Meeting of Investigators, Geneva, Switzerland

24-27 May, 2002

(Meeting to be held at Hotel Château de Coudrée, France)

  Progress report, May 2002

INTRODUCTION

* [Customizing Materials and Services] 

* [Reframing Understanding of Alcohol Issues]

* [Establishing Lead Organizations and Building Strategic Alliance]

* [Establishing and Evaluation Demonstrations]

* [Economic Analysis]

After the Municipality of Martignacco  has taken the responsibility to implement Phase IV in the Region Friuli-Venezia Giulia (January 2000), a lot of work has been done. It is important to mention that our project, together with other Italian projects, are now endorsed by the Ministry of Health and are integral part of a wider national project promoted by the Istituto Superiore della Sanità (PRISMA, dr. E. Scafato). It seems very important to mention that the requested funding is on its way to be delivered, hopefully the following summer. This progress report outlines the major aspects of the actions performed in the Region Friuli-Venezia Giulia, with little or no funding available. For what is carried out at a national level, under the PR.I.S.M.A. umbrella, please refer to the specific documentation. 

Component 1: Customizing Materials and Services

After the consensus conference, held in 1998, where most of the regional experts agreed on the general aspects of the WHO protocol, no other action to customise the Drink-Less package was performed. In the daily work the GPs should jointly consider Alcohol & Tobacco. The general comment that came out was that the GP has little or no time to dedicate to the explanation of the package to the patient, so a shorter version of the AUDIT ( first 3 questions with a cut-off point of 5) would be preferable. The package should be utilised only as a hand out after the simple advice . The GP needs to be able to include the screening capacity within the history taking, together with other general questions, the simple and short advice has also to come “natural” with every client. In this respect, we need to perform more focus groups with the general population and the GPs to better understand the format and content of a more tailored package.

Component 2: Reframing Understanding of Alcohol Issues

It was at the right time that this WHO collaborative study was introduced in Italy. The existing Hudolin methodology for alcoholism treatment (since 1979), did not give room to other ways of approaching alcohol consumption other that as abstainer or alcoholic. The understanding, by experts and the general population, that also moderate, risky and harmful drinkers exist, brought “fresh air” and new topic of discussion and confrontation. After the Consensus conference, the WHO methodology was presented at the annual conference of the GP in September ’99 where the drink-les package and a questionnaire on attitudes was also distributed.

In the framework of the EU funded project E. C. A. To. D. (Exchange of methodology between European Union Countries – NIS and CCE, to define essentials of European Community Actions supporting primary health care action against Tobacco consumption and hazardous Drinking) a set of Focus Groups were performed with young people and alcohol, smokers on alcohol & tobacco, doctors and alcohol, GPs on alcohol & tobacco.

Delphi methodology was also applied to experts and stakeholders in order to reach a consensus on risky drinking.

More action needs to be done to involve other stake-holders such as wine producers and the general population.

Component 3: Establishing Lead Organizations and Building  Strategic Alliances

The “bottom-up” approach is an important feature of this project. Instead of being proposed by Universities or Alcohologic Centres or Services, this project was born within the local municipality of Udine. After the new elected politicians refused to continue to support it, the Municipality of Martignacco (8 km out of Udine) has taken the lead and decided to invest on the community actions connected with this project. Formal agreements were first made with the Local Health Unit that endorsed a Community Research Centre were also a non-smoking Centre was created. The University of Udine was recently involved, underlining the economic evaluation aspect and deciding to study the health gains and develop a model for the municipalities. Strategic alliances will be mainly aimed at involving the mayors of the cities and towns of the region. In this respect the Local Health Unit of Pordenone ( 50 km west of Udine) is now involving a group of GPs on screening and counselling on alcohol and tobacco. Their involvement could also be considered as an important added value.

From the implementation of the demonstration project more alliances will be created especially from other regional provinces and towns. Special care will be put in involving small municipalities and demonstrating their important role in health promoting activities.

Component 4: Establishing and Evaluating Demonstrations

With the activities already performed and with all the potentialities laying within the strategic alliances, provided adequate funding is available, we are now ready to start thinking of the demonstration project.

The general idea is to consider the study area the Health District of Udine (150.000 inhabitants and nearly 150 GPs, Area A) while the Local Health Unit of Gorizia (Area B) could be considered the control group.

Community actions (promoted by the mayors) such as families involvement and actions with bars, restaurants and industries, could be extremely useful in bringing people to the GPs asking to be screened and counselled. Such actions could interest both Areas, while intensive action on GPs will only be performed in Area A, not in Area B. Baseline and follow-up measures, yet to be decided, will be taken. Communication strategies and media involvement will be performed in between and in both areas. Details of the demonstration project will be given in the next progress report.

Economic Analysis

 An attempt to evaluate the costs was also performed but detailed actions will also be performed in the next future by the University of Udine, Faculty of Economy (prof. A. Garlatti)

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