5 years ago

NAT 6/08 - THL

NAT 6/08 - THL

Implementing brief

Implementing brief alcohol intervention in primary and occupational health care � History of brief alcohol intervention in tegic alliances and used a population ap- Finland proach. The researchers travelled around Finland has a long history of interest in the region to make the training sessions brief alcohol intervention, both in research more easily accessible for all. With the and in everyday work. Three dissertations small resources available, however, the on the topic, based on randomized studies, results remained small (Aalto et al. 2003). have been published; one from a trauma There were also other reasons for the low centre (Antti-Poika et al. 1988), one from activity; government health policies were health screenings (Suokas 1992) and the not supportive, professionals were too latest from a primary health care setting busy, they still felt insufficiently trained, (Aalto 2001). The Finnish research activ- they had insufficient resources, they were ity also includes one randomized study of confused about the target group for BI, alcohol abusing primary health care pa- they lacked self-efficacy, expressed the tients with macrocytosis (large red blood need to have simple guidelines, had diffi- cells) (Seppä 1992). There are and have culties in identifying the target group and been several research groups working to uncertainty about the justifications for BI develop biochemical markers for early de- (Kääriäinen et al. 2001b). These obstacles tection of hazardous drinking. are echoed also in the international litera- For almost twenty years there have been ture on the subject (Nilsen et al. 2006). sporadic activities in primary, occupation- Finland has also been a collaborator in al and specialized health care to promote the WHO Phase-IV brief alcohol interven- brief alcohol intervention. However, in tion implementation project and a partner spite of written guidelines (Salaspuro et in the EU PHEPA (Primary Health Care al. 2005), the activity has concentrated on European Project on Alcohol) -project only a few professionals, mainly in lead- (Heather 2006; These ing positions. At the practical professional two collaborations have provided new level, promotional activities for BI have tools and knowledge to aid in national ef- been scarce and of short duration. forts to implement BI. In the mid 2000s a broad regional im- In February 2004, alcohol taxation in plementation project, Pirkanmaa-project, Finland was reduced on average by 33% started in Pirkanmaa, Finland (Kääriäinen (spirits 44%; strong wines 40%; wines et al. 2001a). This project was based on the 10%; beer 32%). The aim was to reduce detected low activity in alcohol-related alcohol imports from other EU countries, matters in health care (Sillanaukee et al. especially from the new EU member state 2002) and it was funded by the Ministry Estonia. A disintegration of preventive of Social Affairs and Health. The target measures led to an increase in consump- groups included those working in both tion and in alcohol-related harm. In 2007 primary and occupational care as well as alcohol was the leading cause of death in hospital settings. The project used mod- among working-age population, both in ern and multi-faceted implementation men and women (Statistical yearbook tools, e.g. short lectures, group-work and 2008). role-play. Additionally, it built local stra- In its decision in principle of 9 October 506 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 2 5. 2 0 0 8 . 6

2003 on alcohol policy, the Government defined the main objectives and the priorities for action to be followed by the public administration to diminish the adverse effects of alcohol. Brief alcohol intervention was emphasized in the Government’s Resolution on Strategies in Alcohol Policy and in the Finnish Alcohol Programme 2004–2007, and the Government funded two large (nationwide) brief intervention implementation projects: the VAMP and the Occupational Health Care Project (Mäklin 2005). The two projects were both aimed at a nationwide implementation of brief alcohol intervention in primary and occupational health care as part of everyday work and thus allowed academic, practical and political interests to come together. Material � The VAMP-project The VAMP-project had a national co-ordinator and 14 regional co-ordinator pairs working in all the five Finnish provinces, that covers 448 municipalities, of which 109 are cities. By the end of the project, 46 municipalities with about 1000 general practitioners and 5000 nurses working in municipal health centres had been reached. The population in the project municipalities was some 25% of the total Finnish population (; Seppä 2008). The regional co-ordinators were a physician–social worker/nurse pair. Working in pairs was decided so as to enable the co-ordinators to receive support from each other. Also, they met with the national co-ordinators four times a year during one-two-day seminars for planning and exchanges of experiences. Their salaries Implementing brief alcohol intervention in primary and occupational health care were paid for by the funding body, but facilities were guaranteed by the municipalities involved. The health care authorities of the municipalities had made a formal agreement to support the activity in the region. Regional co-ordinators mainly came from those local health centres and they had contacts and experience with regional professionals and practices. They did not carry out the brief intervention themselves, but used several methods for activating the professionals to do it; education and training, reminders and support, campaigns and communication. They used modern education methods, e.g. other than lectures, met small groups and heard what the groups needed. They travelled to the health centres and provided the professionals with materials on brief intervention work. This material was specifically designed for the needs of this project. To increase the activity targeted campaigns lasting from one to several days were also organized. The main type was delivering AUDIT-questionnaires to all patients coming to the centres. These campaigns gave information for example of the prevalence of hazardous drinkers in individual centres, which was considered important by the professionals. � The Occupational Health Care Project The Occupational Health Care Project had two co-ordinators who covered the whole of Finland. In the end of the project, 2000 occupational health workers had received training or some other kind of contact with the project. About 40% of occupational nurses and physicians in Finland were involved. The co-ordinator pair – a medical doctor and an occupational nurse – targeted NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 507

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