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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 Table 2. Significant odds ratios (OR) and confidence intervals (CI) based on stepwise backward logistic regression to estimate associations with activity (1=frequently asking patients about alcohol, 0=infrequently), a separate analysis for each professional. Occupational Health Services Primary Health Care Physicians nurses Physicians nurses Sex Male 1.0 n.s. 1.0 1.0 Female 2.0 (1.0–3.8) p=0.217 1.7 (1.3–2.1) 2.4 (1.0–5.6) Age < 45 years 1.0 1.0 n.s. n.s. 46–55 years 5.2 (1.3–20.2) 1.2 (0.5–2.5) p=0.425 p=0.182 > 56 years 2.5 (0.6–8.9) 0.6 (0.3–1.2) Years in practice < 5 years n.s. n.s. n.s. n.s. 6–10 years 11–20 years > 20 years p=0.983 p=0.717 p=0.133 p=0.652 Patients per week < 20 n.s. n.s. 1.0 n.s. 20–39 p=0.708 p=0.648 0.7 (0.4–1.2) p=0.111 40–59 0.8 (0.4–1.4) > 60 1.2 (0.6–2.1) Location rural-population area n.s. n.s. 1.0 n.s. Medium-sized city p=0.359 p=1.000 1.2 (0.9-1.6) p=0.473 Major city 1.8 (1.2–2.5) Skills not particularly skilful n.s. 1.0 1.0 1.0 somewhat skilful p=0.344 1.7 (0.8–3.6) 1.3 (1.0–1.9) 1.9 (1.4–2.5) Moderately skilful 4.5 (2.0–9.9) 2.6 (1.8–3.8) 3.6 (2.5–5.2) very skilful 11.1 (2.8–43.0) 2.5 (1.0–5.9) 3.7 (1.6–8.3) Knowledge not particularly knowledgeable 1.0 1.0 1.0 somewhat knowledgeable 2.2 (0.1–28.0) n.s. 1.5 (0.9–2.5) 2.0 (1.4–2.8) Moderately knowledgeable 4.6 (0.3–54.3) p=0.462 3.1 (1.8–5.1) 3.6 (2.5–5.1) very knowledgeable 13.3 (1.0–164.4) 6.1 (3.3–10.9) 7.6 (4.2–13.8) Education none 1.0 1.0 1.0 half day or shorter 1.1 (0.6–2.1) n.s. 0.7 (0.5–0.9) 1.3 (1.0–1.7) 1–2 days 1.4 (0.5–3.4) p=0.262 0.7 (0.5–1.0) 1.4 (1.0–2.0) 3 days or more 7.3 (0.9–58.0) 1.3 (0.8–1.9) 1.3 (0.8–2.0) a) stockholm, Gothenburg, Malmö, the three biggest cities in sweden (> 250 000 residents). n.s. = not significant 498 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 2 5. 2 0 0 8 . 6

Discussion This study was conducted to investigate the alcohol preventive activity among health care professionals in Swedish OHS and PHC. It was found that OHS professionals were far more active in initiating discussions about alcohol with their patients than their colleagues in PHC. The largest differences were seen with the nurses. OHS nurses addressed alcohol with 85% of their patients, whereas PHC nurses did this only with 28% of their patients. An explanation for the high level of alcoholrelated activity among the OHS nurses is the widespread use of health examination questionnaires to assess patients’ general health and lifestyle status. Alcohol-related questions are typically incorporated into these questionnaires (Holmqvist et al. 2008). However, the present study does not reveal the depth to which alcohol issues are discussed with the patients, as the study questionnaire only enquired about the frequency to which alcohol issues are addressed with patients. This rather crude measure of activity means that the difference between the two settings concerning the total amount of alcohol preventive activity may be smaller than the activity figures indicate. Despite the fact that the difference in activity between the two settings may be partially explained by the frequent use of OHS health examination questionnaires, OHS professionals generally considered themselves more skilful in achieving a change in patients’ alcohol habits and more knowledgeable concerning providing advice to patients with risky alcohol consumption than their PHC counterparts. These findings imply that alcohol issues may be more integral to the agenda of OHS Alcohol prevention activity in Swedish primary health care and occupational health services than they are in PHC. Several researchers (e.g. Ames et al. 2000; Fauske et al. 1996; Kuokkanen & Heljälä 2005; Richmond et al. 1998) have suggested that OHS is a particularly opportune setting for alcohol prevention. Several differences were observed with regard to the basic characteristics of the professionals in the two settings. The OHS professionals were substantially older than their PHC counterparts, with OHS physicians being five years older (on average) than the PHC physicians. Another difference concerned the number of patient encounters. PHC professionals reported meeting substantially larger number of patients per week than their OHS colleagues. However, it is noteworthy that in both settings physicians with the most patient encounters were the most active in addressing alcohol issues with their patients. This implies that time limitation may not ne cessarily be a barrier to alcohol preventive activity in either OHS or PHC settings, a finding that contradicts much previous research (Stange et al. 2002). Perceived skills in achieving a change in patients’ alcohol habits were positively associated with activity for all professional categories except for OHS physicians. A particularly strong association between skills and activity was noted for OHS nurses. Knowledge concerning providing advice to patients with risky alcohol consumption was positively associated with activity for all categories except for OHS nurses, which could be explained by their high level of activity regardless of the extent of knowledge. OHS nurses and PHC physicians were the two professional categories that had received most education in handling risky NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 499