Gandin C, Scafato E, Ghirini S, Galluzzo L and the IPIB working group Claudia Gandin, MD

11

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS

The experience and activities related to Early Identification

and Brief Intervention on alcohol in Italy.

Gandin C, Scafato E, Ghirini S, Galluzzo L and the IPIB working group

Claudia Gandin, MDResearcherIstituto Superiore di Sanità-ISS, Rome (Italy)National Center on Epidemiology, Surveillance and Health Promotion -CNESPS

Inebria 2009, Newcastle (UK), 8/10 October 2009

22


33


SUMMARY

A. The ongoing strategies on alcohol in Italy aimed at developing and enduring implementation of alcohol EPIB in PHC settings.

1. The Frame Law on Alcohol (125/2001)2. The National Health Plan (PSN)3. The National Alcohol and Health Plan (PNAS)4. The National Committee on Alcohol

B. The experience and activities related to IPIB, the Italian EIBI programme at the National Institute of Health – ISS, Rome, Italy.

44


1. The Frame Law on Alcohol (125/2001)

All over Europe, the 125/2001 Italian law is the only one example of a full endorsement of the WHO European Alcohol Action Plan and of the European Charter on Alcohol principles reported as the aims of the law at the art 2.This is to show how a WHO principle introduced by mean the Charter on Alcohol has been transformed into a RIGHT for the Italian population……………….in principle but not really enforced

55


Art. 2 - Aims ensures all people’s rights, especially children and

adolescents, to a family, community and working life protected from the consequences of alcoholic beverages abuse;

fosters access to health and social treatment services for heavy drinkers and their families;

promotes information and education on the negative consequences of alcohol consumption and abuse;

promotes research and ensures adequate standards of training and updating for professionals dealing with alcohol related problems;

supports non profit non-governmental and voluntary organisations which aim is to prevent or reduce alcohol-related problems.

1. The Frame Law on Alcohol (125/2001)

66


2. The National Health PlanThe last NHP renewed the need to implement

actions and strategies that can help in: Promoting healthier lifestyles and habits (life

skills); Tackling misleading risk-taking cultures; Improving settings (family, schools,

communities); Strengthening health protection of the

vulnerable groups; Decreasing “gradients” within and between

groups (inequalities in health) and reduce harm; Ensuring a wider range of initiatives devoted at

the early detection of alcohol abuse.

Source: Ministry of Health, “National Health Plan 2006-2008” available online at: http://www.ministerosalute.it/dettaglio/phPrimoPiano.jsp?id=316

A National Prevention Plan is agreed by the STATE-REGIONS Conference mostly leaving to the regional autonomies the setting and the implementation of strategies and programs

that are ONLY oriented by the National Health Plan.

http://www.ministerosalute.it/dettaglio/phPrimoPiano.jsp?id=316



77


The need for the specific training standard and consequent activities outlined by the PHEPA/EIBI Country strategy found a relevant inclusion among the activities of the National Alcohol and Health Plan 2007-2010. (Piano Nazionale Alcol e Salute – PNAS)

3. National Alcohol and Health Plan (PNAS) 2007-2010

endorsed in April 2007 by the State-Regions Conference

Source: Ministry of Health, “National Alcohol and Health Plan 2007-2010” at:http://www.ministerosalute.it/imgs/C_17_pubblicazioni_623_allegato.pdf

88


3. National Alcohol and Health Plan 2007-2010

Strategic areas of intervention1. Information and education2. Drinking and driving3. Alcohol and work4. Treatment of harmful/hazardous alcohol

consumption and alcohol dependence5. Production and distribution’s responsibility6. Social network to face risk factors alcohol

related7. Strengthening NGOs, voluntary

organizations, self-help and mutual aid groups

8. Monitoring harm done by alcohol and strengthening alcohol policy

99


Actions:

To engage in and train on EIBI of alcohol-related risk people all the PHC professionals (particularly GPs, pediatricians, prevention department’s physicians).

To strength an integrated approach including health services, GPs, voluntary organizations, self-help and mutual aid groups, educational institutions, work, justice and other institutions.

To disseminate standardized tools and methodologies for EIBI to be used for harmful and hazardous alcohol consumption and alcohol dependence evidence- and also need’s evaluations- based.

1010


In line with the European Charter on Alcohol (December 2005) principles the law 125/2001 set up a National Committee on Alcohol including as designated members representatives from several ministries as well as experts from scientific societies, alcohol industry, advocacy groups and from the Istituto Superiore di Sanità.

