World Health Organization Collaborative Project on Identification and Management of Alcohol-related Problems

 in Primary Health Care: Phase IV

 

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

Padova

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

Collaborative Centre

  • Ass. EUROCARE Italia, Padova
  • National Health System, Local Health Unit Padova
  • Drug and Alcohol Addiction Service, NHS, Local Health Unit, Padova
  • Istituto Fondazione A. Devoto, Florence
  • University of Florence, Research Centre for Alcohol Studies
  • National Institute of Health, Rome
  • Agenzia del Centro Alcologico Territoriale
  • (no profit umbrella including local organizations working in the alcohol field)

Chief Investigators

:

Franco Marcomini, Drug and Alcohol Addiction Service, NHS, Local Health Unit, Padova

Vanna Cerrato, EUROCARE Italia, Padova

Tiziana Codenotti, EUROCARE Italia, Padova

Daniele Berto, Drug and Alcohol Addiction Service, NHS, Local Health Unit, Padova

Valentino Patussi, Research Centre for Alcohol Studies, Florence

Gloriana Bartoli, Research Centre for Alcohol Studies, Florence

Emanuele Scafato, National Institute of Health, Rome

Collaborative Investigators:

Sonia Calzavara, Drug and Alcohol Addiction Service, NHS, Local Health Unit, Padova

Nicoletta Carotti, Drug and Alcohol Addiction Service, NHS, Local Health Unit, Padova

Oreste Bazzani , Research Centre for Alcohol Studies Florence

Stefania Polvani (Epidemiological Office, Addiction Dep., NHS) Florence

Elena Paolizzi, National Health System, Local Unit Po Delta area

Andrea Volterrani, DUSS, University of Florence Florence

Geographical Area in Which Implementation Strategy will be Applied

:

The City of Padova and 19 small municipalities included in the Padova Local Health Unit (about 400.000 inhabitants)

Starting Date:

March 2001: in reference to Strand I – Customizing package, it has been completed in collaboration with the Florence North-west subproject, with which common materials have been agreed.

Completion Date:

Expected December 2003

Project Strands and Milestones

:

Strand I:

 - Customisation of early identification and brief intervention package, training (24 months)

Strand II:

  - Demonstration Project (36 months)

Strand III:

 - Evaluation and Outcome Measures (12 months)

The Strategic Alliances will be developed from the beginning of the project and implemented during the process. The communication strategy should be linked to the Demonstration Project(s). The Strands are not placed in a chronological order because they pursue overlapping objectives.

Proposed Funding Sources

:
  • Local Health Authority
  • Ministry of Health - National Institution of Health
  • Social Affair Department, Presidenza del Consiglio
  • City Government of Padova and other small municipalities of this area
  • Banks
  • Local Companies
  • National Association of City Government (ANCI)

Local Support

:
  • City Government of Padova and other small municipalities of this area
  • Municipal Healthy City Offices in Padova
  • Volunteer associations (ACAT, APCAT, ARCAT, AA, Al-Anon, Al-Ateen)

CUSTOMIZING MATERIALS AND SERVICES

Participants

:
  • GPs
  • Primary Health Care Professional Workers
  • Non Professional and NGOs Workers

Methods

:
  • Focus Group
  • Structured questionnaire

It could be possible to revise the Questionnaire used for the Phase III, Strand I, in a shorter form much more linked to the objectives of the present project. This questionnaire should include some questions about attitudes to early identification and brief intervention and willingness to take part in the project. The revised form of the questionnaire could constitute a baseline measures and the way to involve GPs in the project.

Brief Intervention Package: 
  • Revised Drinkless package
  • Booklet for patients
  • Informative booklet for GPs
  • Alcoinforma (Alcohol Addresses)
  • Posters and Leaflet on Alcohol Issues in different areas (women, young people, working place, etc.)

Method of delivery:
  • GPs Associations and networks
  • Sensibilization meetings
  • Post + Telephone + e-mail

Early Identification:
  • AUDIT
  • CAGE
  • Health Survey Questionnaire (HSQ)

Brief Intervention Process

:

Early identification and brief intervention should include different levels of action and it could be composed of three phases:

  • Screening (opportunistic early identification)
  • Brief intervention options: advice, informative materials and package, Self-help groups supports, brief counselling, motivational interviewing
  • follow-up

The different brief intervention options should be clarified and defined considering level of alcohol related problems, indicators of physical, psychological and social factors, patient’s ‘stage of change’.

