5 years ago

NAT 6/08 - THL

NAT 6/08 - THL

A GP’s reflections on

A GP’s reflections on brief intervention in primary health care in Denmark period of liberal government. Nowadays patients are discharged home earlier than before, which means that a growing part of follow-up duties are fulfilled in PHC by GPs (sometimes in collaboration with home nurses). Hence GPs spend a lot of their time on follow-up visits and lack time for normal consultations. Second: Due to the lack of forward planning in offering education places for doctors, there are now too few doctors in general practice; there are many vacancies not only in PHC but also in hospitals. The situation has fluctuated over a 15–20 year period. There have been periods when graduates from the Danish medical schools have had to emigrate to get work and clinical education for specialization. Now the Danish health system is itself advertising for doctors in India, Balticum, Poland and Germany. Finally: The structure of regional management was significantly altered as from Jan. 1st 2007, when the number of municipalities was reduced from 300 to 100. The purpose was to improve the capabilities of the municipalities. Among other things the responsibility for managing alcohol problems (prevention and treatment) was moved from the counties to the municipalities. We do not yet know the impact of this rearrangement of alcohol treatment services but there is a risk that the expertise in the alcohol field will disappear, as skilled staff members at the specialist centres and clinics have to find new jobs elsewhere, as they are not expected to be employed by the municipalities. This, too, could impose a greater workload on PHC. 526 NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 2 5. 2 0 0 8 . 6 Wishes for the future A list of measures that should be taken to improve the future handling of alcohol problems in primary health care would include the following. For the health authorities: • to implement training in motivational interviewing in the curricula at medical schools and for graduate students, as well as to facilitate access to training courses for GPs and their staff, • to support the implementation of the national guideline planned by the National Board of Health in collaboration with the Danish Society of General Practitioners (Dansk Selskab for Almen Medicin). For the municipalities: • to use the existing alcohol treatment centres and clinics and thereby preserve the existing expertise, before professionals start looking for jobs in other fields. For the GP: • as almost every symptom in some way could be connected to alcohol consumption, it is necessary that the patient understands the link between his complaint and the doctor’s question on alcohol consumption. The GP must take the risk of asking a few questions: “Sometimes this symptom is related to alcohol consumption. Can I ask you how much you drink in general?” Maybe the patient is reluctant to answer the question, but he may well return saying: After our last talk I have decided to change my drinking habits. Sverre Barfod, General practitioner Fredriksværk, denmark e-mail:

REFERENCES Babor, T.F. & Grant, M. (eds.) (1992): Programme On Substance Abuse. Project on identification and management of alcohol-related problems. Report on Phase II: A randomized clinical trial of brief interventions in primary health care. Geneva: World Health Organization Barfod, S. & Beich, A. & Jørgensen, A.F. & Sørensen, E. & Sørensen, H.S. & Vendsborg, P. & Zachariassen, A. (1996): Tidlig intervention mod alkohol-problemer. (Early intervention for alcohol problems). Månedsskr Prakt Lægegern 74: 1303–1307 Beich, A. & Gannik, D. & Malterud, K. (2002): Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners. BMJ 325: 870–872 Mabeck, C.E. (2005): Introduktion til den motiverende samtale. (Introduction to motivational interviewing). Munksgaard Danmark Miller, W.R. & Rollnick, S. (1991): Motivational interviewing. Preparing people to change addictive behavior. New York: Guildford Press Miller, W.R. & Rollnick, S. (2004): Motivationssamtalen. (Motivational interviewing) København: Hans Reitzels Forlag Nielsen, B. & Nielsen, A.S. (2001): Odensemodellen. Et bidrag til en evidensbaseret praksis ved behandling af alkoholmisbrugere. (The Odense model. A contribution to A GP’s reflections on brief intervention in primary health care in Denmark an evidence-based practice in the treatment of alcohol abusers). Fyns Amt Saunders, J. & Wutzke, S. (eds.) (1998): Report on Strand I: General practitioners’ current practices and perceptions of preventive medicine and intervention for hazardous alcohol use. A 16-country study. WHO Phase III Collaborative Study on implementing and supporting intervention in primary health care. Copenhagen: WHO Regional Office for Europe. Alcohol, Drugs and Tobacco Programme. EUR/HFA target 12, EUR/ICP/LVNG 02 05 02 Sørensen, E. & Barfod, S. & Jørgensen, A.F. & Zachariassen, A. & Vendsborg, P. (1997): Praktiserende læger og kontrolprincippet. En interview-undersøgelse. (Practising doctors and the principle of control. An interview study). Månedsskr Prakt Lægegern 75: 369–373 Vendsborg, P.B. & Sønderbo, K. (1985): Alkoholismebehandling efter “kontrolprincippet”. (Treatment of alcoholism according to the ”principle of control”). Ugeskr Læger 147: 2179–2183 Zachariassen, A. (1998): Alkoholkontrolprincippet i praksis. Behandling af alkoholstorforbrug i almen praksis efter kontrolprincippet. (The principle of control of drinking in reality. Treatment of high consuming patients in primary health care acccording to the principle of control) Månedsskr Prakt Lægegern 76: 985–988. NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 527

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