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.
Bulgaria
[Customisation]
[Communications] [Strategic Alliance]
[Demonstration Project]
Final Country Chapter, January 2006
Collaborative Centre:
National Centre for Addictions,
Sofia
Chief investigators:
Dr. Alexander Kanchelov, M.D.
Dr. Gueorgi Vassilev, M.D., M.P.H.
Geographical Area in which
Implementation Strategy will be Applied:
Bulgaria
Starting Date:
2 January 2001
Completion Date:
30 December 2006
Project Stands and Milestones:
Strand I: Customisation of materials and services
and development of Communications Strategy
Strand II: The Demonstration Project
Strand III: The iterative process and formulation
of early identification and brief intervention (EIBI) policy for the country
Proposed Funding Sources:
National Health Insurance Fund
National Programme for Psychiatric Reform
Local Support:
Local and communal authorities, Communal Drug
Councils
Regional Health Departments
National Health Insurance Fund – Regional
Offices
CUSTOMIZING MATERIAL AND SERVICES
The brief intervention package to be used is The
Drink-less Programme. To meet the aim of
achieving a widespread implementation of early identification and brief
intervention (EIBI) in particular primary health care setting in the
country, some adjustment of the package to these
particular needs and circumstances related to
the primary health care organization and functioning is needed.
Early Identification:
The early identification instrument to be used is
the AUDIT, with some minor adjustments.
Early identification will be applied to the total adult population of a primary
health care service, it will be done opportunistically, under
normal conditions of primary health care service and where the opportunity
is taken to identify risky drinkers among those attending primary health care facilities for
reasons other than worries about drinking. Personnel
responsible for early identification will
include GPs and/or practice nurses or receptionists (where available).
Brief Intervention Process:
Patients identified as risky drinkers will be
provided with two types of interventions:
- Structured advice to all risky drinkers given
by the GP (as formulated in the Drink-less
Programme).
- more extended counselling ( including
condensed cognitive-behavioural techniques and brief motivational
interviewing ) to patients that are willing to attend for counselling
appointments.
Training of Primary Health Care
Staff:
An early identification and brief intervention (EIBI)
training programme specific to the primary health care requirements in the country will be developed. It will be used to familiarize
primary health care staff with the rationale, principles, methods and
procedures of EIBI. The training model will be closely related to the customized
EIBI package.
Data analysis:
Data from both focus groups and one-to-one
interviews will be analysed in accordance with the guidelines for these
analyses, provided by the Phase IV Focus Group Centre.
REFRAMING UNDERSTANDING OF ALCOHOL ISSUES
General Public:
A large-scale Mass media campaign will be an
essential element of Communications Strategy.
Its main objectives will be to communicate the concept of risky drinking, to
encourage members of the public to ask their GP
about drinking and whether or not they should
cut down, to provide and reinforce information on limits for
"responsible" drinking, to give
confidence to risky drinkers among the public that primary health care are available and
effective in assisting them to solve their drinking problems.
Health Professionals:
Primary health care professionals will be
provided with education on alcohol issue and the
concept of risky drinking and relevant information to modify their understanding
of alcoholism.
Clear messages will be communicated to them that
include: 1) raising the issue of risky drinking
will not alienate patients; 2) risky drinking causes a substantial damage to
public health; 3) EIBI for risky drinking are effective, cost-effective and
relevant to primary health care practice.
Other Stakeholders:
Key-persons, experts, decision-makers,
policy-makers, funders and other influential figures
in the health care services, social services, local authorities, NGOs, volunteer
groups, and other institutions and organizations
with the power to affect the dissemination
process, will comprise another target that will be involved to contribute to
implementation of early identification and brief
intervention in primary health care.
Media Advocacy:
Media advocacy will be used to assist the
Communications Strategy by means of creating links
with local journalists to increase their interest in alcohol-related issues and
establishing a local lobby of journalists to promote
the concept of risky drinking.
Control of Communications
Strategy:
The Communications Strategy will be under the
control of a Steering Group, consisting of
the communications specialist associated with the study, representatives of
local GP organizations, representatives of
other primary health care professional groups, health authority officials,
local authority officers, representatives of NGOs, local voluntary groups, and
others.
The Steering Group will be sub-committee of the
Main Committee, responsible for running the
entire PHASE IV for the country. The Steering
Group will define the aims of the strategy, activate the communications process
and generally guide and monitor the strategy.
ESTABLISHING
LEAD ORGANISATION(S) & BUILDING STRATEGIC ALLIANCES:
Lead organisation(s):
A lead organization will be established with the
function to take the lead in developing a co-ordinated,
country-wide approach to the promotion of early identification and brief
intervention (EIBI) in the country. Its major objective
will be to bring together individuals and organizations with interest in EIBI in
a spirit of co-operation, mutual expected
benefit and effective partnership. the lead organisation
will be based at the National Centre for Addictions and its network.
Building Strategic Alliances:
The lead organisation will attempt to bring
together into effective alliances all organizations
in the country that have an essential role to play in the implementation strategy,
including the following:
- The Ministry of Health
- The Ministry of Social Welfare
- National Health Insurance Fund
- Central and other agencies interested in
funding and supporting special initiatives and innovative
projects in primary health care.
- Central governmental and other agencies
interested in funding activities and research into the reduction of
alcohol-related harm.
- Prominent scientists, academic and
practitioners in the areas of primary health care, training of primary
health care professionals,
treatment and prevention of alcohol problems, etc.
- Key educational and research institutions with
expertise in the development of intervention
and training materials and methods.
- Professional associations, e.g. colleges of
general practitioners, nurses, medical social workers,
psychologists, etc.
- NGOs, voluntary organizations, community
groups that could contribute to the implementation strategy with particular
respect to communicating the concept of risky drinking among the general
public.
- Potential funders and sponsors of the
implementation strategy, including those from the
pharmaceutical industry ( but not the alcohol industry).
DEMONSTRATION
PROJECT(S)
Location(s):
The city of Sliven, having population of
approximately 1000. 000 and 50 PHC physicians.
Projected Start Date:
2 January 2002
Projected Completion Date:
30 December 2005
Design of project:
The Demonstration Project will have a single
before-after study design. The data collection
strategy will include data collection at baseline, completion and follow-up
points, as well as careful evaluation of outcomes
and economic outcomes.
Outcome Measures:
Since the main outcome objective is achieving
widespread, routine and enduring Implementation
of early identification and brief intervention in the primary health care setting, the outcome measures will include:
- change in number of GPs and other health
professionals who screen and intervene
for risky drinking, and the extend to which they do so.
- change in knowledge of relevant alcohol issues
- changes in attitudes of professionals towards
early identification and brief intervention.
- changes in community-wide indices of
alcohol-related harm.
Data collection will be conducted by means of
data-base and follow-up interviews and questionnaires.
Process Measure:
Process variables, relating to how and why the
early identification and brief intervention package is effective in leading to reduced
alcohol consumption, and under which conditions and circumstances, will be
measured through: in-depth interviews with a sample
of patients, structured questionnaire to
collect data on process of change among patients, structured questionnaire
implemented to personnel.
Economic Analysis:
The economic analysis will be based on
community-wide indices of alcohol-related harm, changes
in cost of health care expenditures, impaired productivity, motor vehicle
crashes, and cost and benefits of early
identification and brief intervention widespread implementation for the country.
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