Training of Primary Health Care Staff

:
  • Direct Training
  • Training the Trainers (SIMG, Hudolin Methodology )

Data Analysis:

Content Analysis

  • Coding of categories
  • Thematic analysis

REFRAMING UNDERSTANDING OF ALCOHOL ISSUES

Communication Strategy is mainly based on the Educational Training Programme applied by the Clubs of Treated Alcoholics, Social Ecological Approach, Hudolin's Method. Additionally a mass media campaign could be delivered at later stages in the study. Finally, public conferences called ‘Sensibilization Meetings’ will be organised in local theatres and schools

General Public

:
  • Sensibilization Courses (ACAT)
  • Territorial Alcohol Schools (3rd Module)
  • Posters and Leaflets on Alcohol Issues and Health Status

Health Professionals

:
  • Sensibilization Courses (ACAT)
  • Mono-thematic daily meeting on Alcohol Issue
  • Involvement of GPs Association (SIMG)
  • Congresses, Public Presentations, Study Papers

Other Stakeholders

:
  • Sensibilization Courses (ACAT)
  • Territorial Alcohol Schools (3rd Module)
  • Involvement and alliance with Local Volunteer Associations
  • Local Schools

Media Advocacy

:

Create a link with the Local Mass Media (Radio, TV, Newspapers) to persuade them to give information on Alcohol Issues

Control of Communication Strategy

:

Qualitative data on the response to the initiatives done Pre and Post questionnaire for the different Sensibilization Courses and Meetings proposed

Indicators of the effectiveness of the communication strategy such as: Diffusion of Communication Strategy, Visibility of the Project in the Community, Change on perception about ARPP in the local community and Change on social response about ARPP.

‘Steering Group’ with representatives of GP’s associations (SIMG) and other primary health care Professionals Groups, representatives of voluntary associations (ACAT, AA, Al-Anon, Al-Ateen), representatives of the local government, Media Expert and representatives of local media

ESTABLISHING LEAD ORGANISATIONS AND BUILDING STRATEGIC ALLIANCES

Lead organization(s):
  • University of Florence, Research Centre for Alcohol Studies
  • Epidemiological Office of the Addiction Department (NHCS)
  • Foundation Istituto ‘A. Devoto’, Florence
  • Associations of Clubs of Treated Alcoholics, Padova area

Building Strategic Alliances:
  • Local Municipalities
  • Municipal Healthy City Office Padova
  • Drugs and Alcohol Addiction Service
  • GP’s Associations and networks
  • Volunteer associations (ACAT, APCAT, ARCAT, AA, Al-Anon, Al-Ateen)
  • National Association of City Government (ANCI)
  • Local and National Media
  • Post Graduate Training on ARPP, University of Florence
  • National Trade Unions
  • Ministry of Health
  • Ministry of Social Affair
  • National Institution of Health
  • National Health Care System
  • ARCI (National Association involved in cultural activities)

Methods:
  • Involve Local Associations
  • Create a network of "Alcohol Services"
  • Establish a common territorial strategy
  • Strengthen Territorial Alcohol Centre
  • Implement collaboration between Public, private organizations and Non Profit NGOs
  • Promote community action projects within the community

Evaluation

:

Indicators of the effectiveness of the development of the strategic alliances such as: Diffusion of the Alliances and Building of new spontaneous network within the community.

DEMONSTRATION PROJECT(S)

Location(s):

The City of Padova and 19 small municipalities included in the Padova Local Health Unit  (total population of 400.000 inhabitants)

Population base

:

50.000-100.000 corresponding to 1 city district

Representative and stable population with an high sense of responsibility and identity with the local community.

No. of Primary Health Care Facilities:

To be defined

Projected Start Date

:

March 2001

Projected Completion Date

:

End of 2003

Design of Project

:

Before After Study with baseline and outcome measures

Outcome Measures

:

Baseline and follow-up measures on:

  • n. of participants involved and trained
  • n. of information requested by other participants
  • n. of patients screened and n. of counselling performed
  • n. of requests of advice and help to primary health care services

Pre and Post Questionnaire about: knowledge on alcohol issues, skills and attitude towards early identification and brief intervention

Qualitative analysis of patients responses to the early identification and brief intervention.

Process Measures: 

Structured or semi-structured questionnaire including process indicators with indexes convergence between primary health care workers and patients.

Economic analysis

:

Health Economist

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