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.
Spain
[Customisation] [Communications] [Strategic Alliance] [Demonstration Project]
Final Country Chapter, January 2006
Collaborative Centre:
Program on Substance Abuse of the Health Department of the Autonomous
Government of Catalonia (Órgan Tecnic de Drogodependències)
Chief Investigators:
Joan Colom i Farran and Antoni Gual i Solé
Geographical Area in which Implementation
Strategy will be applied:
Catalonia
Starting Date:
November 1998
Completion Date:
2005
Project Strands and Milestones:
Strand 1: Focus groups, training the trainer workshops,
preparation of materials, strategic alliances, etc.
Strand 2: Implementation
Proposed Funding Sources:
Department of Health
Application for funding "Ajuts per accions especials de recerca
i desenvolupament" of the Department of Universities, Research and
Information Society of the Autonomous Government of Catalonia.
Local Support:
Socidrogalcohol (Spanish Scientific Society
on Alcoholism)
SCMFiC (Catalan Scientific Society on Family Medicine)
Servei Català de la Salut (Official Agency of the Health Department
which contracts providers of ealth services in Catalonia)
Institut Català de la Salut (Public Health Provider)
CUSTOMIZING MATERIALS AND SERVICES
15 focus groups with GPs, nurses, patients,
health planners and alcohol specialists.
Brief Intervention Package, including
delivery systems:
Drink-less package adapted to Catalonia,
with an addendum for treatment of less severe alcoholics in Primary Health
Care and guidelines for referral to specialized centres.
The package is being delivered in the primary health care centres by specialists
in addiction in the same geographical area. The specialists attended the
workshop for trainers, so they were ready to begin the implementation
and holding workshops in any primary health care centres following the
guidelines of the "Skills for change" package.
Early Identification (Screening):
The tools included for the screening
are the following validated questionnaires:
- the Audit questionnaire, in Catalan and in Spanish (Contel et al.1999;
Rubio et al.1998),
- The AUDIT-C (Gual et al. 2002)
- A quantity/frequency questionnaire on alcohol consumption called the
ISCA (Gual et al. 2001).
Each primary health care centre decides whether to use selective or systematic
screening.
Rubio G., Bermejo J., Caballero M.C., Santo-Domingo J. Validación de la prueba para la identificación de transtornos por uso de alcohol (AUDIT) en atención primaria Revista Clínica Española 1998; 1(198) ;11-14
Contel M, Gual A, Colom J, Test para la identificación de transtornos por uso de alcohol (AUDIT): Traducción y validación del AUDIT al catalán y castellano Adicciones 1999; 4-11.
Gual A, Contel M, Segura L, Ribas A, Colom J. El ISCA (Interrogatorio Sistematizado de Consumos Alcohólicos): un nuevo instrumento para la identificación prematura de bebedores de riesgo Medicina Clínica, 18 2001 ; 117: 685-689.
Gual A, Segura L, Contel M, Heather N, Colom J. Audit-3 and audit-4:
effectiveness of two short forms of the alcohol use disorders identification
test.
Alcohol Alcohol. 2002 Nov-Dec;37(6):591-6.
Brief Intervention Process:
Brief intervention is being delivered following the guidelines
of the Drink-less Program.
To facilitate the brief intervention four practical intervention guidelines
as decision-tree has been developed: Alcohol related problems intervention
guideline (the most general one), Motivational approach (to guide the
intervention with unconscious or ambivalent patients), Risky drinking
intervention guidelines, ADS intervention guidelines.
Two different booklets have been developed: one for risky drinkers (adapted
from the original one) and one for dependent drinkers.
Training of Primary Health Care Staff:
Primary health care staff is being trained in five 60-minute sessions
held at the primary health care centre as part of their regular CME activities.
The specialists began the co-ordination with primary health care co-ordinators
on January 2002.
Data Analysis:
Quantitative and qualitative analyses of data collected are being done.
REFRAMING UNDERSTANDING OF ALCOHOL ISSUES
General Public:
The general public is not the target of the communication strategy. The
target is all patients attending primary health care centres. Patients
receive information through posters and leaflets on display in waiting
rooms.
A press conference to introduce, officially, the Drink Less program was
held on 23 November.
Health Professionals:
Health professionals were contacted through the training sessions and specific materials were also distributed. General symposia was held on 21 November for engaging both primary health care co-ordinators & alcohol specialists, before the beginning of the field work.
Other Stakeholders:
Media Advocacy:
The media was informed two days after the general symposia
scheduled via the standard Health Department procedures.
Control of Communications Strategy:
Some questions about the effectiveness of the communication strategy were
added in the questionnaires for patients and for professionals.
ESTABLISHING LEAD ORGANIZATION(S) AND BUILDING STRATEGIC ALLIANCES
Lead organization(s):
Program on Substance Abuse and AIDS of the Health Department
of the Autonomous Government of Catalonia
(Òrgan Técnic de Drogodependències i SIDA)
Building Strategic Alliances:
Socidrogalcohol (Spanish scientific society on alcoholism)
SCMFiC (Catalan scientific society on family medicine)
Servei Català de la Salut (Official agency of the Health department
which contracts providers of health services in Catalonia)
Institut Català de la Salut (Public Health Provider)
Location(s):
Catalonia, with around 6.500.000 inhabitants, has 344 primary
health care centres.
Projected Start Date:
11/2001
Projected Completion Date:
2005
Design of Project:
All primary health care professionals will receive the
Beveu Menys training between 2002 and 2005. In 10% (randomly selected)
of the centres a before-after study for the evaluation process is being
implemented. Two trained evaluators visit the centres selected before
and after the implementation of the program.
Outcome Measures:
We measure changes in attitudes, knowledge and behaviour of both patients
and health professionals.
Attitudes and knowledge of alcohol are being measured through questionnaires
delivered to random samples before and after the implementation process.
Behaviour is measured through random test of medical records to check
the percentage of patients screened and advised. Consultations to specialised
centres and number of referrals are also recorded before and after the
implementation phase.
Process Measures:
During the implementation process, some measures are being
collected:
" % of specialist professionals joined
" % of health professionals trained
" % of Beveu Menys training sessions held
" Number of phone calls to specialists
" Etc.
Economic Analysis:
We are sampling information on the economic costs and savings of the implementation.
If you need more information, contact us at: beveumenys.salut@gencat.net
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