GP’s engagement in detecting and managing abuse of alcohol, illegal drugs, hypnotics and tranquilizers in the Belgian adult population

Background
General practitioners (GPs) Occupational physicians (OPs) can play an important role in detecting and managing substance abuse in the working population. The UP TO DATE project aims at identifying the difficulties these professionals encounter in this area, and to explore ways of collaboration in providing appropriate care.
Research question
What are the experiences, attitudes and decision making of GPs and OPs regarding to alcohol, illegal drugs, hypnotics and tranquilizers abuse from a physician’s perspective?
Method
In this qualitative study, with a phenomenological perspective, 20 GPs and 16 OPs, experienced with substance abuse in daily practice, got a face to face in-depth interview. (October until December 2012). Along with the data collection process the analysis started with a constant comparison between the data and the chosen integrated model of change (De Vries), using coding techniques of grounded theory.
Results
GPs meet important barriers to detect misuse of all substances. To address this issue and the patient’s motivation for change, the doctor-patient relationship is crucial. The risk to disturb the relationship, and loose the patient’s trust, is a major concern. An attitude of patient-centeredness, collaboration and empowerment of the patient is needed to make any progress, to get results and to overcome as a GP the burden of those demanding encounters. Self-care is an important concern.
Collaboration with specialised health providers confronted GPs with various problems: not enough services, long waiting lists, unclear methods and criteria.
GPs lack an insight in the OP’s role, and experience problems to contact them. Whether the OP is a trustful health advocate for their patient is a major concern. Some OPs are perceived too linked to the employer, raising legitimate concerns about professional confidentiality.
Conclusion
These are preliminary results. At the conference, a comprehensive overview on the qualitative analysis will be given.