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Departament de SalutDirecció General de Salut Pública
Eurocare Bridging the Gap (BtG) Project:
Third meeting of networkBarcelona, 11th to 13th May 2006
Alcohol policy in CataloniaAntoni Plasència
Joan Colom Antoni GualLidia Segura
Departament de SalutDirecció General de Salut Pública
Departament de SalutDirecció General de Salut Pública
Alcohol Policy in Catalonia• Public Health in Spain and the reform of public
health services in Catalonia– Dr. Antoni Plasència- General Director of Public
Health• A public health approach to alcohol policy
– Dr. Joan Colom – Director of the Program on Substance Abuse
• The lessons learnt – Dr. Antoni Gual – Head of the Alcohol Unit of the
Government of Catalonia
Departament de SalutDirecció General de Salut Pública
3
Departament de SalutDirecció General de Salut Pública
PUBLIC HEALTH IN SPAINPUBLIC HEALTH IN SPAIN&&
THE REFORM OF THE REFORM OF PUBLIC HEALTH SERVICESPUBLIC HEALTH SERVICES
IN CATALONIAIN CATALONIA
Antoni PlasAntoni PlasèèncianciaDirector general de Salut PDirector general de Salut Púúblicablica
Eurocare Bridging the Gap (BtG). Barcelona, May 11-13, 2006
Departament de SalutDirecció General de Salut Pública
Introduction to the current situation of Public Health in Spainoutline of the basic components of the reform of PH services in CataloniaImplications for alcohol policiesand programs.
PurposePurpose
Departament de SalutDirecció General de Salut Pública
HealthHealth & social context (1)& social context (1)Aging society (lowest fertility rates & high life
expectancy)
Epidemiological profile: Cardiovascular, Cancer, Injuries, AIDS+drugsInequalities (social & geographical)North-East/South-West
Unbalanced trends in Health Objectives
Departament de SalutDirecció General de Salut Pública
Overall improvement in health trendsEmerging (global) health threatsEconomic impactIncreasing media interest and influenceIncreasing sense of vulnerability (individual and collective)Citizens’ growing request for information and empowerment
HealthHealth & social context (2)& social context (2)
Departament de SalutDirecció General de Salut Pública
HealthHealth systemsystem context (1)context (1)Restoration of democracy in 1977New constitutional structure: 17 Autonomous Regions
(Comunidades Autónomas)Quasi-federal model
Spain: 44 million pop.Catalonia: 7 million pop.
Departament de SalutDirecció General de Salut Pública
HealthHealth systemsystem context (2)context (2)
General Health Law, 1986Health care:
- free & universal, no explicit restrictions of access to most procedures - financed through taxes, centrally collected and redistributed (by capitation)- transferal of health responsibilities to the Regions (completed in 2002)- “split” between planning, financing and provision of services (mostly for Hospital & Primary care)
Departament de SalutDirecció General de Salut Pública
Public Health is generally not understood –maybe because when it is effective, nothing happens. Surgeon General Jocelyn Elders, 1995
Departament de SalutDirecció General de Salut Pública
PublicPublic healthhealth (*)(*)
People
NFP org.
Corporations AdministrationsHealth system
“ the organized effort of society to protect and promotehealth, and to prevent disease.”
PH policies
PH services
(*) ≠ publicly financed health care system
Public Health
Departament de SalutDirecció General de Salut Pública
protectionlaboratories
management of health authority
Surveillance and PH emergencyresponse
promotion and prevention
Health monitoring
Other (occupational health, foodsafety, etc.)
