How confident are you at discussing alcohol-related health issues with your patients?
Many pharmacists find raising concerns about alcohol misuse can be quite difficult, especially with older patients.
Focus groups led by Edith Cowan University researchers found just that, with 14 surveyed community pharmacists citing barriers including lack of confidence, knowledge and skills.
While the majority said they felt confident in providing health information about alcohol, there were limits when it came to assisting those with possible alcohol issues beyond advising on medication and alcohol use.
For example, one participant said dispensing medication was the only conduit through which she felt able to have this type of discussion with older clients:
“Well I do work in a community pharmacy where there is a predominately older population so that’s who I see when I work. When alcohol use comes up it is invariably associated with prescription medication – it is ‘will it be ok to drink while I’m taking this?’ There is never any other time where I would feel comfortable bringing it up.”
However most participants agreed they felt more confident raising the issue of alcohol consumption while undertaking scheduled health checks, when alcohol use could be addressed as simply one risk factor within a broader health-related conversation.
Levels of confidence were a top predictor of participants’ willingness to engage older clients. One young pharmacist commented:
“I find it’s very difficult to speak to older people. The one patient that comes to mind is someone whose husband used to come into the pharmacy and so we got to know them a lot better, and as soon as he passed away I think she started to get quite a bit of an alcohol problem, and I think it’s very difficult to bring it up and talk to her about it.”
Another pointed out that in the busy community pharmacy environment, commercial pressures often limit the time a pharmacist can spend with individual clients:
“You don’t get paid for that [chatting] and you’ve got to make enough money to cover you wages, but if you’re just talking about alcohol consumption you’re not particularly getting paid for it so you do have to put time into what you do get paid for. Neither have you got 15 min to talk to someone about their alcohol use, without any benefit to the pharmacy particularly.”
The researchers point out that one of the more experienced participants had worked out that a “softly softly” approach could be more successful in broaching the issue:
“It’s not ‘do you drink alcohol?’ It’s ‘I’m just letting you know’, and then ‘well, oh yes I have a drink every night’, and then we’ll be like ‘oh well I’ll choose a different product for you’, or ‘don’t take this at the same time’, or something, so that you can keep the conversation going a bit … but that does need some training, because that’s hardly a question, it’s more giving information so it doesn’t seem like a confronting interrogation.
The authors conclude that future research should focus on addressing barriers such as limited skills and confidence in raising sensitive alcohol-related issues.
In addition, they say professional activities can be leveraged to enhance community pharmacists’ capacity to engage older clients in alcohol-related health discussions and deliver brief interventions.
How do you broach the topic of alcohol-related issues with patients?