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.

Switzerland

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

Final Country Chapter, January 2006

Collaborative Centre: 

Unité d'Alcoologie, Département de Médecine Communautaire, Hôpitaux Universitaires de Genéve, CH -1211 Genéve 14, Tel:+41 22 372 95 37    Fax:+41 22 372 95 12  Email:pascal.gache@hcuge.ch

Chief Investigators: 

Dr Pascal Gache, Dr Yves Beyeler, Dr Beat Stoll

Geographical Area in which Implementation Strategy will be Applied: 

Canton of Geneva (400 000 inhabitants)

Starting Date: 

June 1999

Completion Date: 

December 2004

Project Strands and Milestones:

1999: 

Validation in French of the AUDIT questionnaire (collaborative study with Lausanne and Paris)                  Steering Committee implementation. 

2000: 

Strategic Alliances (local authorities, leaders of the national campaign about alcohol consumption)

Strand 1 questionnaire (from Phase III)

Baseline measures:

Material customisation (Focus groups on alcohol issues understanding and adapting screening process and intervention package)

Training GPs to Opportunistic Detection and Brief Intervention (ODBI)

2001:    

Evaluation of the dissemination of ODBI among trained GPs

Focus Groups on ODBI maintenance

Training trainers

Training GPs to ODBI (other groups)

Randomised control trial on screening  (AUDIT vs AUDIT in a health questionnaire, in collaboration with Paris)

2002-4: 

Evaluation of the dissemination of ODBI among trained GPs

Focus groups on ODBI maintenance

Dissemination of the final package

Outcome measures

Pool among randomised patients of GPs

Communication of the results

Mass media campaign

After 2004: 

Nation-wide  dissemination (at least French-speaking cantons)

Proposed funding Sources:

  • Fonds National de la Recherche Scientifique

  • Direction Générale de la Santé

  • Office Fédéral de la Santé Publique (national campaign)

  • Private fundings

Local and National Support:

Local:

  • Départment de Médecine Communautaire des HUG

  • Division d'Abus de Substances des HUG

  • Direction Générale de la Santé du canon de Genéve

  • Fédération genevoise de Prévention de l'Alcoolisme (FEGPA)

  • Réseau Médical Genevois

  • Association des Médecins de Genéve (AMG)

  • Groupement des Médecins de l'Addiction (GPMA)

National:

  • Institut Suisse de Prévention de l'Alcoolisme

  • Société Suisse d'Alcoologie

CUSTOMIZING MATERIALS AND SERVICES

  1. Focus groups with GPs, patients, occupational doctors and public health nurses.

  2. Strand I questionnaires

  3. Strand II questionnaires (face to face interviews) with GPs and key - informants

  4. Interview of specialists people in education

Early Identification (Screening)

  1. French validated version of AUDIT used either isolated or in combination to a general health questionnaire (in collaboration with Lausanne and Paris)

  2. Pre-screening symptoms

Brief Intervention Package:

  1. Utilisation of the French version of the 'Drink-less Programme'. French name is 'Boire moins c'est mieux' and adaptation according to the focus groups.

  2. Dissemination of a Swiss version of the Programme 'Boire moins c'est mieux'

Training of Primary Health Care Staff:

  1. Training will be led by the three chief investigators during the first year of training

  2. After the 'training the trainers' session, the training will be readapted according to the reaction of the audience

  3. In case, receptionists will be trained in the screening process (public health interest, goals....)

  4. During the training, guidelines on alcohol dependence will be given to help GPs to manage patients easier.

Data Analysis:

  1. Some recent studies undertook in the Canton of Genéve will be very useful as baseline measures such as an epidemiological study on alcohol consumption and an economic estimation on the burden of alcohol- related problems in the Canton

  2. other measures will be collected from the Office Cantonal de la Statisique, and from the Inststut Suisse de Prévention de i'Alcoolisme