MainMain PH PH servicesservices
Departament de SalutDirecció General de Salut Pública
PublicPublic HealthHealth systemsystem in in SpainSpain: : organisationorganisationTransferralTransferral of PH of PH responsabilitiesresponsabilities to Regions in to Regions in latelate 7070’’ss
DevelopmentDevelopment of Regional PH of Regional PH structuresstructures ((heterogeneousheterogeneous):):-- surveillancesurveillance, , healthhealth protectionprotection, , healthhealth promotionpromotion
Concurrent Concurrent responsabilitiesresponsabilities withwith local local levellevel: : healthhealthprotectionprotection ((alsoalso healthhealth promotionpromotion in in largelarge urbanurban areasareas))
OverlapOverlap withwith somesome PrimaryPrimary CareCare functionsfunctions ((healthhealthpromotionpromotion, , diseasedisease preventionprevention))
OverlapOverlap withwith otherother organisationsorganisations: : environmentalenvironmental, , foodfood, etc., etc.
NationalNational MinistryMinistry of of HealthHealth: : regulatoryregulatory and and coordinatingcoordinating rolerole
VaryingVarying coordinationcoordination amongamong RegionsRegionsNationalNational ReferenceReference Agencies: Agencies: i.ei.e., Centro Nacional de ., Centro Nacional de
EpidemiologEpidemiologííaa, Agencia de , Agencia de SeguridadSeguridad AlimentariaAlimentaria
Departament de SalutDirecció General de Salut PúblicaDepartament de Salut
The Catalan Health System
Financing
Public Health Care Dependency
Planning
SYSTEMRes
earc
hTr
aini
ng
LAWS & REGULATIONS
Departament de SalutDirecció General de Salut Pública
FutureFuture PH PH servicesservices needneed to beto be• able to anticipate• able to solve• based on best available evidence (or on precautionary principle)• enforce the law• close to citizens and territories• transparent in comunication
• able to anticipate• able to solve• based on best available evidence (or on precautionary principle)• enforce the law• close to citizens and territories• transparent in comunication
Generate CCONFIDENCE AND SAFETY !ONFIDENCE AND SAFETY !
Departament de SalutDirecció General de Salut Pública
TheThe reformreform of of PublicPublic HealthHealth in in CataloniaCataloniaA
politicalpriority
(AcordsTinell)
Public Health(including occupational, environmental
health and food safety)
Public Health(including occupational, environmental
health and food safety)
PolicyBenefitsServices
promotion, prevention & protection, with the
support of surveillance, monitoring and research
promotion, prevention & protection, with the
support of surveillance, monitoring and research
An executive organizationoriented to the local level
Agency of Public Healthof Catalonia
“the point of access”
Agency of Public Healthof Catalonia
“the point of access”
With municipalitiesWith citizens
With professionals
Link with GTSCommunity Health
Management of transformation
Link with GTSCommunity Health
Management of transformation
A Public Health Law
Departament de SalutDirecció General de Salut Pública
SomeSome principlesprinciples ofof thethe PHS PHS reformreform in in CataloniaCatalonia (1)(1)
• Separate the regulatory and planning functions fromservice provision -> creation of the Public Health Agencyof Catalonia (ASPCAT)
• Implement an executive and interdepartmentalorganization
• Involve and coordinate PH local and regional resources• Promote coordination with health care• Orient the organization towards quality• Strengthen PH professional training (technical and
managerial levels) • Promote innovation and research linked with practice• Improve communication with the public and the media
Departament de SalutDirecció General de Salut Pública
Sector
GTS
Provision
Generalitat MunicipalitiesRegionalDirector PH
Hosp. S.mental Socio- PCare ESPsanit
PH teams (*)(multidisciplinary )
ESP
A decentralised Agency
connected with municipalities(Governs Territorials de Salut) and with local providers
(*) in collaboration
with municipalteams
A deconcentrated executiveAgency
Regional Agencies
Departament de SalutDirecció General de Salut Pública
ExecutiveExecutive rolerole and and continuitycontinuityCentral level
Local level
Exec
utiv
ero
leServices Services
PRO
TEC
TIO
NSU
RVE
ILLA
NC
E
Continuity and integrationPREVENTIONPROMOTION
audit role
Community health
Departament de SalutDirecció General de Salut Pública
Alcohol & Health: Global BalanceAlcohol & Health: Global Balance
• 10-15% hospital emergencies• 4% hospitalizations• 41,5% treatment demand XAD• 19.900 deaths (>6% annual mortality)
• 30-50% in fatal car injuries• 15-35% in severe car injuries• 17% in occupational injuries • 4.200 deaths by cirrhosis• 10,1 l. of alcohol consumption per capita
Departament de SalutDirecció General de Salut Pública
LinkingLinking alcohol alcohol policypolicy toto publicpublic healthhealth policypolicy• Launch the Catalan Public Health Agency, in charge of
– the design and implementation of programs incorporating effective strategies of health promotion & protection, and disease prevention, with the support of epidemiology, monitoring and research.