4. National Committee on Alcohol

1111


4. National Committee on AlcoholWorking group on: “Training and updating for

professionals dealing with alcohol related problems”

“At the National and Regional level it’s recommendable the implementation of specific training of GPs and health professionals aimed at the prevention of alcohol-related problems. A standard for training and continuous professional education has been already provided by the European Project PHEPA - Primary Health care European Project on Alcohol and the Istituto Superiore di Sanità is prepared and candidated to promote together with the Regions the specific activities in tight coordination with the professional and scientific societies (SIMG, SIA).”

http://www.solidarietasociale.gov.it/NR/rdonlyres/CCA57828-3C95-4568-9D25-9E22395E862F/0/Formazionedelpersonale.doc



1212


Gaining Health 2007-2010

Strategic area 5 “Strengthening primary and secondary prevention on alcohol consumption in primary health care”

Strategic area 8 “Training the health care provider on alcohol consumption and alcohol related problems”.

1313


SUMMARY

A. The ongoing strategies on alcohol in Italy aimed at developing and enduring implementation of alcohol EIBI in PHC settings.

1. The Frame Law on Alcohol (125/2001)2. The National Health Plan (PSN)3. The National Alcohol and Health Plan (PNAS)4. The National Committee on Alcohol

B. The experience and activities related to IPIB, the Italian EIBI programme at the National Institute of Health – ISS, Rome, Italy.

1414


WHO CC for Research and Health

Promotion on Alcohol and

alcohol-related problems

EUROCARE Italy

Working Group CSDA

Centro Servizi Documentazion

e Alcol

Centro Alcologico Regionale

(CAR) Tuscany Region

National Observatory

on Alcohol

ISS,National Centre

on Epidemiology, Surveillance and

Health Promotion (CNESPS)

IPIB working group

E.Scafato (Coordinator), V.Patussi, T.Codenotti, C.Gandin,

L.Mezzani, I.Londi, S.Ghirini, L.Galluzzo, M.Di Rosa, S.Bruni,

E.Vanni, S.Martire, L.Di Pasquale, A.Scafato, N.Parisi, R.Scipione,

R.Russo, R.Travaglini, T.Fanucchi

IPIB working group(Identificazione Precoce Intervento Breve)

1515


The ISS has been indicated by the National Committee on Alcohol as the national provider of the training activities in tight connection with the SIA (Italian Society of Alcohology) and the Regions. It is a concrete example of implementation of EU PHEPA project and integration into the National Alcohol policy.

Until now training in IPIB on alcohol is not yet compulsory for the professionals of the National Health System, but an example of implementation at the Regional level has been the central funding to the Tuscany Region of a specific training programme for all the Regions devoted to IPIB in the workplaces funded by the Centre for Controls of Diseases (CCM).

Training on IPIB in PHC in Italy

1616


IPIB-PHEPA activities The IPIB working team started its activities in

April 2006 to deliver a communication strategy and to organise conferences to announce, promote and disseminate the EIBI-PHEPA programme.

English version

Italian version

1717


The editorial team of the Italian PHEPA training manualIl testo del volume, la traduzione e l’adattamento dei materiali sono stati curati dall’Istituto Superiore di Sanità che ha elaborato il progetto editoriale finale del prodotto finale e coordinato il Gruppo di Lavoro IPIB che comprende:- Osservatorio Nazionale Alcol - Centro Collaboratore dell’Organizzazione Mondialedella Sanità per la Ricerca e la Promozione della Salute su Alcol e Problemi Alcolcorrelati, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute dell’Istituto Superiore di Sanità (coordinamento)- Società Italiana di Alcologia- Centro Alcologico Regionale della Toscana - Regione Toscana- Eurocare Italia- Gruppo di Lavoro CSDA Centro Servizi Documentazione Alcol dell’Osservatorio Nazionale Alcol: Emanuele Scafato (Coordinatore), Valentino Patussi, Laura Mezzani, Ilaria Londi, Claudia Gandin, Lucia Galluzzo, Sonia Martire, Egidio Chessa, Riccardo Scipione, Nicola Parisi, Silvia Ghirini, Monica Di Rosa, Tiziana Codenotti, Silvia Bruni, Antonietta Scafato, Elena Vanni, Lucilla Di Pasquale.Si ringrazia la Dottoressa Rosaria Russo per il supporto tecnico, la revisione dei testi, la verifica dei formati di stampa ed i contatti interistituzionali nazionali ed europei. La stampa del volume, la predisposizione del corso di formazione e la sua attuazione sono resi possibili grazie al finanziamento del Ministero della Salute nell’ambito delle iniziative di comunicazione ai sensi della Legge 125/2001.

1818


IPIB is actually the formal institutional standard of training in Italy allowing to participants to be trained themselves and to train other professionals. The training course has been opened to GPs and to physicians involved in the PHC. In order to reach subgroups of population at risk but otherwise not reachable by GPs, as a novelty for the Italian landscape we open the course also to professionals (physicians and psychologists) from:Services for the treatment of dependences (SERT), Consultories, Workplace prevention setting.

The definition of professionals working in the wide area of the Primary Health Care settings to be involved in the train course is still open.

