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NAT 6/08 - THL

NAT 6/08 - THL

Screening and brief

Screening and brief intervention for alcohol problems in Norway for screening and brief intervention, in order to hopefully try out some new approaches. Why is it so difficult to implement brief intervention procedures in Norway? The Norwegian College of General Practi- tioners (NCGP) has recently issued a policy document where it is clearly stated that with regard to preventive health care and “interventions in multifactorial situations on theoretical risk calculations ... the extent of preventive work must be balanced with other core duties, as the GP´s primary task is to offer health care for the sick”. The full text reads as follows: The NCGP is unconditionally positive to many traditional cause-specific preventive medical measures, such as vaccination and inhibiting the spread of contagious diseases etc, but would like to point out that some aspects of modern proactive medicine are more challenging. Many ethical and practical problems arise when the aim is to base interventions in multifactorial situations on theoretical risk calculations. GPs are under strong pressure to perform health checks and risk assessments related to future illness. For a number of these measures, the usefulness for the general public is poorly or marginally documented. The NCGP believes that GPs must demand a high 520 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 2 5. 2 0 0 8 . 6 standard of documentation and relevance for such measures. The extent of preventive work must be balanced with other core duties, as the GP´s primary task is to offer health care for the sick. http://www.legeforeningen.no/ index.gan?id=144946&subid=0 This quote captures in our opinion an important attitude among the general practitioners, and may explain why compliance with the proposed standardised procedures for case finding and brief intervention with respect to alcohol is so hard to achieve among Norwegian general practitioners. It has been shown time and again through participation in international collaborative projects that for Norwegian GPs the most natural approach is to use the available instruments for risk assessment as an integrated element in treatment schemes more than as a precursor to brief intervention. Hopefully the ongoing project will elucidate this interesting fact further. Olaf G. Aasland the research institute the norwegian Medical association and institute of health Management and health economics, university of oslo, norway e-mail: olaf.aasland@lageforeningen.no Arne Johannesen helse sør-Øst rhF P.o Box 404 n-2303 hamar, norway e-mail:arne9@online.no

REFERENCES Aasland, O.G. & Bruusgaard, D. & Rutle, O. (1987a): Alcohol problems in general practice. Brit J Addict 82: 197–201 Aasland, O.G. & Amundsen, A. & Bruusgaard, D. & Jervell, J. & Mørland, J. (1987b): Norske legers alkoholvaner. (Alcohol use among Norwegian doctors). Tidsskr Nor Lægforen 107 (29): 2553–2558. Aasland, O.G. & Nygaard, P. & Nilsen P. (2008): The long and winding road to widespread implementation of screening and brief intervention for alcohol problems. A historical overview with special attention to the WHO initiatives. NAT 25 (6): 469–476 Babor, T. & Grant, M. (eds.) (1992): Project on identification and management of alcoholrelated problems. Report on Phase II: A randomized clinical trial of brief interventions in primary health care. Geneva, WHO/PSA/91.5 Borgestadklinikken (2001): Primærhelsetjenestens oppgaver i rusmiddelbehandling og forebyggende rusmiddelarbeid. (Tasks of primary health care in alcohol and drug treatment and prevention). Skien: Borgestadklinikken Bringedal, B. & Aasland, O.G. (2006): Legers bruk og vurdering av grønn resept (Doctors´ use and assessment of a fee-for-service lifestyle advice scheme). Tidssk Nor Laegeforen 126 (8): 1036–1038 Bruusgaard, D. & Rutle, O. & Aasland, O.G. (1984a): Alkohol, livsstil og helse i almenpraksis. Pasientenes synspunkter. (Alcohol, lifestyle and health in primary health care. The perspectives ot the patients). Tidsskr Nor Lægeforen 104 (22): 1427–1431 Bruusgaard, D. & Rutle, O. & Aasland, O.G. (1984b): Alkoholproblemer i almenpraksis. (Alcohol problems in primary health care). Tidsskr Nor Lægeforen 104 (22): 1431–1435 Department of Health (1995): Sensible drinking. The report of an inter-departmental working group. London: Department of Health, December 1995 Gallefoss, F. & Drangsholt, K. (2002): Røykeintervensjon og hindringer for dette blant fastleger i Vest-Agder. (Smonking intervention and obstacles for those among doctors in Vest-Agder). Tidsskr Nor Laegeforen 122 (27): 2608–2611 Screening and brief intervention for alcohol problems in Norway 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 Johannesen, A. & Rysst, T. (1998): WHO samarbeidsstudie Fase III. Strategier for å bedre primærhelsetjenestens muligheter til å arbeide med personer med et for høyt alkoholforbruk. Evalueringsrapport. (WHO cooperative study Phase III. Strategies to improve the possibilities in primary health care for work with persons with high alcohol consumption). Oslo, Den norske lægeforening Meland, E. & Ellekjær, H. & Gjelsvik, B. & Kimsås, A. & Holmen, J. & Hetlevik, I. (2000): Forebyggende livsstilsråd mot hjerte- og karsykdommer i primærhelsetjenesten. (Preventive lifestyle advice for cardiovascular diseases in primary health care). Tidsskr Nor Laegeforen 120 (22): 2656–2660 Nylenna, M. & Aasland, O.G. & Waahlberg, R.B. (red): Alkohol og helse. Artikler fra Tidsskrift for Den norske lægeforening. (Alcohol and health. Articles from Tidsskrift for Den norske lægeforening). Oslo: Rusmiddeldirektoratet/Den norske lægeforening Riise, G. & Berg, J.E. & Bull Engelstad, J.C. & Jacobsen, C.D. & Sørensen, B.N. et al. (1995): Alkohol og helse – det bagatelliserte alvor. (Alcohol and health – a serious problem played down) Oslo: Universitetsforlaget 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 Saunders, J. & Wutzke, S. (eds.) (1998): WHO Phase III Collaborative Study on implementing and supporting intervention strategies in primary health care. Report on strand I: General practitioners current practices and perceptions of preventive medicine and intervention for hazardous alcohol use. A 16country study. Copenhagen, WHO Europe. NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 521

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