 0.15, P < 0.01). SBI attitude and patient satisfaction did not differ between women and men. Risky alcohol consumption could be found for 78 patients (29.9%). Of those, 31 were women (39.7%). Table 1. Means, standard deviations and intercorrelations among the variables Variable alcohol consumption patient satisfaction SBI attitude Age Patient satisfaction 0.12 SBI attitude −0.16* −0.33** Age −0.14* −0.15* 0.15* Gender 0.08 0.04 0.03 0.03 Mean 1.30 1.38 4.14 45.18 SD 0.46 0.40 0.60 16.94 Variable alcohol consumption patient satisfaction SBI attitude Age Patient satisfaction 0.12 SBI attitude −0.16* −0.33** Age −0.14* −0.15* 0.15* Gender 0.08 0.04 0.03 0.03 Mean 1.30 1.38 4.14 45.18 SD 0.46 0.40 0.60 16.94 Bold values show significant correlations. *P < 0.05. **P < 0.001. Table 1. Means, standard deviations and intercorrelations among the variables Variable alcohol consumption patient satisfaction SBI attitude Age Patient satisfaction 0.12 SBI attitude −0.16* −0.33** Age −0.14* −0.15* 0.15* Gender 0.08 0.04 0.03 0.03 Mean 1.30 1.38 4.14 45.18 SD 0.46 0.40 0.60 16.94 Variable alcohol consumption patient satisfaction SBI attitude Age Patient satisfaction 0.12 SBI attitude −0.16* −0.33** Age −0.14* −0.15* 0.15* Gender 0.08 0.04 0.03 0.03 Mean 1.30 1.38 4.14 45.18 SD 0.46 0.40 0.60 16.94 Bold values show significant correlations. *P < 0.05. **P < 0.001. Our main analysis revealed main effects for alcohol consumption, F(1, 252) = 4.31, P < 0.05, and patient satisfaction, F(1, 252) = 22.15, P < 0.001. Risky consumers showed a more negative attitude towards SBI (M = 3.99, SD = 0.71) than abstainers or low-level consumers (M = 4.20, SD = 0.55) (see Fig. 1). A similar effect was found for patients who were satisfied with their GP, indicating a more positive attitude towards SBI (M = 4.28, SD = 0.55) than patients who were less satisfied (M = 3.95, SD = 0.63). The analysis furthermore revealed an interaction effect in line with our hypothesis, F(1, 252) = 5.01, P < 0.05 (see Fig. 2), showing by simple comparisons that the SBI attitude of risky consumers was more negative than the SBI attitude of abstainers or low-level consumers only in case of low satisfaction, but not in case of high satisfaction, F(1, 252) = 9.07, P < 0.01. If risky consumers were satisfied with their GP they showed the same positive SBI attitude as the abstainers or low-level consumers of our sample. Fig. 1. View largeDownload slide Scale means of SBI attitude of abstainers/low-level consumers (N = 179) and risky consumers (N = 78); higher values indicate a more positive attitude towards SBI (standard deviation in brackets). Fig. 1. View largeDownload slide Scale means of SBI attitude of abstainers/low-level consumers (N = 179) and risky consumers (N = 78); higher values indicate a more positive attitude towards SBI (standard deviation in brackets). Fig. 2. View largeDownload slide Interaction effect of alcohol consumption and patient satisfaction on the SBI attitude of primary care patients. Fig. 2. View largeDownload slide Interaction effect of alcohol consumption and patient satisfaction on the SBI attitude of primary care patients. DISCUSSION Our results show, like others (Nilsen et al., 2012), that the SBI attitude of general practice patients depends on their drinking status: abstainers or low-level consumers revealed a more positive attitude towards SBI than risky consumers. Our results show that this effect seems to be moderated by the patient’s satisfaction with the GP. We found that even risky consumers show a similar positive attitude towards SBI if they are rather satisfied with their GP. Risky consumers indicate a less positive SBI attitude only under the condition of low patient satisfaction. Our results correspond with previous research also revealing for general practice patients a positive SBI attitude as well as the wish to be routinely asked about alcohol consumption (Nilsen et al., 2012). At first glance this finding seems to contradict the concern of many GPs generally tending to expect a rejecting response by their patients after giving advice to reduce alcohol consumption (Rapley et al., 2006). This contradiction may be resolved by the conclusion in line with Nilsen (Nilsen et al., 2012) that negative experiences of GPs might have been arisen primarily from interactions with patients who have problems with alcohol consumption. These patients are the persons in concern and only they may associate the GPs’ advice to reduce alcohol consumption with negative psychological effects such as self-esteem threat, anxiety of being stigmatized as an addict, or concerns regarding the loss of an apparently effective coping resource (Cunningham et al., 1993). These effects have the potential to induce frustration and a hostile response to the GP (Berkowitz, 1989). No such response can be expected for abstainers or low-level consumers, which may explain their positive attitude towards alcohol- associated screening and intervention activities. Based on these considerations we would assume that risky consumers may need a more empathetic and supportive consultation style when being confronted with SBI. Our results support this idea. Patient satisfaction can be associated with such an empathetic und supportive consultation style (Quaschning et al., 2013). Risky consumers who are satisfied with their GP may hence expect a less degrading interaction with their GP, which can be associated also with a more positive attitude towards SBI. Such a more positive attitude exposed by satisfied patients—for instance by showing an approachable response following SBI—may lead moreover to positive motivational effects on the GPs’ side (Wigfield and Eccles, 2000). There are the following limitations to this study. First, recruitment of general practice