Development of Country-wide Strategies for Implementing Early Identification and Brief Alcohol Intervention in Primary Health Care.

Udine

[Customisation] [Communications] [Strategic Alliance] [Demonstration Project]

In addition to the below information there is a page contains a progress report presented at a Meeting of Phase IV Investigators in Geneva on the 24th - 27th may 2002.   

Click here to see the report: [Progress Report]  

Collaborative Centre:

Community Research Centre of the Municipality of Martignacco, Healthy City.

Partners:

Chief Investigators:

Dr Pierluigi Struzzo, General Practitioner, Martignacco (Udine)

Co-investigators:

Dr Mario Casini - District of Health Services Company (HSC) number four     'Medio Friuli'. Udine.

Dr Fabio Samani -  President of the Regional School for the Training in General Practice. Monfalcone.

Dr Romano Paduano -  Italian Society of General Medicine.

Prof. Andrea Garlatti - University of Udine, Economic Faculty.     

Collaborators

Dr Emanuele Scafato - Instituto Superiore della Sanità, Roma (national co-ordinator)

Dr Allamann Allamanni - Centro Alcologico Integrato, Firenze

Dr Massimo Schneider - Innovo  Association,  Tolmezzo - Udine

Dr Diego Vanuzzo - Cardiology Unit, Health Services Company, Udine

Geographical Area in which Implementation Strategy will be Applied:

Region Friuli-Venezia Giulia, North East of Italy.  Within the Health Service Company (HSC) number four (Udine, 300,000 inhabitants) a smaller area will be defined. A similar area in a second HSC will act as a control group. 

Starting Date:

The project already started in the last months of 1997 when the first contacts were taken to have the project included into the planning document of the HSC.

Completion Date:

It will be co-ordinated under the umbrella project PRISMA. the national project will last 36 months, local duration will depend on funding provisions.

Project Strands and Milestones:

The project will jointly consider risky drinking and tobacco smoking

Strand I: Alliance building and communication strategies:  

• Presentation of the WHO Project to the Leading Health & Scientific Authorities 
• Definition of a Local Project co-ordinating group
• Involvement of the Majors - Independently or through the Regional Network of the Healthy Cities
• Involvement of the Regional Administration - a) Regional Health Authority. b) Training School for GPs
• Involvement of the National Health Authority and request of co-ordination (including the two Florence projects)

Materials Customisation and re-framing alcohol issues:

• Training the GPs trainers and start customisation of materials and re-framing alcohol issues
• Customisation of materials
• Community consultation on best strategies

Strand II:

Strand III:

Proposed Funding Sources:

Major expenses (printing of materials and recovering of data) will be supported by the HSC (direct and 'in kind'). 

Incentives to the GPs are promised starting from 2002.

 The Regional Agency for the Health Services will co-operate in the overall planning, co-ordination and data analysis.

CUSTOMIZING MATERIALS AND SERVICES

Brief Intervention Package:

In a recent meeting (training the trainers) all the alcohol experts (Services for alcohol and drug treatment, GP representatives) of the two HSC (Udine & Pordenone) were informed and training on the WHO approach to alcohol and tobacco issues.  The questionnaire and the materials were examined and the final agreement was endorsed. 

A 'consensus document'  was forwarded to the Press for dissemination. Some of the participants will take care of the GP training.  

GPs will be trained on early detection and 'brief intervention'  and motivational interviewing.

Focus groups were already performed within the framework of the Ecatod project. GPs agreed that AUDIT is too long, a shorter version will be utilised (3 Qs). The rest of the focus groups were mainly aimed at investigating general population feelings and suggestions. 

Early Identification:

As stated above a shorter version of AUDIT will be utilised (3 Qs).

Brief Intervention Process:

A GPs task-force  (10-20) will receive training on motivational interviewing. Intervention modalities will be decided.

Training of Primary Health Care Staff:

We do not have official primary health care staff. Where secretaries exist, the GP will take care of their training. 

Data Analysis:

There will be two levels of data analysis:

1. At local (HSC) level the staff of the districts (5 in each HSC) will recover questionnaires and analyse the patients' list that will be provided to the GPs
2. At central (Health Services Company & Healthy City) level the overall analysis (process, outcome and economical) will be performed.

REFRAMING UNDERSTANDING OF ALCOHOL ISSUES

General Public:

Focus groups with some categories (teachers, alcoholics, bar tenders, etc) of the general public will also be started in order to disseminate the new methodology.

An agreement was already achieved with the Alcohologic Territorial Schools (derived from the Hudolin methodology) whose representatives were present at the 'training the trainers' meeting. These schools usually inform and train the families, schools, etc.

Pharmacists will inform the public on alcohol and tobacco health risks and refer people to their GP.

Health Professionals: 

It was already said about the 'consensus document' given to the Press. There is the agreement on this new methodology from all the major scientific organisations (local & higher level). 

Other Stakeholders:

As stated above , focus groups will be implemented with the general public and stakeholders, that will have been identified. Due to the high national impact of agro-touristic and wine-drinking initiatives, wine producers will be contained and discussion on health issues will be scheduled.

Media Advocacy:

Apart from articles in local papers, Press and Radio support will be sought in the future.

ESTABLISHING LEAD ORGANISATIONS AND BUILDING STRATEGIC ALLIANCES

Lead Organisations:

Community Research Centre of the Municipality of Martignacco, Healthy City

Health Services Company of Udine

University of Udine

Building Strategic Alliances:

Please refer to section above

DEMONSTRATION PROJECT(S)

Location(s):

Region Friuli Venezia-Giulia: The territories included into the HSC number four 'Medio Friuli' encompassing the City of Udine (globally 300 000 inhabitants and 300 GPs) will participate in the study. A restricted number of GPs will participate in the study. A comparable control group will be identified in another HSC where only Community action will be performed. 

Projected Start Date:

Yet to be decided

Projected Completion Date:

24 months from the start date.

Design of Project:

Area A: The GPs will receive the materials by mail & instructions (already trained in the preceding months) They will also receive the complete list of their patients (from 14 years ld to 70?) where they will have to tick each screened and/or counselled patient.  To increase GPs screening and counselling rates, Community Actions will be developed with the participation and support of the Majors, Media, Pharmacists.  Focus groups with general population and other actions that will be decided by the co-ordinating group. 

Area B: After the identification of a comparable group of GPs only community actions will be carried out without any action for the GP.  Their screening and counselling rates will be measured.

Outcome Measures:

• Number of participating GPs

• Number of screened patients (GPs will be given a full list of their patients where they will tick the screened ones) 

• Number of counselled patients (as above)

• Proportion of excessive drinkers in practice population

• Change in GP professional attitude

Process Measures:

[Home Page]    [Welcome]    [Background]    [Current Research]    [Country Projects]    [Contact Us]    [Useful links]