Challenges of managing alcohol use related driving license legislation when using B-Phosphatidylethanol in primary care

Åsa Steensland, Lisa Kastbom, Anna Segernäs, Andrea Johansson Capusan

Keywords: Alcohol Misuse, Alcohol Use Disorder, Automobile Driving, Phosphatidylethanol, Primary Health Care, Qualitative Research

Background:

General practitioners (GPs) have conflicting duties when managing harmful alcohol use: to identify and treat alcohol use related problems but also to report driving unfitness caused by alcohol use disorder. B-Phosphatidylethanol (PEth), a specific biomarker for alcohol intake, is perceived as a useful tool but the clinical implementation is slow and inconsistent. To our knowledge, no previous studies have explored how GPs manage driving license legislation in relation to PEth testing.

Research questions:

How do GPs perceive and manage the legal duty to report unfit drivers when using PEth-tests in Swedish primary health care (PHC)?

Method:

Individual, semi-structured interviews with GPs (n 12) and resident GPs (n 8) were conducted. Participants were recruited from PHC (n 10) units with different patterns of PEth utilization. Interviews were transcribed verbatim and analyzed using qualitative content analysis. The study was approved by the Swedish Ethical Review Authority (Dnr. 2023-04452-01).

Results:

GPs reported difficulties interpreting the driving license legislation and conducting assessments of fitness to drive when PEth test results indicated high alcohol use. They balanced between the duty to report unfit drivers and simultaneously maintain a therapeutical physician-patient relationship. Existing guidelines were not perceived useful and diverse strategies emerged. Some GPs refrained from using PEth testing, or from reporting, while others standardized the management, or used the obligation to report as a motivator for patients to reduce their alcohol intake.

Conclusions:

The results reveal difficulties in complying with the legal duty to report unfit drivers as one of the factors hampering the clinical implementation of PEth in PHC. Since systematic use of PEth could improve early detection of harmful alcohol use, the perceived difficulties can be interpreted as an unintended consequence of this legislation. Clearer guidance on the interpretation of the driving license legislation and the clinical use of PEth is necessary and asked for by the participants.

Points for discussion:

What does driving license legislation in relation to PEth testing state in different countries?

How can PEth be used to increase detection and treatment of harmful alcohol use?

How can policy be improved to facilitate both reporting of unfit drivers and healthcare for patients with harmful alcohol use?

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