IPIB training courses at the ISS

1919


The implementation of IPIB training courses at the ISS

The implementation started on 2007 with the first formal training course, for the duration of two days, and other courses have been carried out at the ISS and at territorial level.

The calls for selection of candidate (24 participants for each) are available at the web page of the Istituto Superiore di Sanità.

The training course received funding from the Ministry of Health (until September 2009) and it received a good evaluation in terms of credits to be earned through the Continuous National Training Programme (ECM), compulsory for the professionals of the National Health System.

2020


Main characteristics of 98/168 participants to the IPIB-PHEPA

training courses at the ISS Number: 98 Age - average(min-max): 47ys (24-60) Gender distribution (%):

M=38% F=62%

Professional categories (%):Physicians: 62%Psychologists: 38%

2121


Distribution (%) of participants by professional categories

27,6 20,4

6,123,5

14,3 8,2

Physicians of national services for the treatment of dependences (SERT)Physicians involved in the workplace prevention settingGPsPhysicians others Psychologists (SERT)Psychologists others

2222


PHEPA evaluation form

At the end of the course, participants fulfilled the original PHEPA evaluation form.

The training course has received a good evaluation by the trainees.

2323


PHEPA Evaluation form-Early Identification 1. Measure alcohol

consumption in standard drinks per week (n=97)

5

92

to some extent a lot

2. Identify hazardous drinkers according to their weekly

alcohol intake (n=96)

90

6


3. Identify hazardous drinkers using the AUDIT (n=97)

4 1

92

not much to some extent a lot

4. Identify hazardous drinkers using the AUDIT C (n=97)

87

19


2424


PHEPA Evaluation form-Brief Intervention 1/3

81,7%91,9%

15,0%8,1%

%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Doctors (n=60)

Phychologists(n=37)

Describe Prochaska and Di Clemente's model of the stages of change (n=97)

11

83

12

not at all not much to some extent a lot

86,7% 89,2%

13,3% 10,8%

%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Doctors (n=60)

Phychologists(n=37)

Describe the basic components of a brief

intervention (n=97)

12

85


2525


78,0%89,2%

22,0%10,8%

%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Doctors (n=59)

Phychologists(n=37)

Describe tipical ways patients show their resistance to

health promotion behaviours (n=96)

79

17


76,7%

94,6%

21,7%

5,4%

%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Doctors (n=60)

Phychologists(n=37)

Provide brief advice to hazardous drinkers taking

into account his/her stage of change (n=97)

15 1

81



2626


73,3%81,1%

23,3%16,2%

%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Doctors (n=60)

Phychologists(n=37)

Respond to a patient's resistance in a way that does not provoke further argument

(n=97)

20 3

74


76,7%86,5%

21,7%13,5%

%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Doctors (n=60)

Phychologists(n=37)

Exchange information in client-centred way (n=97)

18 1

78



2727


Could you apply what you have learnt in your daily job?

n=96

46

17 627

Not much To some extentA lot Very much

At National level, the definition of professionals working in the wide area of the Primary Health Care settings to be involved in the train course is still open.

2828


Conclusion As a final consideration we may say that the

work it’s a never ending process mainly oriented by a dynamic evolution of the demand coming by the different priorities in the huge area of Primary Health Care.

Our experience was extremely important to tailor some customized training issues devoted to comply with the need to integrate into the daily work of very different type of health professionals mainly having in mind the priority targets identified by changing contexts for which a specific approach has to be developed.

2929


Conclusion

The main barrier to the implementation of the IPIB is

FUNDING Where the possibility to pay for the

implementation of the IPIB in the daily activities of health professionals will become a reality, then we will receive a new impetus to give people more chances to be really protected by the alcohol impact on health and safety.

3030


Conclusion Another main barrier to the

implementation of the IPIB is

NETWORK For some professionals its culturally

difficult to collaborate also in the light of some existing barriers related to the organization of the health body and/or to the procedures to be followed in their workplaces. The lack of a professional network in some geographical context do not help a lot to implement IPIB as a main tool of prevention.

3131


WHO CC for Research and Health Promotion

on Alcohol and alcohol-related

problems

EUROCARE Italy

Working Group CSDA

Centro Servizi Documentazio

ne Alcol

Centro Alcologico Regionale

(CAR) Tuscany Region

National Observatory

on Alcohol

ISS,National Centre

on Epidemiology, Surveillance and Health Promotion

(CNESPS)

IPIB working group

E.Scafato (Coordinator), V.Patussi, T.Codenotti, C.Gandin, L.Mezzani,

I.Londi, S.Ghirini, L.Galluzzo, M.Di Rosa, S.Bruni, E.Vanni, S.Martire, L.Di Pasquale, A.Scafato, N.Parisi, R.Scipione, R.Russo,

R.Travaglini, T.Fanucchi

Thanks for your attention

3232


Gandin C, Scafato E, Ghirini S, Galluzzo L and the IPIB working group Claudia Gandin, MD

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