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5 years ago

NAT 6/08 - THL

NAT 6/08 - THL

Alcohol prevention

Alcohol prevention activity in Swedish primary health care and occupational health services the professional categories that had received most education in handling risky drinking. Skills were positively associated with activity for all categories except OHS physicians. Knowledge and education were positively associated with activity for all categories except OHS nurses. CONCLUSIONS OHS professionals were more active than the PHC professionals in addressing alcohol issues with their patients. Education, knowledge, and skills were positively associated with activity for most professional categories in the two settings. KEywORDS Occupational health care, primary health care, alcohol intervention, risk consumption, Sweden 490 NORDIC STUDIES ON ALCOHOL AND DRUGS VOL. 25. 2008 . 6 PHC services enjoy high status and credibility among the general public (Naidoo & Wills 2002). Approximately 70% of the Swedish population visits PHC each year for a health-related problem (Yearbook of Health and Medical Care 2002). Similarly, OHS reach a significant portion of the Swedish population since these services are provided to the employed population (OHS patients also utilize PHC). Nearly three-quarters of the Swedish working population (2.6 million) have access to OHS (Statskontoret 2001) and 32% of the workforce consulted OHS in 2000. A large proportion of the workforce belongs to the age categories that consume most of the alcohol in Sweden (Fauske et al. 1996; Leifman 2003; Vanhoorne et al. 2006). The functions of OHS include rehabilitation, assessing the significance on health of dangers and hazards in the workplace, preventing problems through early intervention, promoting health and work ability together with developing the work environment (SOU 2004). Despite PHC’s obvious potential as an important venue for alcohol interventions, screening and brief intervention are not yet widely accepted as part of routine PHC practice (Beich et al. 2002; Nilsen et al. 2006). PHC professionals rarely ask or advice patients about alcohol consumption (Johansson et al. 2005; Kaner et al. 1999; Roche & Freeman 2004; Seppä et al. 2004; Vinson et al. 2000). Previous research has identified lack of time, fear of negative patient response due to the perceived sensitivity of the subject, negative attitudes to and lack of interest in alcohol prevention as key obstacles for implementation of alcohol preventive measures in PHC settings (Aalto et al. 2003a; Roche & Freeman 2004). Studies have stressed the importance of knowledge, education and training for facilitating increased intervention activity (Aalto et al. 2001; Anderson et al. 2003; Bendtsen & Åkerlind 1999; Deehan et al. 1998; Funk et al. 2005; Kaner et al. 1999; McAvoy et al. 1999). Alcohol preventive work in the OHS arena is not as well researched as interventions delivered in PHC settings. In fact, we have only been able to find three studies from Sweden (Hermansson et al. 2002; Hermansson et al. 2000; Hermansson et al. 1998) and two from Finland (Kuokkanen & Heljälä 2005; Kääriäinen et al. 2001) that have investigated alcoholrelated issues in OHS. The overall findings from these studies suggest that OHS could potentially be an important venue

for alcohol preventive activity, but further research is needed to determine the current levels of activity, education, skills, and knowledge among OHS professionals and to explore the potential for increased efforts. Based on a survey to all of Sweden’s OHS and PHC physicians and nurses, this study addresses critical knowledge gaps by investigating alcohol preventive activity in Swedish OHS and PHC in relation to education in handling risky drinking and perceived skills and knowledge in alcohol issues among the physicians and nurses in these two settings. It is the first nationalbased study of this type in Sweden and one of a few investigations into OHS’ alcohol preventive work. Methods � Study population The target population for the study was all currently active Swedish physicians and nurses in OHS and PHC. Between October 2005 and February 2006, 585 OHS physicians, 1105 OHS nurses, 3845 PHC physicians, and 5677 PHC nurses were mailed an anonymous questionnaire. This was accompanied by a covering letter that explained the rationale for the survey. After two weeks a written reminder including a new questionnaire was sent to all participants. A second reminder with a new questionnaire was sent four weeks after the initial mailing. Addresses for physicians and nurses in OHS were obtained from the Swedish Association of Occupational Health Physicians and the Swedish Association of Occupational Health Nurses. There is no official registry of addresses for PHC staff. Instead, these addresses were obtained Alcohol prevention activity in Swedish primary health care and occupational health services from a private company, Cegedim, which specialises in supplying addresses in the health services field and has a high accuracy. We included only PHC nurses who have the authority to issue prescriptions since these are registered with the Board of Social Security and Welfare and because we believed this would yield a more precise sample. It is estimated that around 80% of all nurses have the authority to issue prescriptions and the majority of these are working in PHC. The questionnaire was compiled by an experienced OHS researcher and a Swedish team of researchers and clinicians participating in the Primary Health Care European Project on Alcohol (PHEPA). The questions were partly based on the Swedish version of the World Health Organization (WHO) Collaborative Study Questionnaire (Geirsson et al. 2005; Kaner et al. 1999). A considerable amount piloting of the questionnaire was done for both OHS and PHC professionals, which led to several revisions before a conclusive version was agreed upon amongst the team members. � Variables The questionnaire consisted of 23 questions of which 10 were extracted for use in this study. The four main study variables were: activity (frequency of addressing the alcohol issue with patients); education (amount of training in handling risky alcohol consumption); skills (perceived competence in achieving change in patients’ alcohol habits); knowledge (perceived knowledge concerning providing advice to patients with risky alcohol consumption). Risky alcohol consumption is typically defined as drinking above a certain NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 491

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