patients was based on voluntary participation. One could argue that patients without alcohol problems may rather agree to participate in a study about alcohol than patients with alcohol problems. Selection bias could hence implicate a limited representativeness of our results. Nonetheless, voluntary participation is a customary practice in this field of research. Secondly, the sample was divided by median split into subgroups of low vs. high patient satisfaction. The use of median split for interval scaled variables leads to a loss of information because of assigning patients with different scores to one subgroup. Although problematized by others (MacCallum et al. 2002) we decided to use the median split to analyze our data for the following reason. It is our intention to assume that satisfied patients may have a more positive attitude towards SBI than less satisfied patients. General practice patients might be either satisfied with their GP or their satisfaction has been impaired by negative experiences. This assumption is based on simple comparisons showing that the SBI attitude differs significantly only in case of low satisfaction between low risk and risky consumers, but not in the case of high satisfaction. Without dichotomization we cannot made this essential assumption. First, dichotomization by median split is justified if a distribution is highly skewed indicating the existence of two more or less distinct groups (MacCallum et al. 2002). Accordingly, we found a highly skewed distribution for the measure of patient satisfaction indicating a strong ceiling effect in the direction of high satisfaction. Secondly, it is justified if not more than one variable was dichotomized in the study. This condition is also met. The independent variable of alcohol consumption level (abstainers/low risk consumers versus risky consumers) follows the theory of a threshold between the two groups depending on the risk to be harmed because of consuming more than the recommended level. Consistently, the AUDIT-C score was introduced into analysis in the sense of a binary variable in line with Bradley et al. (2007). Thirdly, general practice patients asked for satisfaction with the GP may tend to respond in a socially desirable manner, especially in anticipation of a consultation. Such bias can be explained, for instance, by the patients’ concerns with potentially displeasing the GP by criticism. To reduce social desirability bias, all patients were informed about the anonymous data collection and the fact that their GP would not be informed about the data. Fourth, we did not assess the patients’ previous experiences with alcohol screening or intervention (Nilsen et al., 2012). Because of German GPs are usually not trained in the use of SBI we did not expect such previous experiences to a substantial degree. CONCLUSION We show the first time—and in contrast to the GPs’ beliefs—that even patients with risky alcohol consumption can have a positive attitude towards alcohol-associated interventions such as SBI provided that they are satisfied with their GP. Our study underlines thus once more the importance of a trustful and supportive doctor–patient relationship especially in relation to shame-associated issues such as alcohol consumption or alcohol dependency. Despite all of the efforts in the last years SBI could not have been implemented effectively into general practice. Although previous research could identify several barriers, no effective strategy could have been conceived so far based on these findings in order to avert this deplorable situation of more or less resigned GPs because of demotivated and demotivating responding patients. To solve this problem an alternative interpretation—albeit speculative—may be suggested based on our results. Less satisfied patients may have a more negative attitude towards SBI because of anticipating an undesirable behavior by the GP. If this anticipated behavior of the GP influences the patients’ response negatively a change of the GPs’ behavior could be the first step towards the goal of an effective implementation of SBI. Further research should hence investigate more thoroughly the interrelated problem of insufficient adherence on one side and the GPs’ belief of being inefficient on the other. CONFLICT OF INTEREST STATEMENT None declared. REFERENCES Babor TF , Higgins-Biddle JC , Saunders JB , et al. . ( 2001 ) AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care , 2nd edn . Geneva : World Health Organization . Berkowitz L . ( 1989 ) Frustration-aggression hypothesis: examination and reformulation . Psychol Bull 106 : 59 – 73 . Google Scholar CrossRef Search ADS PubMed Bradley KA , DeBenedetti AF , Volk RJ , et al. . ( 2007 ) AUDIT-C as a brief screen for alcohol misuse in primary care . Alcohol Clin Exp Res 31 : 1208 – 17 . 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College, Orlando : Harcourt Brace Jovanovich . Fankhaenel T , Lenz J , Papert S , et al. . ( 2014 a) Screening und Brief Intervention in der Hausarztpraxis: Barrieren gegen eine Frühintervention bei Patienten mit Alkoholmissbrauch . Psychother Psychosom Med Psycho 9/10 : 373 – 7 . Fankhänel T , Klement A , Forschner L . ( 2014 b) Hausärztliche Versorgung für eine Entwöhnungs-Langzeitbehandlung bei Patienten mit einer Suchterkrankung (HELPS) . Sucht Aktuell 21 : 55 – 9 . Hanschmidt F , Manthey J , Kraus L , et al. . ( 2017 ) Barriers to alcohol screening among hypertensive patients and the role of stigma: lessons for the implementation of screening and brief interventions in European primary care settings . Alcohol Alcohol 52 : 572 – 79 . Google Scholar CrossRef Search ADS PubMed Heather N . ( 2012 ) Can screening and brief intervention lead to population-level reductions in alcohol-related harm? Addict Sci Clin Pract 7 : 15 . 