Alcohol screening and alcohol interventions among patients with hypertension in primary health care: an empirical survey of German general practitioners

Abstract

Background: Alcohol is one of the least intervened risk factors in the management of hypertension at the primary care level. In order to improve alcohol interventions, a better understanding of knowledge, attitudes and clinical practice of lifestyle interventions in the management of hypertension is needed.

Method: As a part of a European study (France, Germany, Italy, Spain, UK), 211 German general practitioners (GPs) were recruited in Bavaria and Hamburg and surveyed via an Internet-based questionnaire. Results were compared with the European sample (n = 2870).

Results: One-third of the patients seen by German GPs had hypertension (36.2%, standard deviation (SD): 14.6) and among cases with hypertension, less than half were ever screened for alcohol (4.5 out of 10 patients). The foremost reasons for not screening for alcohol were that alcohol was not considered a major risk factor for hypertension plus the lack of knowledge of appropriate alcohol screening instruments. The majority of German GPs managed patients with hazardous drinking levels themselves or in their practice (71.3%, 95% confidence interval (CI): 64.6–77.2%), but only 42.0% (95% CI: 35.2–49.0%) managed alcohol dependent patients. German screening rates were slightly lower but interventions of screened positive patients higher than the European average.

Conclusions: Rates of alcohol screening in patients with hypertension in primary health care may be increased by improving GPs knowledge of alcohol as a major risk factor for hypertension, increasing GPs education on alcohol and screening instruments, and providing reimbursement. This may increase treatment of alcohol problems in patients with hypertension and reduce hypertension.

Keywords:

• Primary health care
• general practice
• alcohol dependence
• hypertension
• screening

Acknowledgements

The study sponsor also had no role in the writing of the report nor the decision to submit the paper for publication. The corresponding author confirms that the authors had full access to the data in the study at all times, and had final responsibility for the decision to submit for publication. The authors acknowledge all GP associations and all GPs who took the time to respond to the survey.

Disclosure statement

L. K. received funding from Lundbeck for a research project on alcohol epidemiology unrelated to this study. J. M. received personal fees from Lundbeck, outside of the submitted work, and J. R. reports grants from GWT-TUD, personal fees and serving as board member (Nalmefene) for Lundbeck, outside of the submitted work.

Additional information

Funding

The study was financially supported by an investigator-initiated grant given to Jürgen Rehm and the GWT-TUD (Gesellschaft für Wissens- und Technologietransfer der TU Dresden mbH – company with limited liabilities for transferring knowledge and technology of the Dresden University of Technology) by Lundbeck.