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.

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

In addition to the below details you can see updated information of the project: 

1.WHO - PHASE IV - SLOVENIA REPORT (Pecs, September 2001) (format pdf)
2.Progress Report Presented at a Meeting of Phase IV Investigators (Geneva, May 2002)
3.Phase IV: Implementing Country-Wide Early Identification and Brief Intervention Strategies in Primary Health Care - Meeting of Investigators (Paris, March 2003)(format pdf)
4.Phase IV in Slovenia- Document for 'Bridging the Gap' Conference (Warszawa, June 2004) (format pdf)
5. Final Country Chapter January 2006) (format pdf)

Collaborative Centre: 

Department for family medicine at the Medical faculty, University of Ljubljana, Slovenia

Chief Investigator: 

Marko Kolšek, dr.med.

Geographical Area in which Implementation Strategy will be Applied: 

Slovenia

Starting Date: 

June 1999

Completion Date: 

End of 2006

Project Strands and Milestones: - 

-Strand 1 consists of customization process, the development of the communication strategy and the beginning of the alliance-building component. It consists also of the preparation for the demonstration project.

- Strand 2 is the demonstration project itself together with continuing broadening of strategic alliances throughout the country as a whole.

- Strand 3 is the iterative process of further customizing materials and processes and improving the communication and dissemination strategies according to the experiences gained during the demonstration project. The final step is the written early identification and brief intervention (EIBI)  policy in the country as a whole.

Proposed Funding Sources:

 - WHO

- Ministry of Health

- National Health Insurance Company

- Pharmaceutical Companies

Local Support:

 - local budget

- successful companies

 CUSTOMIZING MATERIALS AND SERVICES

Brief intervention package:

A brief intervention package will be developed using existing national and international knowledge and experiences.

Literature (e.g. Drink-less Programme) will be reviewed, focus groups and some other methods (e.g. Delphi methodology, quality circles) will be used to adjust the package to our particular needs and circumstances. The results of E.C.A.T.O.D. Project (Slovenia has joined the project and we've already started with focus groups) will be used , too.

The most appropriate method for delivery the package to primary health care groups, which will be selected in this process, will be used.

Early identification (screening):

Some existing screening methods (e.g. AUDIT) will be reviewed and considered. An appropriate method for Slovenian circumstances will be developed according to the results of this review and eventual adjustments to our situation. Focus groups, workshops or small pilot projects will be used before the final acceptable screening method will be defined.

Brief intervention process:

Different brief intervention methods will be considered to develop the Slovenian one, which will be used in our primary health care groups. Experiences from other collaborating countries in Phase IV will be welcomed during this customisation process.

We will consider the possibility to develop two or three different brief intervention methods from which primary health care team can choose the most acceptable for its motivation and feasibility.

Training of  Primary Health Care Staff:

A training model will be developed considering focus groups' results, international and our own literature. An advice on this aspect from Dr. Gual will be asked and experiences from other collaborating countries will be considered.

Possibilities in including such training to undergraduate and postgraduate education for health professionals will be examined and changes introduced as appropriate.

Data analysis:

Focus groups qualitative analysis will be performed, data from eventual questionnaires will be considered. Other used methodologies will be analysed, too.

General public:

Possibilities in including mass media, educational organisations and local communities in reframing understanding of important alcohol issues will be considered (e.g. articles, interviews, leaflets, ...) and the most appropriate will be used. Existing information channels will be considered and if possible included in our liaisons.

Health professionals:

Special approaches for health professionals will be considered and the most feasible will be used especially in CME, but also possibilities in including these topics in undergraduate and postgraduate education will be examined.

Other stakeholders:

Honoured people (scientists, politicians, physicians, artists, musicians, sportsmen,...) on national and local level will be approached in order to participate in the project and to promote the dissemination process.

Media Advocacy:

An attempt to create links with journalists in mass media (on national and local level) will be made to convince them to divulge the concept of risky drinking.

Control of Communication Strategy:

It will be carried out by a Steering group. The communication strategy will be guided, monitored and evaluated by different methods which will be ascertained as most useful.

Lead Organisation:

Department for family medicine at the Medical Faculty, University of Ljubljana with close collaboration with The National Association of family physicians, The Association of Nurses and The Alcohol Treatment Centre with national WHO coordinator for alcohol problems

Building Strategic Alliances:

An attempt to bring together some organizations and individuals will be made. E.g.:

• - central government
• - ministry of health
• - Institute for public health
• - collaboration with national WHO coordinator for alcoholism
• - local governments, mayors and leaders of political parties
• - University of Ljubljana
• - Centre for treatment of alcohol addiction
• - primary health care institutions
• - ministry of work, family and social affairs
• - ministry of science
• - ministry of education
• - ministry of finances
• - prominent scientists and academics (medicine, economics, education, sociology)
• - professional associations and chambers
• - Red Cross, Karitas
• - pharmaceutical industry
• - Lion's club, Rotary club

Possible methods:

•  - individual contacts with key persons
• - letters to organisations
• - registrations to public invitations for national and local research projects
• - official invitations to conferences, workshops, discussion groups and interviews

On the local level specific smaller steering subgroups (with locally interested parties) will be considered and created if possible.

Location:

Several health centres are being approached and offered collaboration in the project. The most appropriate for the purposes of the demonstration project will be invited:

e.g. Health centre Ljubljana-Šiška (urban) or Health centre Nova Gorica (urban) or Health centre Kranj - they have 25 - 30 primary health care teams for approximately 45000 - 60000 inhabitants;

Health centre Ribnica (rural), Health centre Litija (rural) - 9 primary health care teams for approximately 19000 inhabitants.

We are considering the appropriate number of primary health care facilities that would be convenient for Slovenian situation having in mind only 2.000.000 inhabitants and a little less than 1000 primary health care teams.

 Projected starting date: 

End of 2001

Completion date: 

End of 2005

Design of Project:

Before-after study at two different locations with follow-up also between baseline and final evaluation

- outcome, process and economic analysis would be performed for evaluation

Outcome Measures:

Several possible outcome measures will be considered:

•  - number of GPs (and nurses) who perform early identification and brief intervention
• - knowledge of different alcohol-related topics (of professionals and patients)
• - attitudes toward the idea of early screening and brief intervention
• - number of diagnoses of alcohol-related disease (in primary care and hospital admissions)
• - rates of drink-driving convictions
• - car accidents involving alcohol
• - patients' attitudes and reactions to screening and brief interventions.

The survey could be carried out at these two locations among medical professionals and local population, some data would be collected from national statistics database.

Process Measures:

Possible process measures will be considered, too :

•  - how the GP's early identification and brief intervention (EIBI) helps patients to change their drinking habits
• - why does it help (or does not) patients
• - quality of delivered early identification and brief intervention

These could be measured by questionnaires and by analysis of GPs' and nurses' consultations (e.g. video technic).

Economic Analysis:

For economic analysis a health economist could be invited to help such analysis.

Some possible measures: 

- use of health services before and after the intervention

- sick-leave because of alcohol-related diseases before and after

- car accidents involving alcohol before and after

Data would be gathered by a survey and by collecting data from national statistics.

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