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( 2012 ) When is it appropriate to address patients’ alcohol consumption in health care--national survey of views of the general population in Sweden . Addict Behav 37 : 1211 – 6 . Google Scholar CrossRef Search ADS PubMed Norhayati MN , Masseni AA , Azlina I . ( 2017 ) Patient satisfaction with doctor-patient interaction and its association with modifiable cardiovascular risk factors among moderately-high risk patients in primary healthcare . PeerJ 5 : 2983 . Google Scholar CrossRef Search ADS Pfaff H , Steffen P , Brinkmann A , et al. . ( 2004 ) Der Kölner Patientenfragebogen (KPF) . Köln : Institut für Arbeitsmedizin, Sozialmedizin und Sozialhygiene . Quaschning K , Korner M , Wirtz M . ( 2013 ) Analyzing the effects of shared decision-making, empathy and team interaction on patient satisfaction and treatment acceptance in medical rehabilitation using a structural equation modeling approach . Patient Educ Couns 91 : 167 – 75 . Google Scholar CrossRef Search ADS PubMed Rapley T , May C , Kaner EF . ( 2006 ) Still a difficult business? Negotiating alcohol-related problems in general practice consultations . Soc Sci Med 63 : 2418 – 28 . Google Scholar CrossRef Search ADS PubMed Rumpf HJ , Hapke U , Meyer C , et al. . ( 2002 ) Screening for alcohol use disorders and at-risk drinking in the general population: psychometric performance of three questionnaires . Alcohol Alcohol 37 : 261 – 8 . Google Scholar CrossRef Search ADS PubMed Wigfield A , Eccles JS . ( 2000 ) Expectancy-value theory of achievement motivation . Contemp Educ Psychol 25 : 68 – 81 . Google Scholar CrossRef Search ADS PubMed Appendix A Items of the SBI attitude scale including means and standard deviations for abstainers/low-level consumers (N = 179) and risky consumers (N = 78); higher values indicate a more positive attitude towards SBI. SBI attitude scale Abstainers/low-level consumers Risky consumers P 1) My alcohol consumption should not be of interest for my GP. 3.97* 3.71* 0.085 (1.05) (1.15) 2) My alcohol consumption should not be inquired by questionnaire. 3.84* 3.74* 0.584 (1.26) (1.32) 3) I would accept a periodic inquiry for my alcohol consumption. 4.04 3.79 0.113 (1.08) (1.24) 4) My GP should tell me when I hazard my health by my alcohol consumption. 4.75 4.49 0.009 (0.57) (0.80) 5) My GP should be available for any patient exposing an alcohol problem. 4.15 3.94 0.108 (0.97) (1.00) 6) My GP should work for adequate alcohol consumption in any patient. 4.43 4.13 0.013 (0.85) (1.00) 7) Alcohol problems should not be treated by my GP. 4.39* 4.23* 0.273 (0.99) (1.13) 8) I would accept an increase of waiting time when my GP would treat patients with alcohol problems. 4.08 3.91 0.260 (1.04) (1.23) SBI attitude scale Abstainers/low-level consumers Risky consumers P 1) My alcohol consumption should not be of interest for my GP. 3.97* 3.71* 0.085 (1.05) (1.15) 2) My alcohol consumption should not be inquired by questionnaire. 3.84* 3.74* 0.584 (1.26) (1.32) 3) I would accept a periodic inquiry for my alcohol consumption. 4.04 3.79 0.113 (1.08) (1.24) 4) My GP should tell me when I hazard my health by my alcohol consumption. 4.75 4.49 0.009 (0.57) (0.80) 5) My GP should be available for any patient exposing an alcohol problem. 4.15 3.94 0.108 (0.97) (1.00) 6) My GP should work for adequate alcohol consumption in any patient. 4.43 4.13 0.013 (0.85) (1.00) 7) Alcohol problems should not be treated by my GP. 4.39* 4.23* 0.273 (0.99) (1.13) 8) I would accept an increase of waiting time when my GP would treat patients with alcohol problems. 4.08 3.91 0.260 (1.04) (1.23) *Recoded means for the analysis. SBI attitude scale Abstainers/low-level consumers Risky consumers P 1) My alcohol consumption should not be of interest for my GP. 3.97* 3.71* 0.085 (1.05) (1.15) 2) My alcohol consumption should not be inquired by questionnaire. 3.84* 3.74* 0.584 (1.26) (1.32) 3) I would accept a periodic inquiry for my alcohol consumption. 4.04 3.79 0.113 (1.08) (1.24) 4) My GP should tell me when I hazard my health by my alcohol consumption. 4.75 4.49 0.009 (0.57) (0.80) 5) My GP should be available for any patient exposing an alcohol problem. 4.15 3.94 0.108 (0.97) (1.00) 6) My GP should work for adequate alcohol consumption in any patient. 4.43 4.13 0.013 (0.85) (1.00) 7) Alcohol problems should not be treated by my GP. 4.39* 4.23* 0.273 (0.99) (1.13) 8) I would accept an increase of waiting time when my GP would treat patients with alcohol problems. 4.08 3.91 0.260 (1.04) (1.23) SBI attitude scale Abstainers/low-level consumers Risky consumers P 1) My alcohol consumption should not be of interest for my GP. 3.97* 3.71* 0.085 (1.05) (1.15) 2) My alcohol consumption should not be inquired by questionnaire. 3.84* 3.74* 0.584 (1.26) (1.32) 3) I would accept a periodic inquiry for my alcohol consumption. 4.04 3.79 0.113 (1.08) (1.24) 4) My GP should tell me when I hazard my health by my alcohol consumption. 4.75 4.49 0.009 (0.57) (0.80) 5) My GP should be available for any patient exposing an alcohol problem. 4.15 3.94 0.108 (0.97) (1.00) 6) My GP should work for adequate alcohol consumption in any patient. 4.43 4.13 0.013 (0.85) (1.00) 7) Alcohol problems should not be treated by my GP. 4.39* 4.23* 0.273 (0.99) (1.13) 8) I would accept an increase of waiting time when my GP would treat patients with alcohol problems. 4.08 3.91 0.260 (1.04) (1.23) *Recoded means for the analysis. Appendix B SBI attitude scale: German original Items. Mein Hausarzt sollte sich nicht für meinen Alkoholkonsum interessieren. Mein Alkoholkonsum sollte nicht durch einen Fragebogen erfragt werden. Ich würde eine regelmäßige Nachfrage nach meinem Alkoholkonsum akzeptieren. Mein Hausarzt sollte mich informieren, wenn ich meine Gesundheit durch meinen Alkoholkonsum gefährde. Mein Hausarzt sollte sich allen Patienten mit einem Alkoholproblem zur Verfügung stellen. Mein Hausarzt sollte sich für einen adäquaten Alkoholkonsum einsetzen. Mein Hausarzt sollte die Behandlung von Alkoholproblemen ablehnen. Würde sich die Wartezeit durch die Behandlung von Alkoholproblemen verlängern, so würde ich dies in Kauf nehmen. © The Author(s) 2018. Medical Council on Alcohol and Oxford University Press. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Alcohol and Alcoholism Oxford University Press

