Twenty-four training sessions were conducted over 2003, 2004 and 2005 with a total of 424 people attending, of whom 419 completed evaluation forms. Responders were 300 (73%) FPs, with 112 in other categories, including medical student, nurse, pharmacist, ambulance officer, psychologist or counsellor, drug and alcohol worker, and probation and parole officer. Not all respondents answered all questions. Analysis of the results below is confined to FPs (n = 300). One hundred and sixty-nine (56%) FPs were from urban areas and 131 (44%) from rural areas.
The learning expectations the doctors described covered three general areas: information; identification and assessment skills; and intervention and management skills. A selection of typical responses is grouped under these headings. Among 'information needs', responses included 'what drinking levels are safe?' 'what is problem drinking?' 'how to manage problem drinking?' Needs expressed for identification and treatment included 'latest methods of assessment and intervention', 'how do I get the message through?' 'techniques to identify and approach a problem drinker', 'what to do with drinkers who deny their dependence?' Under 'intervention and management skills', FPs expressed they wanted strategies to use on recalcitrant or relapsing patients, a quick and effective way of intervening, strategies to use with relapse and problems such as family difficulties, work problems, and drink driving; and management of hazardous intake, dependence, and withdrawal.
Other expectations voiced were 'obtaining information about drinking and driving, with emphasis on the RTA's new initiative'; update on the new medications for treatment of alcohol problems; indications for detoxification, and the detox sedation regimen; other drug withdrawal management, and information about local followup and support services. Networking with colleagues was also mentioned.
Of the 199 separate consent forms collected from doctors, 142 (71%) agreed to being on the RTA list as a provider of brief intervention to drink-drive offenders entering the Interlock Program. Thirteen were not eligible (due to reasons such as imminent retirement, maternity leave, registrar or locum status) and 44 declined.
At pre-test, 7% (95% CI: 4 to 10) of FPs felt 'not at all confident' at identifying problem drinkers, 11% (95% CI: 7 to 14) were 'not at all confident' in deciding what steps to take next, and 13% (95% CI: 9 to 17) were not at all confident at carrying out a brief intervention, whereas at post-test no-one responded this way. In further analyses the five response categories were collapsed into 'not confident', 'undecided' and 'confident' (Figures , , ). While 49% (95% CI: 43 to 55) of the FPs attending our training sessions indicated at baseline that they felt confident in identifying at-risk drinkers, this proportion rose to 90% (95% CI: 87 to 93) post-session. They also reported increased confidence in their ability to advise patients, which rose from 36% (95% CI: 31 to 41) to 90% (95% CI: 87 to 93). These differences were all statistically significant at p < 0.000. On comparing responses between urban and rural FPs, the rural FPs showed significantly higher levels of confidence than the urban FPs both at pre- and post-test over all items (p = 0.001), except for their confidence in ability to conduct brief intervention at pre-test (p = 0.123). The rural FPs' level of confidence rose from 42% to 97% on this item while the urban FPs rose from 31% to 84%. However, in both rural and urban FPs the rise in confidence remained significant and did not differ between the groups.
Ability to identify at-risk drinkers.
Deciding the steps to take with at-risk drinkers.
Conducting brief intervention for risky alcohol use.
Positive comments about the workshop included comments such as 'good combination of theory and practice; very relevant to family practice; case studies helpful; excellent presentation of a rarely discussed problem'. Other statements mentioned the practical nature of the 'helpful, easy to use materials' and the importance of identifying not only high-risk but also low-risk drinkers 'as prevention is extremely important'. Negative comments and suggestions included 'how to initiate alcohol reduction apart from losing licence?; not sure how negative patients will be with the Interlock program; would like a full workshop on the intervention; still a difficult issue to effectively address'.