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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 GOAL • decrease in symptoms • decrease in alcoholrelated diseases • work capacity • length of life • treatment satisfaction • decrease in health are visits TARGETED COLLABORATION • specialised health care, addiction clinics • information to the citizens/ patients ever, not be measured in these projects. In order to get a permanent change in brief intervention activity the co-ordinators themselves have not participated in the brief intervention work, but focused on training and activating others that will stay in the practical work. In practice, the professionals met in small groups when possible. Reminder-visits were frequent and material and consultations were freely offered by the co-ordinators and feedback KNOWLEDGE • alcohol-related health consequences • differential diagnostics of these consequences • diagnosis and treatment • methods to recognize hazardous drinking • content of brief intervention The goal is measured, other measures will be followed PROCESSES • feedback from the professionals • discussions to change attitudes • knowledge-based education • support • information to the population • written material for patients 510 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 2 5. 2 0 0 8 . 6 RESOURCES • coordinators • all the physicians and nurses in the centres • consultations • occupational health care • maternity and child care • health check-ups VALUES AND ETHICS • patients have right to knowledge of their healthrelated topics • health care professionals need to inform patients of health risks • patients have right to do decisions based on the given information Figure 2. Quality elements of the two brief intervention projects according to the quality criteria by STAKES from the professionals out in the field was heard. One problem today is that professionals move from one centre to another, taking their knowledge and experience of brief alcohol interventions with them. Therefore, the projects aimed to have contact persons in the municipalities, who will continue to maintain the project’s activity and remind professional staff about the importance of brief alcohol intervention.

Implementing brief alcohol intervention in primary and occupational health care � C) Follow-up and evaluation ning of the study, the design is not rigor- Both projects have been action-projects ous enough; many confounding factors where the co-ordinators continuously have may have contributed to the change. If a received feedback from the field. Thereby controlled design is used, it is impossible they have been able to tailor the content in practice to protect the control area from of the follow-up sessions according to the contamination. This is especially true as needs of the professionals. the implementation projects are usually In each municipality a separate evalua- funded by organizations, which are not tion of the project will be done. The in- interested in a strictly scientific evaluacrease in given brief alcohol interventions tion. The projects are time-limited and at the health care centres will be measured there may not be a possibility to detect by two different quantitative methods. the changes in activity during the funding These surveys will involve patients and period of about 2–3 years. Therefore the professionals – both nurses and physicians measure should include some other vari- in the VAMP region, as well as physicians ables preceding the final goal, for example also in non-VAMP regions. In the occupa- attitudes or increasing need for education tional health care project, surveys about and training. activity in doing brief interventions have The long development of the Finnish been sent to professionals both before and preventive alcohol work in primary health after the project. care setting has in the present case-report been evaluated in the frame of the two lat- Discussion est brief intervention projects. The posi- It takes time to implement new practices tive trend seen here is a consequence of (Rogers 2003). The history from health care the long history of activities nationally and shows, that decades pass before especially internationally. Actually, the two projects non-medicine based new practices are ac- themselves are a consequence of earlier efcepted. There is some evidence of what forts and in a way they represent a result kind of practice implementation is most in themselves. effective. The evidence implies that an ar- It takes time before progress in form of ray of different activities should be done, results can be clearly seen. This has hap- not only lectures and education (Hulscher pened during the two projects presented et al. 2005). It is also known that activities here. Earlier efforts have affected atti- which are effective in some cultures and tudes and increased knowledge in health organizations may not work in others. This care, the political situation in Finland has means that implementation projects must, forced politicians to fund preventive alco- at least at country level, be tailored to local hol work, increase in alcohol consump- needs (Heather 2006). tion has changed attitudes of citizens Earlier studies also tell us that measur- and developments in the academic gening the change in implementing new praceral practice and occupational health care tices is difficult. If the change is measured have highlighted prevention. Thus, many by comparing the outcome measures to obstacles found in national surveys – non- the corresponding measures in the begin- supportive government health policies, NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 511

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