Patient Satisfaction as a Moderator of Risky Alcohol Consumers’ Attitude Towards Screening and Brief Intervention: A Cross Sectional Survey

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Abstract

Abstract Aims Although shown to be effective, General Practitioners (GPs) tend to refuse the implementation of Screening and Brief Intervention (SBI). Their expectation of negative response by patients seems to contrast with the positive attitude towards SBI of these patients. This discrepancy may be resolved by regarding moderators such as drinking status and patient satisfaction. We hypothesized that the attitude towards SBI will be more positive for abstainers or low-level consumers in comparison to high risk consumers especially in case of low patient satisfaction. Methods Ten GP offices in Germany received the questionnaires for a recruitment maximum of 30 patients each. Patient satisfaction was measured by the Koelner Questionnaire of Patient Satisfaction and drinking status was evaluated using the AUDIT-C. To assess the SBI attitude a pretested 8-item Likert scale was used. Results Questionnaires of 257 patients could be analyzed. Almost a third of patients were risky consumers (N = 78, 29.9%). They showed a more negative attitude towards SBI (M = 3.99, SD = 0.71) than abstainers or low-level consumers (M = 4.20, SD = 0.55). The main analysis revealed main effects for alcohol consumption, F(1, 252) = 4.31, P < 0.05, and patient satisfaction, F(1, 252) = 22.15, P < 0.001, as well as an interaction effect, F(1, 252) = 5.01, P < 0.05, showing that the SBI attitude of risky consumers was more negative than the SBI attitude of abstainers or low-level consumers only in case of low satisfaction. Conclusions Risky consumers show a more positive attitude towards SBI when they are satisfied with their GP. Our results thus suggest the use of a supportive consultation style for the intervention of risky consumers. Short Summary SBI attitude of general practice patients depends on their drinking status: abstainers or low-level consumers revealed a more positive attitude towards SBI than risky consumers. This effect is moderated by the patient’s satisfaction. Risky consumers show a more positive attitude towards SBI if they are satisfied with their GP. INTRODUCTION Preventive approaches such as screening and brief intervention (SBI) to reduce alcohol consumption in general practice patients have been shown to be effective (Kaner et al., 2007). However, General Practitioners (GPs) tend to refuse the implementation of SBI into their routine care (Heather, 2012). Several studies were conducted to identify the motivational barriers to SBI implementation held by GPs. They revealed a remarkable number of barriers such as organizational factors (e.g. lack of financial incentives), staff factors (e.g. lack of knowledge), or patient factors (e.g. negative reaction in terms of embarrassment or unease) (Johnson et al., 2011). Taking a critical look at these results one might suppose that these barriers would not all really affect the readiness of GPs to implement SBI. One could moreover speculate that socially desirable barriers, such as workload, were reported instead of less desirable barriers, such as the belief of being ineffective in treating patients with alcohol problems (Kaner et al., 1999). Concerns regarding ineffectiveness may be justified, however, because of experiences with patients rejecting alcohol-associated interventions (Hanschmidt et al. 2017). Accordingly, German GPs identified lack of adherence as the main source of frustration and low readiness when working with alcohol issues (Fankhänel et al., 2014a, b). In contrast to the GPs’ view, research investigating the patients’ acceptance of alcohol-associated interventions in general practice revealed a rather positive attitude towards interventions such as SBI (Nilsen et al., 2012). For instance, in one study conducted in Sweden, only 1.8% agreed completely that alcohol habits are peoples’ own business and not something health care providers should ask about (Nilsen et al., 2012). To solve this ostensible discrepancy between the patients’ and the GPs’ views the individual drinking status should be considered. Previous research showed for instance that risky and harmful consumers—the patients intended for receiving SBI—expressed a significantly greater reluctance than abstainers or low-level consumers (Nilsen et al., 2012). The positive influence of patient satisfaction has been shown for several aspects of health care such as quality of doctor–patient relationship or adherence to treatment (Norhayati et al., 2017). It may be expected hence that patient satisfaction may also have a moderating influence on the patients’ attitude towards alcohol-associated activities by the GP. Because of perceiving their GP as more benevolent or supportive, more satisfied patients may be more approachable in relation to alcohol-associated interventions. In the present study, we tested for the moderating effect of patient satisfaction on the patients’ attitude towards SBI in relation to the individual drinking status of the patient. We hypothesized an interaction effect