Beyond effectiveness: barriers and solutions for implementing brief alcohol interventions in primary care in Czechia

Introduction:
Brief interventions (BI) represent effective strategies for reducing alcohol-related harm, yet their implementation in primary care is challenging. This study aimed to assess general practitioners’ (GPs) perceptions of BI effectiveness, identify key implementation barriers and propose solutions for wider adoption.

Material and methods:
A modified two-round Delphi study was conducted among 20 Czech GPs. Participants were randomly selected from the national registry and invited for voluntary participation with inclusion requiring active BI delivery in clinical practice. They evaluated BI effectiveness across different risk categories, estimated time and cost requirements, and identified implementation barriers and facilitators. Consensus was defined as ≥ 75% agreement.

Results:
GPs reached a strong consensus on the effectiveness of BI particularly for high-risk drinkers (83%) and those at risk of alcohol dependence (89%). The stigma associated with alcohol use was identified as the most significant barrier (100%), followed by insufficient financial incentives (94%) and time constraints (72%). Despite these obstacles, 94% of GPs agreed BI is cost-effective. Key recommendations for improving BI adoption included targeted education (100%), digital screening tools (94%) and financial incentives (94%).

Discussion:
Although healthcare professionals in Czechia are required to assess patients for risky and harmful substance use where appropriate, BI are still not widely conducted. While GPs acknowledge BI’s effectiveness, organisational and financial issues limit its routine use. Strengthening interdisciplinary collaboration and improving BI accessibility through digital tools could enhance its impact.

Conclusions:
Addressing barriers to BI implementation requires systemic changes, including education, financial incentives and policy reforms. Without of measures of this kind, the potential of BI to reduce alcohol-related harm will remain underutilised in primary care.