– providing support to policy formulation and planning– monitoring changes in key determinants and outcome indicators
• Development of a regional strategy on mental health promotion and mental disorder prevention in the framework of a global reorganisation of the public health policies and resources.
• Complement the medical approach with population-based public health interventions to address the broad dimensions of alcohol problems at the community level.
Departament de SalutDirecció General de Salut Pública
Public Health is generally not understood –maybe because when it is effective, nothing happens. Surgeon General Jocelyn Elders, 1995
The support of the population to public health ishigh... once it understands what it is about.
H. Taylor, 2002. The Future of Public Health
Departament de SalutDirecció General de Salut Pública
A A betterbetterorganizationorganization for a for a
betterbetter serviceservice
For more information:Reforma de la Salut Pública a la web del Departament de Salut:
http://www.gencat.net/salut/depsan/units/sanitat/html/ca/dir446/index.html
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
A public health approach to alcohol policy
Joan ColomDirector of the Program on Substance
Abuse
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Index
• Alcohol as a health determinant: overcomingcultural barriers
• Alcohol in the Health Plan• Guidelines of the Program on Substance Abuse• The Catalan Network on Addictions (XAD)• From treatment to prevention:
– PHC: the Beveu Menys experience– School: ‘Salut i escola’ program
• Next steps: alcohol at work, road casualties, marketing control, etc.
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
0 200000 400000 600000 800000
Alcohol, 1996
Illegal Drugs,1997
Public Health Costs
Costs not related tohealth
Accidents
Other Departments
Legal Departments
Indirect Costs
Alcohol as a drug: overcomingcultural barriers
Sources: Portella et al., 1998García-Altés et al., 2000
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Risky Drinking Prevalence
6
7
8
9
10
11
12
13
14
1999 2001 2003
15-29 years 15-65 years
Source: Household Survey on Drugs. Program on Substance Abuse
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Health Plan 2002-2005Alcohol Chapter
• 3 general targets for health until 2010:– Reduce accidents related to alcohol– Reduce morbidity related to alcohol– Reduce prevalence of excessive alcohol
consumption among general population and specially among young people
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
• Integrated Mental Health Strategy to be launched in 2006. – To increase the commitment of the networks specializing
in health promotion and the prevention – Improve the competency and the capacity of PHC in the
treatment of people with mental health disorders and addictions
• Preparation of a Map of Health, Public Health and Social Services and an Integrated Governmental Plan for Caring for People with Mental Health Problems (IGPMH).
Director Plan on Mental Health and Addictions (DPMHA)
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Guidelines of the Program on Substance Abuse
• Addictions are diseases and must be treated within the Health System
• The Drugs Plan must deal with all drugs, including alcohol and tobacco
• Drug and alcohol related problems must be viewed from a Public Health perspective
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Guidelines of the Program on Substance Abuse
• Legislative activities• Prevention activities• Treatment of addictions. Creation of a network
of specialized centers (XAD)• Harm reduction activities• Introduction of alcohol related issues in Primary
Health Care.• Strategy to introduce programs of Drugs at Work
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Legislative activities
• Two laws (20/85 and 10/91) have been developed by the Catalan Parliament concerning “substances that can produce addiction”.