between risky alcohol use and patient satisfaction with regard to acceptance of SBI. In particular, the attitude towards SBI will be more positive for the abstainers or low-level consumers in comparison to high risk consumers. However, this gap is hypothesized to be smaller among individuals with higher patient satisfaction. MATERIALS A convenience sample of 10 GP offices in Germany was asked to participate by personal communication. On site, the practice nurse was informed about the study and asked about inviting their GP to participate. When the GP agreed to participate, study information, consent forms, and questionnaires were handed over to the practice nurse. She was instructed to administer the questionnaire to 30 consecutive patients visiting the GP office for any reason during the daytime from Monday to Friday. The study took place during a 6-month period from April to September 2016. Study protocol and research materials were approved by the Ethics Committee of the University of Halle. The questionnaire started with information about the WHO recommendation stating that each patient should be screened and—in case of risky consumption—treated by brief intervention (Babor et al., 2001). To assess the SBI attitude of patients an 8-item Likert scale was developed and pretested by eight members of the research team. The scale development was based on research results showing that attitudes should be conceptualized as one-dimensional constructs indicating a general liking or disliking for a certain object or behavior (Eagly & Chaiken, 1993). Since no elaborate belief system regarding GP alcohol-associated activities was expected, a one-dimensional measure was developed to assess a generalized attitude including self-related and social aspects of SBI. After answering the questionnaire, the research team members discussed construct validity, comprehensibility and unambiguousness during a common debriefing session and decided about the final scale design (Cronbach’s alpha = 0.73). Patient satisfaction with the GP was measured by the following four GP-related subscales of the KPF (Koelner Questionnaire of Patient Satisfaction (Pfaff et al., 2004)): (1) professional competence, (2) neglect by the GP, (3) confidence in the GP and (4) support by the GP (Cronbach’s’ alpha = 0.92). Alcohol consumption was assessed by the AUDIT-C (Bush et al., 1998), which is a three-item screening test to detect alcohol misuse among general practice patients (Bradley et al., 2007). As recommended by previous researchers different cut points were used for women (risky consumption ≥3) and men (risky consumption ≥4) (Rumpf et al., 2002; Dawson et al., 2005; Bradley et al., 2007). The AUDIT-C was scored only if all questions were answered. Patient demographic data and practice information were also gathered. To test for the moderating effect of patient satisfaction, the sample was divided into patients with high and low patient satisfaction based on median split (Median = 3.73). Then we computed an ANCOVA with alcohol consumption (abstinence or low-level consumption/risky consumption) and patient satisfaction (high/low) as between-subjects factors, age as covariate and SBI attitude as the dependent variable. SPSS statistical software, version 22.0, was used to calculate means as well as standard deviations and to run all further analyses. A statistically significant difference was stated for P < 0.05. RESULTS Ten GPs agreed to participate in the study, each of whom was running an urban single practice in the city of Halle or Dresden. The GP offices each provided between 21 and 30 questionnaires (M = 28.8, SD = 2.72). Because of missing data in the AUDIT-C, 28 questionnaires had to be excluded from the analysis (9.8%). Finally, 257 questionnaires were analyzed. Mean age of patients was 45 years (SD = 16.94), ranging from 15 to 89 years. Almost half of the patients were women (N = 120, 46%). The patients’ SBI attitude was measured by an 8-item Likert scale. The patients reported a mean SBI attitude of M = 4.14 (SD = 0.60). Mean patient satisfaction was M = 3.62 (SD = 0.41). Older patients showed a more positive SBI attitude (r = 0.15, P < 0.05) than younger patients (see Table 1). Older patients were also more satisfied with their GP than younger patients (r = 0.15, P < 0.01). SBI attitude and patient satisfaction did not differ between women and men. Risky alcohol consumption could be found for 78 patients (29.9%). Of those, 31 were women (39.7%). Table 1. Means, standard deviations and intercorrelations among the variables Variable alcohol consumption patient satisfaction SBI attitude Age Patient satisfaction 0.12 SBI attitude −0.16* −0.33** Age −0.14* −0.15* 0.15* Gender 0.08 0.04 0.03 0.03 Mean 1.30 1.38 4.14 45.18 SD 0.46 0.40 0.60 16.94 Variable alcohol consumption patient satisfaction SBI attitude Age Patient satisfaction 0.12 SBI attitude −0.16* −0.33** Age −0.14* −0.15* 0.15* Gender 0.08 0.04 0.03 0.03 Mean 1.30 1.38 4.14 45.18 SD 0.46 0.40 0.60 16.94 Bold values show significant correlations. *P < 0.05. **P < 0.001. Table 1. Means, standard deviations and intercorrelations among the variables Variable alcohol consumption patient satisfaction SBI attitude Age Patient satisfaction 0.12 SBI attitude −0.16* −0.33** Age −0.14* −0.15* 0.15* Gender 0.08 0.04 0.03 0.03 Mean 1.30 1.38 4.14 45.18 SD 0.46 0.40 0.60 16.94 Variable alcohol consumption patient satisfaction SBI attitude Age Patient satisfaction 0.12 SBI attitude −0.16* −0.33** Age −0.14* −0.15* 0.15* Gender 0.08 0.04 0.03 0.03 Mean 1.30 1.38 4.14 45.18 SD 0.46 0.40 0.60 16.94 Bold values show significant correlations. *P < 0.05. **P < 0.001. Our main analysis revealed main effects for alcohol consumption, F(1, 252) = 4.31, P < 0.05, and patient satisfaction, F(1, 