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Abstract
Brief Intervention (BI) for hazardous drinkers at a Primary Health Care (PHC) level can be implemented during the interaction between a GP and his/her client in a range of contexts and opportunities, the GP's office being a primary context. Communication skills are needed for professionals in order to deliver the BI and they should be familiar with motivational interviewing. This pilot study, carried out during 2006–2007, observed how GPs are able to effectively communicate with their hazardous drinking clients when implementing BI. Four GPs have voluntarily participated in the study, altogether interviewing 13 clients in their office in the province of Florence (Italy). Two types of questionnaires were used: a questionnaire on the quality of BI and a questionnaire on the reformulation and summarizing skills. At the end of each interview both questionnaires were independently completed by both the GP and an attending research psychologist. Also, 12 interviews were videotaped and subsequently evaluated by two clinicians. On the whole, GPs scored high regarding their effective communication skills as well as in terms of the quality of BI implemented during the interviews at their offices. The study's limitations are noted and research needed in the future is suggested.
Notes
1The often used taxonomy of “risky drinkers” needs to be carefully delineated in terms of its dimensions as well as the critical conditions (endogenous as well as exogenous ones), which are necessary for this behavior and lifestyle to exist/occur if it is not to remain a stakeholder's valued shibboleth and label rather than being a useful and necessary tool for effective treatment planning, implementation, and assessment. Editor's note.
2The reader is referred Hills's criteria for causation which were developed in order to help assist researchers and clinicians determine if risk factors were causes of a particular disease or outcomes or merely associated. (Hill, A. B., 1965. The environment and disease: associations or causation? Proceedings of the Royal Society of Medicine, 58: 295–300). Editor's note.
3The traditional hierarchical medical model, which focuses on the IP (identified and targeted patient) and not upon a dynamically interacting, and necessary treatment “constituency,” which represents a range of existing—but not necessarily accessible—individuals and systems whose involvement and engagement in the treatment would/could facilitate goal achievement and/or minimize barriers to change, has not considered the need to assess and to document changes in these “others.” Editor's note.
4With the advent of artificial science and its theoretical underpinnings (chaos, complexity, and uncertainty theories) it is now posited that much of human behavior is complex, dynamic, multidimensional, level/phase structured, noninear, law-driven, and bounded (culture, time, place, age, gender, ethnicity, etc.). Change, motivation, and self-image, however, each is and can be defined as such behaviors/processes. (Buscema, M. (1998). Artificial neural networks, substance use and misuse, 33(1–3). As the reader, consider the pause/level dimensions of change; it is useful to also consider the critical conditions (endogenous as well as exogenous ones), which are necessary for the planned-for change to occur (begin, continue, become anchored and integrate, change as de facto realities change, cease, etc.) or not to occur. Editor's note.
5The WHO Brief Intervention (BI) package was the so-called Drink-less Programme used in conjunction with the AUDIT screening instrument. However, to meet the aims of Phase IV of achieving a widespread implementation of BI in each participating country, it was necessary to readjust the BI package to the specific needs of each country (see World Health Organisation, Citation2006, p. 19).
6The Leonardo Cooperative is an organization of about 100 GPs in Florence; Leonardo has agreed to endorse the Florence 1 PRISMA project promoted by Florence Health Agency. Altogether, 25 GPs entered the whole Project, and four volunteered for the Client/GP interaction study.
7This study was not designed to investigate causal relationships. Editor's note.
8The reader is referred to the literature of the Medical Humanities movement, which has developed over the course of the past three decades. Physicians such as Rita Charon, Richard Selzer and Rafael Campo explored the use of narrative, personal essay, and poetry, to illuminate the human dimensions of illness and the integral reciprocity between practitioner and patient/client. In the nursing field, poets such as Veneta Masson, Cortney Davis, and Belle Waring—to name but a few—have created a new genre of writing with their images of nursing.