• They are devoted to issues related with sales and availability of alcohol, establish age restrictions and legislate the limits of promotion and advertising
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Guidelines of the Program on Substance Abuse
• Legislative activities• Prevention activities• Treatment of addictions. Creation of a network
of specialized centers (XAD)• Harm reduction activities• Introduction of alcohol related issues in Primary
Health Care.• Strategy to introduce programs of Drugs at Work
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Prevention Activities
1. Health Education at school2. Leisure3. Specific groups4. Community5. Workplace
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
At school: preventive tools
“My friends, my garden”
(1993) 6-8 years
Tales that explain both personal conflicts and relationships problems that have to be sorted out.
“The adventure of life”(1999) 8-12 years
-To promote health habits and firm attitudes over consumption-To offer materials and training to students teachers and parents
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
At school: Preventive equipment
CD-Rom“Limit Zero”(1994) 14 -18 Relation between alcohol and car driving.
“And you, what do you think?” (1999) from 14Productive discussion about subjects as Living with the group, The free time, fashion and publicity, etc.
“Going out”(2001) from 17
Productive discussion about the “Going out”behaviour
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Risk Reduction
• Monitoring scheme on new patterns of youth’s drug and alcohol use
• Consensus Commission for a “safer night”
• Programmes:– On site information– On site pill testing
Aims:
• Increase either contact and retention
• Decrease morbidity and mortality
• To give information about Harm and risk associated.
• Decrease either social exclusion and
social conflict
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Guidelines of the Program on Substance Abuse
• Legislative activities• Prevention activities• Treatment of addictions. Creation of a
network of specialized centers (XAD)• Harm reduction activities• Introduction of alcohol related issues in Primary
Health Care.• Strategy to introduce programs of Drugs at Work
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Catalan Drug Addiction Network(Xad)
Specialised Resource Network for people with drug
addiction related problems.
• Public Health Care Network
• Health care to all Drug Addictions
• Wide distribution throughout Catalonia
• Free access
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Catalan Drug Addiction Network(Xad)
INPATIENTUNITS: 11Beds: 53
OUTPATIENT UNITS
60
C.T.Units: 10
Dual Diagnosis Units2 Rehabilitation programs: 13
Directorate General of Substance Abuse and AIDS. Department of Health and Social Security.
Methadone Programs 72
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Heroïna15%
Alcohol42%
Cocaïna25%
Cannabis4%
Altres4%
Tabac10%
Admissions to treatment- 2004
Font:Òrgan Tècnic de Drogodependències
N: 14.537
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Guidelines of the Program on Substance Abuse
• Legislative activities• Prevention activities• Treatment of addictions. Creation of a network
of specialized centers (XAD)• Harm reduction activities• Introduction of alcohol related issues in Primary
Health Care.• Strategy to introduce programs of Drugs at Work
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Harm Reduction Activities
• Guidelines on best practice
• Substitution treatment
• Syringe exchange and condom distribution
• Out-reach work and peer education
• Drop-in centres
• Drug users’ involvement
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Guidelines of the Program on Substance Abuse
• Legislative activities• Prevention activities• Treatment of addictions. Creation of a network
of specialized centers (XAD)• Harm reduction activities• Introduction of alcohol related issues in
Primary Health Care.• Strategy to introduce programs of Drugs at Work
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Primary health care activities• Training courses for nurses and GPs• Setting goals for alcohol screening through the Health Plan • Establishing the Minimum Common Criteria for
intervention in alcohol related problems in Primary Health Care
• Testing of packages to screen and assess briefly risk drinkers
• “Beveu Menys”/Drink Less Program• Primary Health European Project on Alcohol (PHEPA
Project) funded by the European Commission• International Network on Brief Interventions of Alcohol
Problems
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Customization of the training manual
Customization of theintervention package
Training thetrainers (n=84)
DISSEMINATION
347 PHC Centres7915 PHC professionals
Creation XaROHITERATION
Customization ofthe training manual
Training thetrainers (n=66)
Customization of theintervention package
2002
-200
520
05-2
008
The “Beveu Menys” Program
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
December 2005:• 84 trainers• 340 trainings• 98 % PHC centres• 7915 professionals• 900.000 € spent• Training packages:
– 8687 PHC – 109 trainers (XAD)
• Bulletins: 21
100%
90.2%
98.6%
100%
100%96.5%
100%
100%
What have we done?
