B-phosphatidylethanol testing to identify hazardous alcohol use in primary health care-a game changer and a challenge for general practitioners: a qualitative study.

Abstract

Background and aims: Alcohol use disorder (AUD) and hazardous alcohol use are common but underdiagnosed in primary health care (PHC). This study aimed to explore general practitioners' (GPs') experiences and perceptions of using B-Phosphatidylethanol (PEth), a specific quantitative biomarker for alcohol use, in their clinical work with patient consultations and treatment follow-up in Swedish PHC.

Design, participants, and setting: Individual interviews were conducted with GPs and resident GPs (n 20) in Swedish PHC and analysed using qualitative content analysis.

Findings: The overarching theme PEth testing in primary health care-a game changer and a challenge illustrated that PEth testing has improved the prerequisites for the GP-patient interaction while making it more complex. Four categories underpinned this theme: Comprehending the context, describing the challenges in the GP-patient interaction when hazardous alcohol use or AUD was suspected; Getting the pieces in place, illustrating the struggle of integrating PEth testing into clinical practice and how it diminished the role of alcohol history taking; The challenges and facilitators of the conversation, comprising both the difficulties in informing about PEth testing and the positive impact on the interaction, and Considerations based on the PEth test results, emphasising the consequences of elevated PEth test results and their influence on physicians' motivation to using PEth.

Conclusions: PEth is an important tool in the identification of hazardous alcohol use. Emerging ethical dilemmas regarding patient information on PEth testing and management of medical and medico-legal obligations when test results indicate high alcohol use need to be addressed in future guidelines for clinical management of PEth.