What factors determine Belgian general practitioners’ approaches to detecting and managing substance abuse? A qualitative study based on the I-Change Model

BMC Family Practice

Research Article

Marc Vanmeerbeek¹  Frederic Ketterer¹  Philippe Mairiaux²  Linda Symons³  Roy Remmen³  Lieve Peremans⁴  Marie-Claire Lambrechts⁵  Lode Godderis⁶ 

[1] Department of General Practice/Family Medicine, University of Liege, Avenue de l’Hôpital 3, CHU B23, 4000, Liege, Belgium;Department of Occupational Health and Health Promotion, University of Liege, Avenue de l’Hôpital 3, CHU B23, 4000, Liege, Belgium;Department of Primary and Interdisciplinary Care, University of Antwerp, Campus Drie Eiken, R3, Universiteitsplein 1, 2610, Wilrijk, Belgium;Department of Primary and Interdisciplinary Care, University of Antwerp, Campus Drie Eiken, R3, Universiteitsplein 1, 2610, Wilrijk, Belgium;Department of Public Health, Vrije Universiteit Brussels, Laarbeeklaan 103, 1090, Brussel, Belgium;KU Leuven, University of Leuven, Centre for Environment and Health, blok D – box 7001, Kapucijnenvoer 35/5, 3000, Leuven, Belgium;KU Leuven, University of Leuven, Centre for Environment and Health, blok D – box 7001, Kapucijnenvoer 35/5, 3000, Leuven, Belgium;IDEWE, External Service for Prevention and Protection at Work, Interleuvenlaan 58, 3001, Heverlee, Belgium;

关键词: General practitioners;    Substance abuse;    Attitudes of health personnel;    Motivation;    I-Change Model;   

DOI  :  10.1186/1471-2296-15-119

 received in 2014-03-12, accepted in 2014-06-06,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundGeneral practitioners (GPs) are considered to play a major role in detecting and managing substance abuse. However, little is known about how or why they decide to manage it. This study investigated the factors that influence GP behaviours with regard to the abuse of alcohol, illegal drugs, hypnotics, and tranquilisers among working Belgians.MethodsTwenty Belgian GPs were interviewed. De Vries’ Integrated Change Model was used to guide the interviews and qualitative data analyses.ResultsGPs perceived higher levels of substance abuse in urban locations and among lower socioeconomic groups. Guidelines, if they existed, were primarily used in Flanders. Specific training was unevenly applied but considered useful. GPs who accepted abuse management cited strong interpersonal skills and available multidisciplinary networks as facilitators.GPs relied on their clinical common sense to detect abuse or initiate management. Specific patients’ situations and their social, psychological, or professional dysfunctions were cited as cues to action.GPs were strongly influenced by their personal representations of abuse, which included the balance between their professional responsibilities toward their patients and the patients’ responsibilities in managing their own health as well the GPs’ abilities to cope with unsatisfying patient outcomes without reaching professional exhaustion. GPs perceived substance abuse along a continuum ranging from a chronic disease (whose management was part of their responsibility) to a moral failing of untrustworthy people. Alcohol and cannabis were more socially acceptable than other drugs. Personal experiences of emotional burdens (including those regarding substance abuse) increased feelings of empathy or rejection toward patients.Multidisciplinary practices and professional experiences were cited as important factors with regard to engaging GPs in substance abuse management. Time constraints and personal investments were cited as important barriers.Satisfaction with treatment was rare.ConclusionsMotivational factors, including subjective beliefs not supported by the literature, were central in deciding whether to manage cases of substance abuse. A lack of theoretical knowledge and training were secondary to personal attitudes and motivation. Personal development, emotional health, self-awareness, and self-care should be taught to and fostered among GPs to help them maintain a patient-centred focus. Health authorities should support collaborative care.

【 授权许可】

Unknown   
© Ketterer et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.