252) = 22.15, P < 0.001. Risky consumers showed a more negative attitude towards SBI (M = 3.99, SD = 0.71) than abstainers or low-level consumers (M = 4.20, SD = 0.55) (see Fig. 1). A similar effect was found for patients who were satisfied with their GP, indicating a more positive attitude towards SBI (M = 4.28, SD = 0.55) than patients who were less satisfied (M = 3.95, SD = 0.63). The analysis furthermore revealed an interaction effect in line with our hypothesis, F(1, 252) = 5.01, P < 0.05 (see Fig. 2), showing by simple comparisons that the SBI attitude of risky consumers was more negative than the SBI attitude of abstainers or low-level consumers only in case of low satisfaction, but not in case of high satisfaction, F(1, 252) = 9.07, P < 0.01. If risky consumers were satisfied with their GP they showed the same positive SBI attitude as the abstainers or low-level consumers of our sample. Fig. 1. View largeDownload slide Scale means of SBI attitude of abstainers/low-level consumers (N = 179) and risky consumers (N = 78); higher values indicate a more positive attitude towards SBI (standard deviation in brackets). Fig. 1. View largeDownload slide Scale means of SBI attitude of abstainers/low-level consumers (N = 179) and risky consumers (N = 78); higher values indicate a more positive attitude towards SBI (standard deviation in brackets). Fig. 2. View largeDownload slide Interaction effect of alcohol consumption and patient satisfaction on the SBI attitude of primary care patients. Fig. 2. View largeDownload slide Interaction effect of alcohol consumption and patient satisfaction on the SBI attitude of primary care patients. DISCUSSION Our results show, like others (Nilsen et al., 2012), that the SBI attitude of general practice patients depends on their drinking status: abstainers or low-level consumers revealed a more positive attitude towards SBI than risky consumers. Our results show that this effect seems to be moderated by the patient’s satisfaction with the GP. We found that even risky consumers show a similar positive attitude towards SBI if they are rather satisfied with their GP. Risky consumers indicate a less positive SBI attitude only under the condition of low patient satisfaction. Our results correspond with previous research also revealing for general practice patients a positive SBI attitude as well as the wish to be routinely asked about alcohol consumption (Nilsen et al., 2012). At first glance this finding seems to contradict the concern of many GPs generally tending to expect a rejecting response by their patients after giving advice to reduce alcohol consumption (Rapley et al., 2006). This contradiction may be resolved by the conclusion in line with Nilsen (Nilsen et al., 2012) that negative experiences of GPs might have been arisen primarily from interactions with patients who have problems with alcohol consumption. These patients are the persons in concern and only they may associate the GPs’ advice to reduce alcohol consumption with negative psychological effects such as self-esteem threat, anxiety of being stigmatized as an addict, or concerns regarding the loss of an apparently effective coping resource (Cunningham et al., 1993). These effects have the potential to induce frustration and a hostile response to the GP (Berkowitz, 1989). No such response can be expected for abstainers or low-level consumers, which may explain their positive attitude towards alcohol- associated screening and intervention activities. Based on these considerations we would assume that risky consumers may need a more empathetic and supportive consultation style when being confronted with SBI. Our results support this idea. Patient satisfaction can be associated with such an empathetic und supportive consultation style (Quaschning et al., 2013). Risky consumers who are satisfied with their GP may hence expect a less degrading interaction with their GP, which can be associated also with a more positive attitude towards SBI. Such a more positive attitude exposed by satisfied patients—for instance by showing an approachable response following SBI—may lead moreover to positive motivational effects on the GPs’ side (Wigfield and Eccles, 2000). There are the following limitations to this study. First, recruitment of general practice patients was based on voluntary participation. One could argue that patients without alcohol problems may rather agree to participate in a study about alcohol than patients with alcohol problems. Selection bias could hence implicate a limited representativeness of our results. Nonetheless, voluntary participation is a customary practice in this field of research. Secondly, the sample was divided by median split into subgroups of low vs. high patient satisfaction. The use of median split for interval scaled variables leads to a loss of information because of assigning patients with different scores to one subgroup. Although problematized by others (MacCallum et al. 2002) we decided to use the median split to analyze our data for the following reason. It is our intention to assume that satisfied patients may have a more positive attitude towards SBI than less satisfied patients. General practice patients might be either satisfied with their GP or their satisfaction has been impaired by negative experiences. This assumption is based on simple comparisons showing that the SBI attitude differs significantly only in case of low satisfaction between low risk and risky consumers, but not in the case of high satisfaction. Without dichotomization we cannot made this essential assumption. First, dichotomization by median split is justified if a distribution is highly skewed indicating the existence of two more or less distinct groups (MacCallum et al. 2002). Accordingly, we found a