Distrust, regulation, and alcohol disclosure

University Of Pennsylvania, Philadelphia PA

Investigators

Abstract

Knowledge about the effect of alcohol on health outcomes has grown rapidly over the past decade. Research has shown that even moderate levels of alcohol consumption significantly increases the risk of developing cancer, cardiovascular disease and digestive tract conditions, as well as contributes to injury, accidents, violence and increased mortality. Despite the growing evidence of alcohol's impact on health, a critical proportion of hazardous use goes undetected by the medical system. Since primary care physicians are uniquely positioned to assess risky drinking at the earliest stages, policy recommendations focus on regulating physician screening of patient alcohol use. Policy interventions regarding the detection, evaluation and management of alcohol use and abuse have recently been proposed in a variety of arenas, including federal and state legislatures, insurance and managed care organizations, professional and medical associations and patient advocacy groups. Many of these proposed interventions are targeted toward primary health care settings to increase physician routine screening of patient alcohol use and improve clinical practice. As new technologies become available to determine individual susceptibility to outcomes of alcohol use, such as genetic testing, health care policies governing their implementation and utilization will also become necessary. However, accurate assessment of alcohol risk involves full patient disclosure of alcohol intake as well as physician screening and susceptibility assessment. These policy interventions could have a variety of influences, both intended and unintended, on patient disclosure behavior. Interventions that result in increased distrust of the health care system, for example, may paradoxically decrease the willingness of patients to accurately disclose their alcohol use. If the health care policy attributes having the greatest potential for unintended consequences could be identified prior to implementation, modifications could be made to prevent or reduce potential subsequent impact on disclosure behavior. This study proposes to explore the potential behavioral impact of interventions designed to improve physician assessment of alcohol associated risks, such as mandatory alcohol screening or use of genetic testing for alcohol susceptibility, on patient health care related distrust and alcohol disclosure. The specific aims of this study are to: 1) assess the relationship between patient distrust of the health care system and their willingness to accurately disclose their alcohol use to their primary care physician; 2) examine the potential unintended consequences of policies designed to regulate physician screening and detection of alcohol use on patient trust and disclosure; 3) explore how new technologies, such as genetic testing for alcohol susceptibility, could influence patient trust and disclosure.