Difusió segons RS
(anterior a l’actual reestructuració)
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
“Salut i Escola” Health & School Program• Open consultation at school of nurses from PHC
centres• Aimed at improving adolescents’ mental health
(eating disorders, anxiety disorders and depression) and addiction problems.
• A special circuit of collaboration among services has been designed and includes the mental health services
• A parallel evaluation process has been implemented and it is planned to extend the program to all the territory
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Next steps• Full integration of the alcohol policy in the new Catalan Public Health
Agency and in the Mental Health Strategy• Improving the epidemiological surveillance on alcohol consumption and
alcohol problems• Better monitoring of the accomplishment of the regulations on alcohol
specially those related with selling, promotion and advertising• Continuation of the dissemination of EIBI in primary health care and
spreading the initiative to other health settings (hospitals, emergencies, etc.).
• Complete the dissemination of the Health and School program.• Development and promotion of workplace based prevention programs in
the framework of the agreement signed in march 2002. • Reduce alcohol-related traffic casualties • Working towards the development of a national, multisectorial and
comprehensive alcohol policy
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
The lessons learnt
Antoni Gual1,2 & Lidia Segura2
1. Alcohol Unit, Neurosciences Institute. Hospital Clínic. Barcelona
2. Program on Substance Abuse. Public Health Gen. Dir.. Health Dep. Catalonia.
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Index• A regional/national perspective
– The Beveu Menys evaluation– The Xaroh
• A European perspective– The Phepa 1 evaluation– The Phepa 2 Project – The Inebria experience
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
The “Beveu Menys” evaluation
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Acceptance of the Course
• Rate of Attendance high and maintained during all sessions
• 83% of participants attended at least 80% of the sessions.
02468
101214161820
1 2 3 4 5
Sessions
83%
17%
Accreditation
Certification
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
What's the impact of training ontrainers?*
Strongly disagree -/+
Strongly agree
To train PHC teams in alcohol is important 0 2 0 2 4 29 63To train PHC professionals pays off 6 6 10 18 20 24 14
Coordination between PHC and specialists is impossible 47 39 4 8 2 0 0
* Results are shown in percentages. N=49
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Drink Less Evaluation ++ + +/- - --
Global evaluation 15 68,3 16,7 0 0
Useful to give advice 10 40 41,7 8,3 0
Increase skills 10,2 40,7 42,4 6,8 0
Helps in daily clinical work 6,8 69,5 10,2 13,6 0
Helps to screen 8,1 31,7 43,3 16,7 0
• Results are shown in percentages (N=63)
• Attended 94% of professionals interviewed
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Changes in Professionals at 3 monthsBasal Folow-up Analysis
N % N % pWomen 55 68,8 41 61,2 n.s.
I have enough training 47 58,8 41 61,2 n.s.SDU contents in grams 43 57,3 49 87,5 p<0.001
% Patients screened (x;sd) 46,71 32 21,60 25,4 p<0.001% Risky drinking/day (x;sd) 3.93 4.80 5,14 6,8 n.s% AD /day (x;sd) 1,17 1,6 2,32 4,42 n.s
I’m satisfied to help to change alcohol habits
50 62,5 50 84,7 p<0.05
Risky Drinking Criteria 39 51.3 36 63,2 n.s.Use of standardized instruments 6 7,9 24 42,1 p<0.01
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Medical Records: ResultsBasal Folow-up Analysis
N % N % pWomen 488 57,5 452 55,9 n.s
Age (X, SD) 54.85 19.60 52,52 21,56 n.s.Screened last 3 Months 75 8.8 74 9.2 n.s.
Shared treatment 1 1,6 1 2 n.s.
MR opened (X, SD) 7.35 4.94 7.51 5.39 n.s.
Risky Drinking 2 3,2 3 4,6 n.s.Alcohol Dependent 3 4,8 1 1,6 n.s.
