Post on 01-Feb-2018
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
EMCDDA - Brief Intervention and Motivational Interviewing
for young Alcohol and Cannabis users
– Lisbon, Jan. 23rd 2013 -
Screening and Brief Intervention in Primary Care
in Germany
- Current practices, shortcomings and future developments -
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
What to talk about?
current practice
current shortcomings
open questions
future options
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Germany: • 81.7 Mio. Inhabitants
357.000 km²
Health care system:
• 342.000 practicing doctors (2011)
• 141.000 in private practice
• 56.700 family practitioners
• 3.4 per 1.000 inhabitants (OECD-Ø: 3.0)
• Statutory Health Insurance-System
• free choice of doctors
Expenditures:
• 4,338 US$ (PPP) (OECD: 3.268 US$)
• 11.6% of GDP (2010) (OECD: 9.5%)
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Current Practice: Screening and Brief Intervention
„Haves and have-nots“ in Germany:
• Manuals & Handbooks on BI for doctors
• Training curriculum on addiction medicine (50 h)
For adolescents:
• Printed and online information on psychtropic substances
• intervention and training programs
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Current Practice: Manuals on Brief Intervention
in Primary care
• on smoking,
• hazardous drinking
• misuse of prescription drugs
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Manual on Brief Intervention for
Patients with Alcohol Problems
• doctor-patient communication
• evaluation of alcohol consumption and situations
• ambivalences and motivation to change
• alcohol questionnaire
• identifying drinking stages
• Interventions
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Manual on misuse of prescription drugs
• patient-typologies
• doctor-patient communication
• evaluation of drug consumption and purposes
• stages of and motivation to change
• assessing past and current drug use
• information on problematic substance groups
• detoxification
• quality control measures for doctor´s practice
• recommendations for doctor´s prescription
• professional support systems and agencies
• short version for doctor´s desk
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Manual on misuse of prescription drugs
Short version for doctor´s desk:
• common complaints and physical symptoms
• helpful questions for interaction with patient
• history and amounts of drug use
• recommendations for drug-prescription
• detoxification
according to different substance groups
Bundesärztekammer | Arbeitsgemeinschaft der deutschen Ärztekammern 9
Manual on misuse of prescription drugs:
Practice-Evaluation – in combination with a training course
Manual utilization (n=267)
Rating results (n=209)
high relevance of contents for
practical work
would recommend manual to a
colleague
used it after the training course on
addiction medicine
changed my behavior
on prescribing drugs
73,2%
78,3%
67,0%
94,7%
31,5%
Bundesärztekammer | Arbeitsgemeinschaft der deutschen Ärztekammern 10
Knowledge on the topic (Interventiongroup vs. Controlgroup – Self-assessment)
Control-Group Intervention-Group
Relevance of the topic 40,8% 56,5%
Information on the topic 48,0% 56,6%
Ability to identify a problem with
prescription drugs50,4% 57,1%
Ability to treat a dependency on
prescribed drugs29,8% 38,6%
1) very high / high on a 5-step Likert Scale
1)
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Module I10 h
Basics 1 (4 h) Basics 2 (6 h)
Module II8 h
AlcoholTobacco
Module III4 h
Prescription Drugs
Module IV8 h
Illegal Drugs
Topic of choice(Deepening of Module II, III oder IV,
depending on participants professional background and interest)
6 Std.
Module V14 h
Motivational InterviewingPractical Applications
Current Practice:
Training of doctors on substances and BI (50 h)
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Training and intervention programs for adolescents
with problematic alcohol use
Printed and online information,
intervention and training
programs for adolescent
alcohol users
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Training and intervention programs for adolescents
with problematic substance use
Printed and online information,
intervention and training
programs for adolescent
substance users
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
easy access
no social barriers
long term contact – teachable moments
health is the issue
integration of behavioral and physical aspects
preventive health screenings as gateway
proven effectiveness
Brief Intervention in Primary Care The Pro`s:
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
A broad application of brief intervention is still widely missing
No primary-care-based BI for adolescents is available
Reality of BI in Primary Care in Germany
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Cultural barriers
Self concepts of the medical profession
Cultural barriers of the patient
Fears of economic damage
Lack of incentives: time, money, gratification
Lack of knowledge and training
Brief Intervention in Primary Care
The Con`s:
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
What it takes:
Doctors need to be convinced that BI
• is useful and effective,
• will save time,
• won´t hurt,
• can be applied appropriately as needed
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
What it takes:
• An integrated and ongoing training of doctors in BI
• Practice-oriented materials
• A target-oriented and appropriate remuneration for BI
• A open social environment
• additional services for easy transferrals
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Outlook
• Negotiations with health insurances and Ministry of Health
on BI in primary care
• Draft of a Law on Prevention and Health Promotion
extending Health Check Ups to primary prevention
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Thank you for your attention !