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NAT 6/08 - THL

NAT 6/08 - THL

The long and winding

The long and winding road to widespread implementation of screening and brief intervention for alcohol problems REFERENCES Anderson, P. & Laurant, M. & Kaner, E. & Wensing, M. & Grol, R. (2004): Engaging General Practitioners in the Management of Hazardous and Harmful Alcohol Consumption: Results of a Meta-Analysis. Journal of Studies on Alcohol and Drugs 65: 191–199 Babor, T. & Grant, M. (eds.) (1992): Project on identification and management of alcohol-related problems. Report on Phase II: A randomized clinical trial of brief interventions in primary health care. Geneva, WHO/PSA/91.5 Babor, T. & de la Fuente, J.R. & Saunders, J. & Grant, M. (1992): AUDIT – The Alcohol Use Disorders Identification test: Guidelines for use in primary health care. Geneva, WHO/PSA/92.4 Babor, T. & Higgins-Biddle, J.C. & Saunders, J. & Monteiro, M.G. (2001): AUDIT – The Alcohol Use Disorders Identification Test. Guidelines for use in primary health care, Second edition. Geneva, WHO/MSB/01.6a Eccles, M.P. & Grimshaw, J.M. & Johnston, M. & Steen, N. & Pitts, N.B. & Thomas, R. & Glidewell, E. & MacIennan, G.& Bonetti, D. & Walker, A. (2005): Applying psychological theories to evidence-based clinical practice: Identifying factors predictive of managing upper respiratory tract infections without antibiotics. Implementation Science 2 (26): 1–14 Edwards, G. & Orford, J. & Egert, S. & Guthrie, S. & Hawker, A. & Hensman, C.& Mitcheson, M.& Oppenheimer, E. & Taylor, C. (1977): Alcoholism: A Controlled Trial of “Treatment” and “Advice”. Journal of Studies on Alcohol 38 (5): 1004–1031 Gomel, M.K. & Wutzke, S.E. & Hardcastle, D.M. & Lapsley, H. & Reznik, R.B. (1998): Cost-effectiveness of strategies to market and train primary health care physicians in brief intervention techniques for hazardous alcohol use. Social Science and Medicine 47 (2): 203–211 Jellinek, E.M. (1960): The disease concept of alcoholism. New Haven, CT: College and University Press Kaner, E.F.S. & Dickinson, H.O. & Beyer, F. & Pienaar, E. & Campbell, F. & Schlesinger, C. & Heather, N. & Saunders, J. & Burnand, D. (2007): Effectiveness of brief alcohol 476 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 2 5. 2 0 0 8 . 6 interventions in primary care populations. Cochrane Database of Systematic Reviews 2. Art. No.: CDC004148. DOI: 10.1002/14651858.CD004148.pub3 Kristenson, H. & Öhlin, H. & Hultén-Nosslin, M.-B. & Trell, E. & Hood, B. (1983): Identification and intervention of heavy drinking in middle-aged men: results and follow-up of 24–60 months of long term study with randomized controls. Alcoholism: Clinical and Experimental Research 7 (2): 203–209 Le Gô, P.M. (1976): Le depistage precoce et systematique de buveur excessif. Departement d’alcoologie therapeutique de Rionlaboratoires, Paris, France Nilsen, P. & Aalto, M. & Bendtsen, P. & Seppä, K.-L. (2006): Effectiveness of Strategies to Implement Brief Alcohol Intervention in Primary Healthcare – a Systematic Review. Scandinavian Journal of Primary Healthcare 24: 5–15 Nilsen, P. & Kaner, E. & Babor, T.F. (2008): Brief Intervention, Three Decades On – An Overview of Research Findings and Strategies for More Widespread Implementation. Nordic studies on alcohol and drugs 25 (6): 453–467 Rose, G. (1981): Strategy of prevention: lessons from cardiovascular disease, British Medical Journal 282 (6279): 1847–51 Russel, M.A.H. & Wilson, C. & Taylor, C. & Baker, C.D. (1979): Effect of general practitioners’ advice against smoking. British Medical Journal 2 (6184): 231–235 Saunders, J.B. & Aasland, O.G. (1987): WHO collaborative project on identification and treatment of persons with harmful alcohol consumption. Report on Phase I: Development of a screening instrument. Geneva, WHO/MNH/DAT/86.3 WHO (1980): Problems related to Alcohol Consumption. Technical report series 650. Geneva, Switzerland WHO (1983): Identification and Treatment of Persons with Harmful Alcohol Consumption – Research Protocol. Geneva: WHO WHO Brief Intervention Study Group (1996): A Cross-National Trial of Brief Interventions with Heavy Drinkers. American Journal of Public Health, 86 (7): 948–955 Wilkins, R.H. (1974): The hidden alcoholic in general practice. London: Elek Science.

FredriK sPaK anniKa andersson Large scale implementation of early identification and brief intervention in Swedish primary health care – will it be successful? Introduction All through the 20 th century, the Swedish state has been actively involved in alcohol policy, which has likely contributed to the comparatively low alcohol consumption, as seen from a European perspective. Although traditionally Swedish alcohol consumption has been thought to constitute binge drinking, with a concentration on spirits, the pattern has in fact long since changed, and the main proportion of consumption is nowadays consumed with meals (Eurobarometer 2003) while spirits only constitute 18% of the total alcohol sales in Sweden (CAN 2007). Sweden is also one of the countries with the highest proportion of alcohol consumers among the population (CAN 2007). Results from the annual national public health survey 2007 indicated that 17% of men and 10% of women in the Swedish population aged 16–84 were harmful consumers (Folkhälsoenkät 2007). This indicates that many of the people who visit health care are/have been exposed to harmful alcohol use, which is thus a robust reason for discussing the health impact of alcohol with patients. As most people visit Family Medicine regularly (80% of the population in a two-year period), Primary Health Care (PHC) lends itself readily A B S T R A C T F. Spak & A. Andersson: Large scale implementation of early identification and brief intervention in Swedish primary health care – will it be successful? AIM The aim is to describe the Swedish efforts to implement secondary prevention of alcohol problems on a large scale in Primary Health Care. RESULTS Sweden has a long tradition of working in prevention of alcohol problems, on both national and local levels. The activities have increased over recent years, especially regarding the dissemination of knowledge about harmful use of alcohol and implementation of early identification and brief intervention (EIBI) methods. Compared to the implementation of EIBI in most other countries, these activities appear to have been promoted to a high level in Sweden. This development has probably been the result of several activities in this field, both national and international, rather than the result of any single measure. CONCLUSION Although there is evidence that education alone is not a sufficient solution to implement new methods, the main focus was competence enhancement in Sweden. As more people lately have been engaged in EIBI, both in connection with implementation and research, our prediction is that this research field will be boosted in NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 Country report 477

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