ÅSA THURFJELL - Hazardous alcohol use in patients with hypertension in routine primary health care- prevalence and methods to address and detect

Project description

Background

Hypertension and alcohol are important risk factors for global disease burden. Alcohol can contribute to hypertension and impair the treatment effect. General Practitioners (GPs) miss to identify a majority of patients with hazardous alcohol use. The validated screening test Alcohol Use Disorders Identification Test (AUDIT) is seldom used in PHC. The relative new alcohol biomarker Phosphatidylethanol (PEth) has become frequently used in Primary Health care (PHC), but studies in that context is scarce.

Aim

We aim to advance the evidence on how to address alcohol and detect hazardous use of alcohol in patients with hypertension treated in PHC.

Method

1. To explore GPs’ experiences of using PEth, with control and treatment of hypertension, we will include a purposive sample of GPs to participate in focus groups. We will use a semi structured interview guide with mostly open-ended questions. The interviews will be audio-taped, written verbatim, and analyzed with Inductive content analysis. Ethics approval: 2020-04725, 2021-01707. (Qualitative study)
2. To define the prevalence of hazardous alcohol use, in a population with hypertension, we will include 270 patients from different Primary Health Care Centres (PHCCs) and add PEth and AUDIT to annual control of hypertension. By using Medrave M4 we will extract patients and stratify to three groups of hypertension (controlled, uncontrolled, treatment resistant), randomize, and then invite. Prevalence of hazardous alcohol, defined with PEth and AUDIT, will be described in the three groups and we will adjust for possible confounders. Ethics approval: 2020-04725, 2022-02085-02. (Observational cross-sectional study)
3. To explore patients’ experiences of routine use of PEth in the care of their hypertension we will invite them to individual semi structured telephone interviews. Recruitment will be done purposefully from one PHCC where PEth is used routinely with hypertension. A semi structured interview guide will be used. The interviews will be audio-taped, written verbatim and analysed with Grounded Theory method. Ethical approval: 2022-04826-01. (Qualitative study)
4. As a first step, prior a future RCT, we will study the feasibility of using PEth and AUDIT in care of hypertension. We will recruit approximately 20 patients from different PHCCs and add PEth and AUDIT to the annual control. We will study rates of recruitment and adherence, challenges for personal, number of patients with hazardous use (detected with PEth or AUDIT), and number of patients who are offered support to reduce consumption. Ethical permit: Will be applied for. (Feasibility study)

Relevance

The project will clarify the magnitude of hazardous use of alcohol in patients with hypertension and increase knowledge if, from both GPs’ and patients’ perspective, PEth is a useful tool to address alcohol and detect hazardous use in routine PHC. Effective routines to detect hazardous alcohol use may increase the use of methods to support patients to change the habit.