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5 years ago

NAT 6/08 - THL

NAT 6/08 - THL

sverre BarFod A GP’s

sverre BarFod A GP’s reflections on brief intervention in primary health care in Denmark After 29 years in general practice and the last 20 years working in the research field of management of alcohol problems I want to stress why I still think brief intervention (BI) could be a useful method in general practice, in spite of all the known barriers. The Danish health care system and treatment of alcohol problems Health care is free in Denmark. General prac- titioners (GPs) are independent entrepreneurs working to an agreement with the public health insurance. Only a small part of the GP’s income is from others sources. Some two thirds of GPs are working in a shared clinic with other doctors and most have nurses on the staff. Patients can freely choose their own doctor within a 15 km limit of their home address. If they are not satisfied with the doctor, they can change GP after 6 months. Some twenty years ago the most common way in Denmark for GPs to treat alcohol problems was simply to tell the patient to stop drinking and often to also offer a prescription of disulfiram (Antabuse ®). Very few GPs had I wish to thank Per Vendsborg for his valuable comments on the manuscript. A B S T R A C T S. Barfod: A GP’s reflections on brief intervention in primary health care in Denmark with a 15 year engagement in the alcohol field an experienced GP considers the challenges in Denmark for improved conditions to practically approach the management of alcohol problems in Danish primary health care through brief intervention. Although brief intervention seemed to support the controlled drinking paradigm, popular in the mid-1980s in Denmark, implementation was not successful at the time. Brief intervention was not acknowledged as treatment and routine screening was not approved of by the GPs. However, GPs have become increasingly aware of the importance of lifestyle issues in health care. Motivational interviewing is suggested as a method that can pave the way to increased implementation. More involvement by nurses could be crucial. Further, there is a need to tackle structural and resource barriers in the health care system, and to improve the education of medical staff. KEywORDS Alcohol, brief intervention, Denmark, history, controlled drinking, motivational interviewing NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 Country report 523

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