highly skewed distribution for the measure of patient satisfaction indicating a strong ceiling effect in the direction of high satisfaction. Secondly, it is justified if not more than one variable was dichotomized in the study. This condition is also met. The independent variable of alcohol consumption level (abstainers/low risk consumers versus risky consumers) follows the theory of a threshold between the two groups depending on the risk to be harmed because of consuming more than the recommended level. Consistently, the AUDIT-C score was introduced into analysis in the sense of a binary variable in line with Bradley et al. (2007). Thirdly, general practice patients asked for satisfaction with the GP may tend to respond in a socially desirable manner, especially in anticipation of a consultation. Such bias can be explained, for instance, by the patients’ concerns with potentially displeasing the GP by criticism. To reduce social desirability bias, all patients were informed about the anonymous data collection and the fact that their GP would not be informed about the data. Fourth, we did not assess the patients’ previous experiences with alcohol screening or intervention (Nilsen et al., 2012). Because of German GPs are usually not trained in the use of SBI we did not expect such previous experiences to a substantial degree. CONCLUSION We show the first time—and in contrast to the GPs’ beliefs—that even patients with risky alcohol consumption can have a positive attitude towards alcohol-associated interventions such as SBI provided that they are satisfied with their GP. Our study underlines thus once more the importance of a trustful and supportive doctor–patient relationship especially in relation to shame-associated issues such as alcohol consumption or alcohol dependency. Despite all of the efforts in the last years SBI could not have been implemented effectively into general practice. Although previous research could identify several barriers, no effective strategy could have been conceived so far based on these findings in order to avert this deplorable situation of more or less resigned GPs because of demotivated and demotivating responding patients. To solve this problem an alternative interpretation—albeit speculative—may be suggested based on our results. Less satisfied patients may have a more negative attitude towards SBI because of anticipating an undesirable behavior by the GP. If this anticipated behavior of the GP influences the patients’ response negatively a change of the GPs’ behavior could be the first step towards the goal of an effective implementation of SBI. Further research should hence investigate more thoroughly the interrelated problem of insufficient adherence on one side and the GPs’ belief of being inefficient on the other. CONFLICT OF INTEREST STATEMENT None declared. REFERENCES Babor TF , Higgins-Biddle JC , Saunders JB , et al. . ( 2001 ) AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care , 2nd edn . Geneva : World Health Organization . Berkowitz L . ( 1989 ) Frustration-aggression hypothesis: examination and reformulation . Psychol Bull 106 : 59 – 73 . Google Scholar CrossRef Search ADS PubMed Bradley KA , DeBenedetti AF , Volk RJ , et al. . ( 2007 ) AUDIT-C as a brief screen for alcohol misuse in primary care . Alcohol Clin Exp Res 31 : 1208 – 17 . Google Scholar CrossRef Search ADS PubMed Bush K , Kivlahan DR , McDonell MB , et al. . ( 1998 ) The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test . Arch Intern Med 158 : 1789 – 95 . Google Scholar CrossRef Search ADS PubMed Cunningham JA , Sobell LC , Sobell MB , et al. . ( 1993 ) Barriers to treatment: why alcohol and drug abusers delay or never seek treatment . Addict Behav 18 : 347 – 53 . Google Scholar CrossRef Search ADS PubMed Dawson DA , Grant BF , Stinson FS , et al. . ( 2005 ) Effectiveness of the derived Alcohol Use Disorders Identification Test (AUDIT-C) in screening for alcohol use disorders and risk drinking in the US general population . Alcohol Clin Exp Res 29 : 844 – 54 . Google Scholar CrossRef Search ADS PubMed Eagly AH , Chaiken S . ( 1993 ) The Psychology of Attitudes . College, Orlando : Harcourt Brace Jovanovich . Fankhaenel T , Lenz J , Papert S , et al. . ( 2014 a) Screening und Brief Intervention in der Hausarztpraxis: Barrieren gegen eine Frühintervention bei Patienten mit Alkoholmissbrauch . Psychother Psychosom Med Psycho 9/10 : 373 – 7 . Fankhänel T , Klement A , Forschner L . ( 2014 b) Hausärztliche Versorgung für eine Entwöhnungs-Langzeitbehandlung bei Patienten mit einer Suchterkrankung (HELPS) . Sucht Aktuell 21 : 55 – 9 . Hanschmidt F , Manthey J , Kraus L , et al. . ( 2017 ) Barriers to alcohol screening among hypertensive patients and the role of stigma: lessons for the implementation of screening and brief interventions in European primary care settings . Alcohol Alcohol 52 : 572 – 79 . Google Scholar CrossRef Search ADS PubMed Heather N . ( 2012 ) Can screening and brief intervention lead to population-level reductions in alcohol-related harm? Addict Sci Clin Pract 7 : 15 . 