Implementing pragmatic case finding to address alcohol use in general practice: a mixed methods feasibility study.

BACKGROUND

Screening and brief interventions (SBIs) for alcohol use are effective but challenging to implement in primary care settings. Universal screening is resource-intensive and may not align with general practitioners' (GPs) perceived professional role. Pragmatic case finding (PCF), which integrates alcohol discussions into clinically relevant contexts, may provide a feasible alternative to traditional SBI.

AIM: This study aimed to assess the feasibility and acceptability of tailored, theory-based educational outreach visits (EOVs) to embed PCF in primary care, explore its influence on professional practice in addressing alcohol, and examine changes in determinants of GP behaviour pre- and post-implementation.

DESIGN AND

SETTING

Four EOVs were delivered in GP clinics in Stavanger and Oslo, Norway, involving 37 GPs and 22 support staff, to enhance GPs' ability to manage alcohol-related health problems.

METHOD: A mixed-methods feasibility study comprising semi-structured group interviews and quantitative surveys. Group interviews explored GPs' experiences, while the Determinants of Implementation Behaviour Questionnaire (DIBQ) assessed changes in knowledge, skills and intentions. Qualitative data were thematically analysed. Quantitative data were analysed using descriptive statistics.

RESULTS

GPs (n = 10) perceived the EOVs as feasible and acceptable, preferring in-person over remote delivery. Key themes included greater awareness of alcohol's health impacts, sustaining awareness of hidden cases, reducing stigma through normalised discussions, and balancing motivation with the challenge of changing entrenched habits. Survey findings (n = 19) showed a gradual, positive shift in GPs' knowledge, skills, and goals to discuss alcohol.

CONCLUSION

The EOVs were feasible and acceptable for embedding PCF in primary care. They may strengthen GPs' capacity to address alcohol in routine consultations, but further research is needed to assess fidelity, sustainability, and patient-level outcomes.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov ID: NCT04725552.