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Patients ResultsBasal Folow-up Analysis
N % N % p
Women 620 64,1 627 61,5 n.s.
Age (Mean and SD) 52,8 18,6 54,6 19 n.s
Once a month 322 33,6 362 35,6 n.s
Risky drinkers 185 19,3 180 18,7 n.s.
Primary Studies 640 67 685 67,8 n.s.
Working 432 44,7 410 39,9 p<0.03
Never Screened 493 51,1 542 53,4 n.s
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
What's the impact of training on HealthProfessionals: increase of referrals
3000
4000
5000
6000
7000
8000
1998
1999
2000
2001
2002
2003
1000
2000
3000
4000
1998 1999 2000 2001 2002 2003
Referrals to the network of specialized centres
AlcoholOther drugs
Alcohol referralsPHCOther sources
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
The process evaluationFocus groups: strengths
TRAINERS & PHC DIRECTORS• Facilitation of the contact and approach between
Drug Addiction Network and PHC• Good acceptance of the courses by the PH
professionals, specially nurses• High interest on motivational approach by PHC• Referral rates for alcohol dependence to
specialized centres a marked increase • Demand of continuity strategies
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
The process evaluationFocus groups: weaknesses
TRAINERS & PHC DIRECTORS• Lack of time of the PHC professionals: priority is
given to treatment vs preventive interventions• No agreement on the implementation level • Lack of facilities for the implementation: Medical
Record, contractual goals• Lack of contractual agreement related to the
intervention
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
What have we learnt from the initialexperience?
• Alcohol poses a difficult challenge to the HealthSystem.
• The change will not appear dramatically. Slow changesare to be expected if continuous work is done. The firstmovement in PHC appears with the most severe cases.
• Implementation should be reinforced throughcontractual incentives
• Future developments should enhance the nurses role, and promote a more active implication of PHC workers
• More resources should be allocated to the wholesystem.
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
The “Beveu Menys” Implementation
As an iterative processCreation of the PHC network (XaROH)Creation of the Alcohol and Primary Health Group (GAAP) Creation of the Nursing working group.CME strategies
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Next stepsIntroduction of an Alcohol Screening Indicatorin the Health System Contract.Adaptation of the BM tools for the existing computerized medical records in PHC settingsInclusion of the preventive work on alcohol consumption in the professionals' personal contract goalsDissemination of SBI techniques to other settings (hospitals, emergency rooms, etc.).Settlement of relations with Latin America.
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
A European perspective
– The Phepa 1 evaluation– The Phepa 2 Project – The Inebria experience
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
PHEPA– European recommendations and clinical guidelines
for health care purchasers and providers
– European training program for primary health care professionals
– Comprehensive Internet site database on good practice, providing the evidence base in the domains of efficacy, economics, health and policy
– Series of country specific dissemination experiences and strategies.
PHEPA
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
What have we done?• Products have been finished• Four international meetings were hold • Country Based Teams have been settled
and implementation strategies have been prepared
• PHEPA II approved by the EC for co-financing expanding the work to 24 countries
PHEPA
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Clinical Guidelines SummaryI. IntroductionII. Methods to prepare the guidelinesIII. Describing alcohol consumption and alcohol related harmIV. Alcohol and healthV. Identifying hazardous and harmful alcohol consumption VI. Effectiveness of brief interventionsVII. Cost and cost effectiveness of brief interventionsVIII. Implementing identification and brief intervention
programmesIX. Assessing the harm done by alcohol and alcohol dependenceAnnexeAcknowledgements
Available on-line at: www.phepa.net
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Training Programme1 Introduction and basic concepts
2 Early identification
3 Brief Intervention I
4 Brief Intervention II
5 Alcohol Dependence
6 Implementation of the EIBI Alcohol Programme
Available on-line at: www.phepa.net
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Phepa.net
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Implementation in countriesAssessment tool
Creation of working groups at a national level
Design of a country based national strategy
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Evaluation
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Enhanced ability to affectpublic policy
Development of valuablerelationship
Ability to have a greater impactthan I could have on my ow n
Acquisition of additionalf inancial support
Most important Extremely important Very importantSomewhat important Not important
Please rate the advantages of participating in this project
PHEPA
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Evaluation: General Overview
0%10%20%30%40%50%60%70%80%90%
100%
The project was allworth it?
