Progress Report Presented at a Meeting of Phase IV Investigators (Geneva, May 2002)

Meeting of Investigators, Geneva, Switzerland

24-27 May, 2002

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

 

This is the report of the work done since the last meeting in Pecs (7.-11.9.2001).

We still have problems with funding – for this year we’ve got some money from the National Health Insurance Company, the Ministry of Health.

Customization of materials and procedures

We’ve done a preliminary analysis of some life style questionnaires that were filled in by patients during preventive check-ups at their GPs’ practices. As I reported already at the meeting in Pecs we succeeded to incorporate 3-questions AUDIT in this questionnaire with some changes. After this analysis we redefined cut-off scores for the screening test to be positive.

Here is slovene version of 3-Q AUDIT (adapted by dr. Marko Kolšek):

1. How often did you drink alcohol last 12 months (beer, wine, spirits, alcoholic cider) ?
2.  never
3.  once a month or less
4.  2 – 4 times a month
5.   2 – 3 times a week
6.   4 times a week or more

2. How many drinks containing alcohol did you have on a typical day when you are drinking last 12 months? (One drink – unit is: 1 dcl of wine or 2,5 dcl of beer or cider or 0,3 dcl of spirit.)
3.  1/2 or 1 drink
4.  2 drinks
5.  3 – 4 drinks
6.  5 – 6 drinks
7.   7 drinks or more

3. How often did you drink during last 12 months

• – men:  6 drinks or more per one occasion ?
• – women:  4 drinks or more per one occassion ?

1.  never
2.   less than once a month
3.  monthly
4.  weekly
5.  daily or almost every day

Cut off score for men is 6 points, for women 5 points.

With such cut off scores you get false positive or false negative results as little as possible.

Our national recommendations for low risk drinking are:

MEN:                      14 units or less per week (2 units or less per day)

and  5 units or less per one occasion

WOMEN:              7 units or less per week (1 unit or less per day)

and    3 units or less per one occasion

(1 unit of alcohol is approximately 10 g of pure alcohol)

Here is a simulation of different possible answers with points, grams of alcohol per week and per day – supposing that the answer on the third question is a) = 0 points:

Original version AUDIT – first three questions

1. Question	Answ. e) = 4 points	answ. d) = 3 points	answ. d) = 3 points	answ. d) = 3 points	answ. d) = 3 points
2. Question	Answ. b) = 1 point	answ. c) = 2 points	answ. b) = 1 point	answ. c) = 2 points	answ. d) = 3 points
TOTAL	5 POINTS	6 POINTS	4 POINTS	5 POINTS	6 POINTS
G alc/day	35 – 140 g	210 – 280 g	10 – 60 g	60 – 120 g	100 – 180 g
G alc/day	5 – 20 g	30 – 40 g	1 – 9 g	9 – 18 g	15 – 26 g
RESULTS OF THE TEST	women pos. men neg.	men pos. women       pos.	women neg men neg.	women pos. men neg.	women       pos. men pos.
	some false pos. women	no false pos.		few false pos. women	some false pos. men

Adapted slovene version 3-Q AUDIT – first three questions

1. question	answ. e) = 4 points	answ. e) = 4 points	answ. e) = 4 points
2. question	answ. a) = 0 points	answ. b) = 1 points	answ. c) = 2 points
TOTAL	4 POINTS	5 POINTS	6 POINTS
g alco/ week	35 – 70 g	80 – 140 g	120 – 280 g
g alco/day	5 – 10 g	12 – 20 g	18 – 40 g
RESULTS OF THE TEST	women neg. men neg.	women pos. men neg..	women pos. men pos.
		no false pos..	some false pos. men

 

1. question	answ. d) = 3 points	answ. d) = 3 points	answ. d) = 3 points
2. question	answ. b) = 1 point	answ. c) = 2 points	Answ. d) = 3 points
SKUPAJ	4 POINTS	5 POINTS	6 POINTS
g alco/ week	40 – 60 g	60 – 120 g	100 – 180 g
g alco/day	5 – 9 g	9 – 18 g	15 – 26 g
RESULTS OF THE TEST	women neg. men neg.	women pos. men neg.	women pos. men pos.
		few false pos.. women	some false pos.. men

 

Reframing understanding

Three more focus groups were run with GPs and with lay people on attitudes towards EIBI.

The summary of the results of these focus groups are as follows:

GPs’ perspective:

–    GP has the best opportunity to screen for risky drinking

• – there’s no need to work with hazardous drinkers because than GPs would be the first to work with
• – but also that it’s important to start with hazardous drinkers not only alcoholics
• – drinking is the only problem, there are many others and GPs are already overloaded by work on smoking, depression, cancer,…
• – the best opportunity to talk about drinking with a patient is his problem related to drinking
• – nurses should be integrated in EIBI
• – the society (politics, national insurance) still has a destimultive role

Patients perspective: 

• – patients don’t always tell the truth about their drinking
• – patients were not uniform whether GP should ask his patients of drinking regularly or only when he comes with a problem related to alcohol
• – it is not very normal not to drink alcohol
• – there are no uniform recommendations on the »safe« limits for alcohol drinking even among physicians
• – GPs should behave as they »preach«
• – nurses should not ask about alcohol
• – family, peer group and sociaty are important for individual drinking habits but people will drink as long alcohol will be produced

The EIBI concept was presented on the national GPs’ meeting.

There were several live radio and TV talk-shows on alcohol drinking.

Strategic alliances

Some university faculties were invited to collaborate at the project:

• – social work
• – economy
• – psychology
• – sociology
• – art and design
• – social sciences
• – pedagogy

Till now collaboration with the School for social work, Art academy is already going on.

We collaborate with the Ministry of Health in the preparation of special »law for alcohol issues«. There are several lobbies that disable the integrity of the law, but anyway something is going to be prepared.

We’ve prepared instructions for the national programme for brief interventions on alcohol drinking problems.

We collaborated in the preparation of a questionnaire for the anual national »public opinion research« with limited success – not many of our remarks and suggestions were considered.

Demonstration project

After the meeting in Pecs we decided to start the demonstration project in spite of the lack of money and without final leaflets for patients and GPs.

To get the starting point situation 2 questionnaires (one for GPs and one for the population) were prepared with questions on :

• – alcohol knowledge
• – attitudes on alcohol issues
• – alcohol drinking habits (3Q AUDIT and CAGE)
• – GPs’ performance on screening for hazardous and harmful drinking

The questionnaires was delivered to GPs, to their patients in waiting rooms, to some workers and to some schools at the predefined region of approximately 55.000 inhabitants and 30 primary health care teams. We defined a control group in another part of Slovenia where the same questionnaires are delivered to GPs and their patients.

We’ve run two workshops with GPs and nurses of the region on refraiming understanding of alcohol issues and one workshop on health behaviour change counseling for brief interventions (that was learned on the intensive course at Cardiff).

We are starting to establish local steering group.

Dr. Marko Kolšek