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5 years ago

NAT 6/08 - THL

NAT 6/08 - THL

Implementing brief

Implementing brief alcohol intervention in primary and occupational health care all the occupational health clinics in Finland, and especially their physicians and nurses. The co-ordinators’ salary came from the funding body, but facilities were provided at the Finnish Institute of Occupational Health. They used several methods to activate the professionals to do brief intervention: education, free materials, support, campaigns and communication. They travelled to all parts of Finland giving lectures and demonstrations to professionals. Part of the materials was specifically designed for occupational health care practice (handbook of brief intervention in occupational health care, drinking diary). Methods The two projects will be evaluated both quantitatively and qualitatively, and the evaluations will be reported separately. Here we present the qualitative aspects, measured qualitatively and by quantification, in which we have studied 1) how actively the municipalities participated in the project over the period of the project – e.g. was the activity applied nationally?– and 2) the quality of the projects. For the first question (1), we analysed a) the number of municipalities willing to participate in the VAMP by years 2004- 2006 and collected feedback from the field concerning b) how much training the professionals asked for as well as c) how many of them participated in the training sessions. The second part (2) is based on the evaluation instrument ‘Quality criteria on alcohol- and drug-related preventive projects’, developed by a multi-professional expert group at STAKES (Ehkäisevän päihdetyön ... 2006). This measure was developed as 508 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 2 5. 2 0 0 8 . 6 a project planning aid and also for ranking project funding applications. The assessment here consists of the authors’ own critical review of every pre-set element of the quality criteria. The elements are a) Content – knowledge, values, ethics and targeted collaboration; b) Activity – goal, resources, processes; and c) Follow-up and Evaluation. Results � 1. Participation activity In spite of the wide advertising of the VAMP-project, only 16 municipalities from four counties joined the project initially in 2004. Extensive efforts were made to activate the biggest cities and several contacts took place with the health care leaders. The project was open to new participants once a year. Over time, the interest in joining increased significantly (Figure 1). By 2006, all five of the six Finnish counties were involved. For example from the Lapland county all but two of the municipalities had joined the project. Nationwide, an open one-day seminar was given in all counties. These seminars gathered Number of 50 40 30 20 10 0 2004 2005 2006 Figure 1. Number of municipalities joining the national brief intervention project (VAMP) in 2004–2006

together a multi-professional audience of up to 100 participants per session. Several municipalities not involved in the project wanted to have a half-day training on brief intervention; this trend also clearly increased over the project years. The national co-ordinators also trained trainers for municipalities that had not joined the project; this was done, as need for this arose during the final year of the project. Based on the discussions in the field, in the end of the VAMP-project few doubts remained of the importance of brief intervention among the health care leaders. Comments from the professionals in the occupational health care surveys showed that the importance of BI was recognised. The project did not, however, reach all professionals in the field; even in the VAMP municipalities 10–20% of the professionals never came to the sessions. No specific BI- projects will be funded in primary health care after VAMP. With this lack of resources, the likelihood for sustainable results is expected to come from the efforts of those experts who received training within the project. The Occupational Health Care Project had only two co-ordinators, but did reach 40% of all occupational health care professionals. The result of the National survey of occupational health services in 2004 (counting the amount of clinics involved and number of brief interventions per year) showed that over 50% of occupational health care units do brief interventions. However, the volume is low (only 10 000 BIs per year), while at least 100 000 would be needed to make 25% of risky drinkers in Finnish occupational health care to get this treatment (Kuokkanen &Heljälä 2005). When this project ends the Finnish Insti- Implementing brief alcohol intervention in primary and occupational health care tute of Occupational Health will continue activation of the implementation through ongoing training. � 2. Quality assessment Based on the quality criteria (Ehkäisevän päihdetyön ... 2006) mentioned above the quality of the two projects was assessed (Figure 2). In figure 2, the points of the triangle represent the quality of the content and activity; the central area represents follow-up and evaluation. � A) Content – knowledge, values, ethics and targeted collaboration The main aim of the projects was to gather good knowledge of brief intervention and early detection. As advised in the guidelines, all the training that was given was evidence-based (Salaspuro et al. 2005; www.phepa.net). Concerning values and ethics we have evaluated both patients’ and professionals’ attitudes and values in relation to alcohol-related discussions and treatment in health care (Kääriäinen et al. 2001b ; Aalto et al. 2001; Aalto et al. 2002). The values and ethics have been permanently discussed in the co-ordinators’ meetings and in sessions in the participating municipalities. The project-workers of both projects have participated in the coordinators’ meetings. � B) Activity – goal, resources, processes The final goal of the two projects was to decrease alcohol consumption among hazardous drinkers. A short-term goal was to activate health-care professionals to do brief intervention. If increase in given brief alcohol interventions will be reached it can be supposed that the projects also got closer to their final goal. This will, how- NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 509

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