  3. Pools among Patients will also be useful

  4. Dissemination of ODBI will be measured with the GPs

  5. Data will be analysed by the Division d'épidémiologie Clinique du Département de Médecine Communautaire

REFRAMING UNDERSTANDING OF ALCOHOL ISSUES

General Public

  • Communication strategy from the national campaign

  • Articles in the local newspapers

  • Swiss French-speaking television

  • Internet Site of the Département de Médecine Communautaire

  • Communication strategy from the Fédération Genevoise de Prévention de l'Alcoolisme (FEGPA)

  • Self-help groups should also be involved in the communications strategy to endorse the programme and warn the public about hazardous alcohol consumption

Health Professionals:

  • Article in the French-speaking Swiss medical journals about Community action on alcohol problems.

  • Communication strategy from the national alcohol campaign

  • Lecture given in the weekly hospital meeting mostly attended by GPs

  • Publication of an ABC of the understanding of alcohol issues (10 articles of one page in the same journal as previously mentioned)

Other Stakeholders:

The Conseil d'Etat de Genéve has to be involved in the programme because of the Swiss political system.  It defines the Public Health policy in the Canton and gives some priorities. Its policy is implemented by the Direction Générale de la Santé. Alcohol-related problems remain a huge Public Health problem and two years ago a report has put alcohol as a major health priority.

Media Advocacy Control of Communications Strategy:

The major topics will be:    

  • What are the safe limits?

  • Why is it important to respect safe limits?

  • Is your GP the best health professional to talk to you about alcohol.

  1. Through the national campaign, media will be contacted and will be used as a way of diffusion of the new alcohol issues.

  2. Medical journals will also be associated with the campaign

  3. The Steering Group will also involved in the diffusion of the messages through the media

  4. In September 2000 a congress on early detection and brief intervention will be held in Lausanne. All GPs from the French speaking region and also from surrounding cantons will be invited to attend the meeting. The Geneva project will be presented at this occasion.

ESTABLISHING LEAD ORGANIZATION(S) AND BUILDING STRATEGIC ALLIANCES

Lead Organization(s):

  1. Réseau Médical Genevois (REMED)

  2. Groupement des Médecins de l'Addiction (GPMA)

  3. Association des Médecins de Genéve (AMG)

  4. Direction Générale de la Santé

Building Strategic Alliances:

  1. REMED, GPMA and AMG will be well represented in the Steering Group (SG) in order to influence the implementation of the Programme.

  2. Alliances with leaders of the national campaign to include this action in the global national plan and to set Geneva as a pilot project within the campaign.

  3. Other representatives from the official organisation will be associated to the decision of the SG according to the Public Health priorities.

  4. In the process of building strategic alliances the SG will be aware of including every one who has to be in the Programme

  5. Attempts of effective collaboration has to be a real concern of the SG

  6. Alliances have to be developed with physicians from Lausanne who are involved in the training of GPs to ODBI. There is a programme in the Canton de Vaud to implement  training of GPs on this topic.

DEMONSTRATION PROJECT(S)

Location:

Canton de Genéve (400 000 inhabitants)

Canton  de Vaud (600 000 inhabitants) as a control canton for comparing baseline and outcome measures

Project Start Date: 

September 2001

Projected Completion Date:

 April 2004

Design of Project:

  • Before/after study in the Canton de Genéve

  • RCT to evaluate the best way of screening (AUIDT vs AUDIT in a health questionnaire)

  • Comparison of before/after studies with the Canton de Vaud 

Outcome Measures:

  1. Number of GPs trained/Number of GPs

  2. Number of GPs using ODBI/Number of GPs trained

  3. Number of patients screened/Number of patients to be screened

  4. Number of risky drinkers/Number of patients

  5. Number of patients counselled/Number of patients to be counselled

These measures will be implemented regularly among participating GPs according to a randomised selection of working days.

Process Measures:

Interviews with patients about the process of screening and counselling. Also interviews with GPs about the change they perceive in their practice

Economic Analysis:

We will use the same type of measures as those used in the economic study recently completed in the Canton de Genéve. These will be used as baseline measures.

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