Swedish Risk Drinking Project surveys physicians and nurses of Sweden

The proportion of health care personnel reporting that they always or often queried their patients regarding alcohol use has increased significantly. This is particularly notable with nurses, where the proportion has doubled to 60 per cent, and midwives, where 92 per cent estimate their capacity to identify risk consumption as good or very good. That states a three-year follow up of the Swedish Risk Drinking Project, which surveyed physicians and nurses in primary, occupational, maternity, and child health care across the entire country.

Sweden has experienced rapid changes in alcohol consumption, likely due to the effect of entry into the European Union (EU). Once noted for its relatively low alcohol consumption, Sweden experienced a 30 per cent increase during its first decade of EU membership.

Considerable resources have been invested to break new ground in alcohol prevention and Sweden is among those nations which invest most resources per capita in this area. One such investment is the Risk Drinking Project, which started in 2004. Its objective is to ensure that queries about alcohol consumption are a natural element in the daily interactions between health care staff and patients, integrated in such a way that it reflects the importance of alcohol as a source of medical injuries and illnesses. The project addresses early, preventive measures (secondary prevention) rather than focusing on alcohol abuse or severe alcohol-related problems.

Despite the fact that research has established that brief alcohol interventions are effective, widespread implementation of alcohol preventive measures has been slow internationally as well as in Sweden. Learning from other closely related areas such as tobacco reduction, the Risk Drinking Project proposed that the most effective way forward would involve motivational interviewing (MI) techniques and offering advice in a way that is tailored to the daily work practices of physicians and nurses in health centres.

The implementation of the Risk Drinking Project has been thoroughly evaluated, resulting in several scientific papers and a dissertation thesis. Baseline measurements were carried out in 2006 and were repeated in 2009 by Linköping University, which specializes in implementation research. Preliminary 2009 results were published in September 2009.

Results from all sub-projects - targeting general practitioners (GPs), nurses and resident doctors training to become specialists in family medicine in primary health care, physicians and nurses in occupational health care, and nurses in maternity and child care - show that extensive and comprehensive training in MI and the use of screening techniques have taken place across the country in recent years.

The proportion of primary health care physicians who consider themselves sufficiently knowledgeable to discuss give advice on alcohol with patients has also increased strongly. Eight of ten GPs in the country now consider themselves "fairly" or "very" knowledgeable, compared with six out of ten GPs three years ago. However, the nurses in primary health care are the group with the most striking improvements. The proportion who state that they have fairly good or very good knowledge on giving advice on alcohol has doubled from 30 to 60 per cent.

"This means that health care personnel more frequently ask patients about their alcohol habits and gives medical advice on the issue", according to Svante Pettersson, project manager. "We already know that screening and brief intervention of hazardous and harmful alcohol use is the most effective alcohol prevention method that can be implemented in the health care system."

Six out of ten primary health care physicians today say they bring up alcohol issues with their patients as their standard practice, considerable progress compared with the situation three years ago. Although questions to patients about smoking, physical activity and obesity are still more common than alcohol in many regions of the country, addressing alcohol issues has increased strikingly the last three years in all regions and prior differences between the different county councils are levelling out. Considering the relatively short project duration (three years) it is noteworthy that the study shows such large improvements.

Another interesting finding in the three-year follow-up is that the volume of received education in MI is strongly related to how often health care personnel discuss alcohol with their patient. The more extensive education on MI, the more often the question is asked and the more effective one considers oneself in helping patients change lifestyle-related habits. In other words, skills in MI seems to yield greater confidence regarding one's own effectiveness in addressing alcohol issues, both about alcohol use and other lifestyle habits.

Sub-reports for each of the groups of health care personnel are available from the project web site. A large national conference about the Swedish Risk Drinking Project takes place in Stockholm January 20-21, 2010.