Padrões de consumo alcoólico em pacientes da atenção primária à saúde e dificuldades encontradas pelos médicos para seu reconhecimento

Abstract

Introduction: The services of Primary Health Care attend significant part of the Brazilian population, in which alcohol abuse may be a common condition. Primary Health Care professionals are in a favorable position for identifying and managing patients with problems related to alcohol consumption. Objectives: To determine the patterns of alcohol consumption among patients attended in Primary Health Care in a city in Southeastern Brazil. Also, the frequency of questioning patients about their alcohol consumption and recognition of them as risk drinkers, the characteristics of this approach by physicians, the level of knowledge and barriers observed by physicians in screening the alcohol consumption were also investigated. Materials and Methods: This cross-sectional study was conducted in 41 Family Health Units in the city, from November 2010 to November 2011. We interviewed the patients to collect sociodemographic data, assessed the alcohol consumption through questionnaires Alcohol Use Disorders Identification Test (AUDIT) and Cut down, Annoyed by criticism, Guilty, Eye-opener (CAGE), and analyzed their medical records to check the frequencies of recognition of alcohol abuse by physicians, and the conduct adopted towards it. Afterward, the 41 Family Health physicians answered a questionnaire about the management of patients in relation to alcohol consumption and their difficulties with this approach. Results: A total of 932 adult patients (576 women and 356 men) were interviewed. Overall, 17.5% had AUDIT ≥ 8 and 10.5% had positive CAGE; among them only 12.6% were recognized as alcoholics, and in approximately 50% of their medical records there was no notes on the conduct adopted by the professional. Men showed risk use (AUDIT ≥ 8), positive CAGE, were asked about alcohol consumption and recognized as alcoholics more often than women. AUDIT ≥ 8 was more common among men who did not cohabitate with a partner, with no religion, with higher income, working and without chronic disease; and among black women, AUDIT ≥ 8 was more often in those with no religion and without chronic disease. Positive CAGE was more frequent among men 35-54 years who did not cohabitate with a partner, and among women with no religion. Questions about alcohol consumption were more frequent among men aged 35 to 54 years and/or with chronic diseases, and among black women and/or with chronic illnesses. Among the physicians, 85.4% evaluated themselves as unsafe in addressing alcohol consumption, and the use of screening instruments for alcohol consumption was not reported. The main barriers mentioned for screening alcohol consumption were lack of training and lack of time by physicians, and refusal to accept the diagnosis and to answer questions about it by patients. A large majority of physicians considered their responsibility in screening, advising and referencing, but not in treating alcohol consumption. Conclusions: Alcohol use is common among patients attended in the Family Health Units, but it is poorly recognized by professionals and a minority of alcoholics is advised about the risk of alcohol consumption. The medical reports suggest that there is a great difficulty in approaching this issue with the patient and emphasize the need to implement strategies of training and motivation for screening the alcohol consumption.