5 years ago

NAT 6/08 - THL

NAT 6/08 - THL

Evaluation of a training

Evaluation of a training program to implement alcohol screening, brief intervention and referral to treatment in primary health care in Minas Gerais, Brazil Score Means 3 0 * 2 5 23.5 20 2 0 1 5 1 0 5 0 GP N u r AU X+C H W Ps y+SW Professional Categories * p< 0,05 pre and post (t test paired) # p < 0,05 in Tukey Test with GP (pre) � Extent of screening and brief intervention * 25.6 # * 25.7 # 21.9 22 Pre Post * 22.1 19.5 Figure 6. Perceived obstacles to brief internvention at baseline (pre-training) and follow up (post-training) During the three-month post-training evaluation period, 3061 AUDIT screenings were conducted by health professionals in different types of health services. Of those screened, 69% of the patients were male. The mean age of the patients was 36 years. According to their AUDIT scores, 32% were identified as risky drinkers, 11% as harmful drinkers and 2.1% as patients with possible alcohol dependence. In general, men (mean AUDIT score = 5.6) scored significantly higher than women (mean= 3.9) (p

depending on the measure and missing data). The results show the frequency of asking screening questions was negatively correlated with the age of the professional, positively correlated with self-efficacy and positive expectancies for SBI, and negatively correlated with perceived obstacles to screening and brief intervention. Except for age, the correlations were similar for the reported frequency of advising patients about the need to modify their alcohol use. Neither performance indicator was correlated significantly with the measure of confidence. � Key Informants The key informant interviews suggested that at the beginning of the program both trainers and trainees reported high expectations for the training program, especially in terms of the way it was organized. As reported by one health manager, “We appreciate the simplicity of the SBI technique (...).” But after the training, difficulties were reported, such as lack of time, competition with other work duties, lack of motivation, resistance to work with alcohol issues, inadequate system infrastructure, incomplete work teams, lack of official support by the government and difficulties in referring patients. One problem was expressed in these words: “(...) you are going to identify people for whom you do not have an adequate program or service to refer them to.” In spite of the difficulties pointed out by these professionals, almost all of the study’s participants recognized the importance of the training and the SBI strategies. Evaluation of a training program to implement alcohol screening, brief intervention and referral to treatment in primary health care in Minas Gerais, Brazil Discussion Considering the technical knowledge acquired and the attitudinal changes observed among these professionals, it is reasonable to conclude that the training program had an important impact on the readiness of health professionals to implement SBI in these cities, especially among auxiliary nurses and community health workers. Moreover, it was observed that after the training all of the professional groups acquired an equivalent level of knowledge of SBI and alcohol-related problems. The data indicate that the training was more effective in changing the perception of difficulties to perform brief intervention than to do screening. Perhaps this was due to the general need to rely on others in the clinic to conduct screening interviews, score the screening test, and report positive screening results to the clinician responsible for conducting the brief intervention. The community health workers were the professional group with the best performance in a number of areas. As in previous research (Babor et al. 2006), both the number of screenings and the number of patients who received an intervention following a positive screen varied across professional groups, with community health workers delivering the highest proportion of interventions. One explanation of this finding is the job characteristics of this professional group, who are more dedicated to delivering preventive health services in the community. For the other professional groups the curative paradigm is still very strong in their education, perhaps rendering their atti- NORDIC STUDIES ON ALCOHOL AND DRUGS V O L . 25. 2008 . 6 535

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