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( 2012 ) When is it appropriate to address patients’ alcohol consumption in health care--national survey of views of the general population in Sweden . Addict Behav 37 : 1211 – 6 . Google Scholar CrossRef Search ADS PubMed Norhayati MN , Masseni AA , Azlina I . ( 2017 ) Patient satisfaction with doctor-patient interaction and its association with modifiable cardiovascular risk factors among moderately-high risk patients in primary healthcare . PeerJ 5 : 2983 . Google Scholar CrossRef Search ADS Pfaff H , Steffen P , Brinkmann A , et al. . ( 2004 ) Der Kölner Patientenfragebogen (KPF) . Köln : Institut für Arbeitsmedizin, Sozialmedizin und Sozialhygiene . Quaschning K , Korner M , Wirtz M . ( 2013 ) Analyzing the effects of shared decision-making, empathy and team interaction on patient satisfaction and treatment acceptance in medical rehabilitation using a structural equation modeling approach . Patient Educ Couns 91 : 167 – 75 . Google Scholar CrossRef Search ADS PubMed Rapley T , May C , Kaner EF . ( 2006 ) Still a difficult business? Negotiating alcohol-related problems in general practice consultations . Soc Sci Med 63 : 2418 – 28 . Google Scholar CrossRef Search ADS PubMed Rumpf HJ , Hapke U , Meyer C , et al. . ( 2002 ) Screening for alcohol use disorders and at-risk drinking in the general population: psychometric performance of three questionnaires . Alcohol Alcohol 37 : 261 – 8 . Google Scholar CrossRef Search ADS PubMed Wigfield A , Eccles JS . ( 2000 ) Expectancy-value theory of achievement motivation . Contemp Educ Psychol 25 : 68 – 81 . Google Scholar CrossRef Search ADS PubMed Appendix A Items of the SBI attitude scale including means and standard deviations for abstainers/low-level consumers (N = 179) and risky consumers (N = 78); higher values indicate a more positive attitude towards SBI. SBI attitude scale Abstainers/low-level consumers Risky consumers P 1) My alcohol consumption should not be of interest for my GP. 3.97* 3.71* 0.085 (1.05) (1.15) 2) My alcohol consumption should not be inquired by questionnaire. 3.84* 3.74* 0.584 (1.26) (1.32) 3) I would accept a periodic inquiry for my alcohol consumption. 4.04 3.79 0.113 (1.08) (1.24) 4) My GP should tell me when I hazard my health by my alcohol consumption. 4.75 4.49 0.009 (0.57) (0.80) 5) My GP should be available for any patient exposing an alcohol problem. 4.15 3.94 0.108 (0.97) (1.00) 6) My GP should work for adequate alcohol consumption in any patient. 4.43 4.13 0.013 (0.85) (1.00) 7) Alcohol problems should not be treated by my GP. 4.39* 4.23* 0.273 (0.99) (1.13) 8) I would accept an increase of waiting time when my GP would treat patients with alcohol problems. 4.08 3.91 0.260 (1.04) (1.23) SBI attitude scale Abstainers/low-level consumers Risky consumers P 1) My alcohol consumption should not be of interest for my GP. 3.97* 3.71* 0.085 (1.05) (1.15) 2) My alcohol consumption should not be inquired by questionnaire. 3.84* 3.74* 0.584 (1.26) (1.32) 3) I would accept a periodic inquiry for my alcohol consumption. 4.04 3.79 0.113 (1.08) (1.24) 4) My GP should tell me when I hazard my health by my alcohol consumption. 4.75 4.49 0.009 (0.57) (0.80) 5) My GP should be available for any patient exposing an alcohol problem. 4.15 3.94 0.108 (0.97) (1.00) 6) My GP should work for adequate alcohol consumption in any patient. 4.43 4.13 0.013 (0.85) (1.00) 7) Alcohol problems should not be treated by my GP. 4.39* 4.23* 0.273 (0.99) (1.13) 8) I would accept an increase of waiting time when my GP would treat patients with alcohol problems. 4.08 3.91 0.260 (1.04) (1.23) *Recoded means for the analysis. SBI attitude scale Abstainers/low-level consumers Risky consumers P 1) My alcohol consumption should not be of interest for my GP. 3.97* 3.71* 0.085 (1.05) (1.15) 2) My alcohol consumption should not be inquired by questionnaire. 3.84* 3.74* 0.584 (1.26) (1.32) 3) I would accept a periodic inquiry for my alcohol consumption. 4.04 3.79 0.113 (1.08) (1.24) 4) My GP should tell me when I hazard my health by my alcohol consumption. 4.75 4.49 0.009 (0.57) (0.80) 5) My GP should be available for any patient exposing an alcohol problem. 4.15 3.94 0.108 (0.97) (1.00) 6) My GP should work for adequate alcohol consumption in any patient. 4.43 4.13 0.013 (0.85) (1.00) 7) Alcohol problems should not be treated by my GP. 4.39* 4.23* 0.273 (0.99) (1.13) 8) I would accept an increase of waiting time when my GP would treat patients with alcohol problems. 4.08 3.91 0.260 (1.04) (1.23) SBI attitude scale Abstainers/low-level consumers Risky consumers P 1) My alcohol consumption should not be of interest for my GP. 3.97* 3.71* 0.085 (1.05) (1.15) 2) My alcohol consumption should not be inquired by questionnaire. 3.84* 3.74* 0.584 (1.26) (1.32) 3) I would accept a periodic inquiry for my alcohol consumption. 4.04 3.79 0.113 (1.08) (1.24) 4) My GP should tell me when I hazard my health by my alcohol consumption. 4.75 4.49 0.009 (0.57) (0.80) 5) My GP should be available for any patient exposing an alcohol problem. 4.15 3.94 0.108 (0.97) (1.00) 6) My GP should work for adequate alcohol consumption in any patient. 4.43 4.13 0.013 (0.85) (1.00) 7) Alcohol problems should not be treated by my GP. 4.39* 4.23* 0.273 (0.99) (1.13) 8) I would accept an increase of waiting time when my GP would treat patients with alcohol problems. 4.08 3.91 0.260 (1.04) (1.23) *Recoded means for the analysis. Appendix B SBI attitude scale: German original Items. Mein Hausarzt sollte sich nicht für meinen Alkoholkonsum interessieren. Mein Alkoholkonsum sollte nicht durch einen Fragebogen erfragt werden. Ich würde eine regelmäßige Nachfrage nach meinem Alkoholkonsum akzeptieren. Mein Hausarzt sollte mich informieren, wenn ich meine Gesundheit durch meinen Alkoholkonsum gefährde. Mein Hausarzt sollte sich allen Patienten mit einem Alkoholproblem zur Verfügung stellen. Mein Hausarzt sollte sich für einen adäquaten Alkoholkonsum einsetzen. Mein Hausarzt sollte die Behandlung von Alkoholproblemen ablehnen. Würde sich die Wartezeit durch die Behandlung von Alkoholproblemen verlängern, so würde ich dies in Kauf nehmen. © The Author(s) 2018. Medical Council on Alcohol and Oxford University Press. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

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Alcohol and AlcoholismOxford University Press

Published: Jan 25, 2018

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