The design and validation of a brief screen and resources to assist general practitioners (GPs) identify early or established problem gambling and to provide brief intervention in GPs’ patient population

Abstract

Aims: To identify demographics and develop a brief screen for early and established problem gambling amongst patients' attending a GP (family doctor). Resources developed included a self-help manual for patients and a brief GP manual. Methods: Surveys of GP patients and clients attending a programme for problem gambling treatment (CGS programme). Feedback from gambling treatment specialists and patients were used to distil potential screen questions based on existing screens and health issues. GP attitudes to intervention in problem gambling were canvassed. Results: GPs (85%) regarded problem gambling as within their mandate but only 19% considered they had sufficient training to identify and help problem gamblers. Sixty percent of male patients (n=241) regarded their GP as appropriate in help-seeking for problem gambling. Some 6.4% of male patients were probable pathological gamblers using the South Oaks Gambling Screen (SOGS). In a subsequent survey 6.5% of combined male and female patients (n=491) met that criteria. Most SOGS positives (87%) and 39.6% of SOGS negatives knew of problem gamblers amongst their family or friends. Ethnicity of SOGS positives was a strong variable (NZ European 2.1%; Maori 8.42%; Pacific Island patients 24.6%). Patients who expected their GP to read their gambling responses were less likely to answer truthfully than those responded anonymously (X12=4.0 p=.05). In the CGS programme 70% of 195 clients diagnosed as pathological gamblers and 67% of 49 pre-pathological gamblers misused alcohol (Audit .13). Counsellors (n=66) specialising in treatment of problem gambling saw a cut-off of four affirmed questions requiring intervention. The final Eight Screen, at a four cut-off, identified 9.6% of patients (n=784), 77% of all SOGS positives (specificity 95%; Positive Predictive Value = 53%) and was reliable (Cronbach's alpha 0.971). Patients presenting with musculoskeletal or particularly psychological problems were more likely to be gambling problematically. Conclusions: The Eight Screen is an effective GP tool for early intervention. Indicators for problem gambling screening are ethnicity (Maori, Pacific Island, Asian, Indian), presentations for psychological problems, alcohol misuse and general periodical screening. GPs require training around problem gambling intervention to meet their desire to provide this service, while patients need further encouragement to disclose gambling problems. .es and statistical analysis. Demographic data from those identified as being at risk for problem gambling was compared with control groups to ascertain indicators that the screen should be offered.