I will join such aproject again
Absolutely disagree
Somewhat disagree
Uncertain
Somewhat agree
Absolutely agree
PHEPA
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Evaluation: General OverviewBenefits and costs
0 %
10 %
2 0 %
3 0 %
4 0 %
5 0 %
6 0 %
7 0 %
8 0 %
9 0 %
10 0 %
Much more disadvantagesthan advantagesMore disadvantages thanadvantagesBoth are equal
More advantages thandisadvantagesMuch more advantages thandisadvantages
How do the advantages compare to the disadvantagesof participating in this project?
PHEPA
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Evaluation: Members satisfaction
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The way people in the group work together
The general way in which the project wasdeveloped
The progress of the group since thebeginning of the project
Completely satisfied Mostly satisfied Somewhat satisfied
A little satisfied Not at all satisfied
PHEPA
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Clinical Guidelines
Training Manual
Internet website & database
National dissemination strategy
Excellent Good Fair Bad Very bad
Your opinion on the achievement of the products?
PHEPA
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
‘PHEPA Project on disseminating brief interventions on alcohol problems Europe wide’
• The general objective of the present project is:– to build on the experience and products of
PHEPA I– to promote the dissemination of best practice
on early identification and brief interventions on alcohol problems within the general population.
PHEPA
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Catalonia
BelgiumBulgariaCzech RepublicEnglandEstoniaDenmarkFinlandFranceGermanyGreeceHungaryIrelandItalyLithuaniaLatviaNetherlandsPoland
B
P I GrS
D
SlF
UKIr
F
Sw
PlG
N
B
HCz
PolandPortugalRomaniaSloveniaSlovak RepublikSpain SwedenTurqueyEUROPREV
Partners of the Phepa II Project•24 associated partners•10 collaborating partners (6 countries and EUROPREV)
PHEPA
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Phepa II. Specific objectives• To create a sustained European Platform of health
professionals and brief interventions• To develop an assessment tool and a registry to assess and
document the current status of services for brief interventions• To build an Internet based resource centre for health
professionals, policy makers and providers, on brief interventions;
• To roll out a training programme throughout Member States to harmonize the skills of European health professionals
• To roll out clinical guidelines throughout Member States toharmonize the quality of brief interventions.
PHEPA
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Conclusions1. Alcohol is a main public health problem that
contributes enormously to the workload of PHC professionals
2. European PHC professionals still lack training and clear guidelines on how to intervene in alcohol related problems, ranging from risky drinking to severe dependence
3. There’s a need for homogenisation of intervention criteria at a European level.
PHEPA
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Conclusions3. There’s a need for homogenisation of
intervention criteria at a European level. The PHEPA project contributes to this homogenisation by producing and rolling out European clinical guidelines on alcohol, a training programme for PHC, a web site on good clinical practice and a series of country based strategies.
PHEPA
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
International Network on Brief Interventions for Alcohol Problems [INEBRIA]
3rd International Conference of INEBRIALisbon, 26th – 28th October 2006
WHO
Organization: The conference will be hosted by Dr. Maria Joao Heitor dos Santos and Dr. Cristina Ribeiro, General Directorate of Health – Lisbon (Portugal) and will be organized with the support of WHO and the Department of Health of the Government of Catalonia, that holds the Inebria Secretariat.
Speakers: include Peter Anderson, Tom Babor, Cheryl Cherpitel, Joan Colom, Antoni Gual, Nick Heather, Isidore Obot, and Kaija Seppä.
More details of the conference at www.inebria.net
Departament de SalutDG Salut Pública. Òrgan Tècnic de Drogodependències.
Health DepartmentDG Public Health. Program on Substance Abuse
Moltes gràcies
(Thanks for your attention)
www.gencat.net