THE GENERAL-PRACTITIONER, THE DRUG MISUSER, AND THE ALCOHOL MISUSER -MAJOR DIFFERENCES IN GENERAL-PRACTITIONER ACTIVITY, THERAPEUTIC COMMITMENT, AND SHARED CARE PROPOSALS

Background The primary care setting has been regarded in government po licy and the scientific literature as an ideal setting for the work ne eded to meet the Health of the Nation drug and alcohol targets. Althou gh studies have pointed to the negative attitudes held by general prac titioners (GPs) towards alcohol-and drug-misusing patients, there has been no direct comparison of the work and attitudes of the GP towards these patients. Aim. To compare the work and attitudes of GPs towards alcohol-and drug-misusing patients. Method. All GPs in an outer London area (157 doctors) were surveyed, using an eight-page postal question naire, collecting clinical and attitudinal data alongside demographics and practice information. A response rate of 52% was achieved. Result s. General practitioners reported working with only 3.5 patients drink ing above recommended guidelines in the previous four working weeks, a nd even fewer drug-using patients (0.75). While they viewed the alcoho l-misusing patients negatively, the drug misuser elicited substantiall y more negative attitudes. The primary care setting was seen as approp riate to work with the alcohol-misusing patient but not with drug user s. Training and support from local services would encourage substantia lly more GPs to work with alcohol misusers but not with drug misusers. Conclusions. Our findings indicate that there are some cautious groun ds for optimism that GPs are willing to work with alcohol misusers; ho wever, with regard to drug misusers, we find a GP workforce that is on ly minimally involved with this group and would not be greatly encoura ged by the provision of additional training, support, or incentives. T he Health of the Nation targets are not being met, and GPs are not det ecting adequate numbers of the patients at whom these targets are aime d. Emphasis has been placed on the role of primary care, but the real achievements that can be made require detection of the less severe dri nkers and injecting drug misusers.