Role legitimacy, comfort and confidence providing tobacco, alcohol and other drug care: a cross-sectional study of Australian early-career general practitioners

ABSTRACT

Australian general practitioners (GPs) see most Australians each year and, as tobacco, alcohol and other drug use (substance use) are common, GPs often see problematic, risky or dependent substance use. This study aimed to explore early-career GPs’ role legitimacy, comfort and confidence managing patients with problematic use of tobacco, alcohol, psychoactive pharmaceutical or illicit substances.

Using the ‘5A’s framework: Ask, Assess, Advise, Assist and Arrange, we surveyed 251 early-career GPs (GP registrars) on role legitimacy, confidence managing patient substance use, and sources of clinical information, advice and support.

There was strong agreement that managing substance use is a GP’s role, with high levels of confidence ‘Asking’ (screening) about tobacco and alcohol use, which decreased across other substance classes. Early-career GPs reported lower levels of confidence ‘Assessing’ and ‘Advising’ (brief interventions); and much lower levels of confidence ‘Assisting’ (treating) and ‘Arranging’ (follow up and/or referral) for patients with substance issues across all substances, including tobacco. Participants were most likely to seek advice from senior colleagues in their practice.

Early-career GPs reported lower than optimal levels of confidence for all substances. Our findings have important implications for educators globally. Education that improves confidence across all 5As for high-prevalence substances (tobacco and alcohol) while focusing on increasing comfort screening and improving understanding of referral pathway options for low-prevalence substances may improve early-career GPs’ confidence. This could increase engagement in managing substance use issues potentially leading to better health and wellbeing outcomes for patients.

KEYWORDS:

• General practice
• primary health care
• attitude of health personnel
• alcohol and other substances
• early-career clinicians

Acknowledgments

The authors wish to thank the GP registrars for completing the questionnaire and allowing the use of their results.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical approval

Ethics approval for the study was obtained from the Human Research Ethics Committee of South East Sydney Local Health District (approval number: HREC ref no. 17/145 (LNR/17/POWH/291).

Supplementary material

Supplemental data for this article can be accessed here.