B-Phosphatidylethanol sampling in primary health care to detect harmful alcohol use – perceptions among physicians

Background 
Early detection of harmful alcohol use is of importance to reduce alcohol associated morbidity and mortality. During the last decade, a new 100% specific biomarker for alcohol intake, B-Phosphatidylethanol (PEth), has been available. Although general practitioners (GPs) perceive PEth-testing as a useful tool in detecting harmful alcohol use, the implementation of PEth in primary health care (PHC) is slow and inconsistent. Local laboratory data (unpublished) shows a 20-fold variation in PEth sampling between different primary health care centers (PHCCs). Considering the lack of guidelines regarding the clinical setting in which it is most suitable to use, PEth is not estimated to be used to its full potential in PHC. 
The aim of the study is to explore physicians’ experiences and perceptions of using PEth-tests in PHC, to better understand the potential barriers to a wider implementation of this instrument. 
Methods 
The research team consists of one addiction specialist researcher (AJC), three GPs (AS, LK, ÅS) and one psychiatry resident (ML). ÅS and ML conducted individual in-depth semi-structured interviews, via telephone, digitally or face to face using an interview guide developed by the research team. We included GPs and resident GPs (hereafter GPs) (n = 20) with a variety of ages and clinical work experience. The participants were recruited via e-mail contacts from 10 PHCCs from urban and rural areas in all parts of the region of Östergötland, Sweden. We used local lab data to identify PHCC level of PEth use and invited participants from three PHCCs with high PEth use, three with a low PEth use and two with intermediate PEth use. Thoughts and attitudes towards using PEth in PHC were explored and in-depth questions were asked to reach a deeper understanding of the participants’ experiences and perceptions. Interviews were digitally recorded and transcribed verbatim. Data will be analyzed using inductive qualitative content analysis. The study was approved by the Swedish Ethical Review Authority (Dnr. 2023-04452-01). Verbal and written informed consent were obtained from all participants. 
Results 
Preliminary results show varying experiences of using PEth-tests in PHC among the participating GPs. Advantages as well as barriers to systematic PEth sampling in clinical practice emerged. GPs perceived test properties, with few sources of error as advantageous and PEth was regarded as a convenient follow up measure. Putting an “objective measure” on consumption aided broaching a sensitive subject. Disadvantages such as time constraints, economical aspects, concerns regarding personal integrity and considerations regarding Swedish traffic security legislation and the obligation to report inappropriate drivers were described. 
Conclusion
Experiences of clinicians on the use of PEth as a clinical tool can inform implementation and improve detection and follow up of harmful use of alcohol in PHC.