5^BLS Regione Friuli Venezia Giulia Liceo Scientifico “Albert Einstein”
From small municipalities to the regional government and more…: a process of SBI integration into...
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Transcript of From small municipalities to the regional government and more…: a process of SBI integration into...
From small municipalities to the regional government and more…: a process of SBI integration into
Friuli – Venezia Giulia health policy
Dr Pierluigi Struzzo Regional Centre for the Training in PHC
Monfalcone, IT
Municipalityof Udine
1998 Municipalityof Martignacco
2004
How to implement BI ?
BIon
Alcohol 76 GPs
BIOn Alcohol
& Tobacco
CommunityHealth
Promotion
Local health
Unit70 GPs
-Qualitative research-Community involvement-Needs and Resources-Empowerment
Province of Udine
32 Municipalities
Regional centre for the
training in PHCCMEGeneral practice
teaching
Faculty of Medicine
BI & BMIon
Lifestylesand
CV diseases790 Gps
WHOVenice Office
onHealth Promotion
GPsCardiologistsPublic Health
In practice…
CME for regional GPs
• Training the trainers (60)– 20 health districts
• 1 cardiologist• 1 teaching GP• 1 public health
• Training the 1040 GPs
About the GPs they trained
• 807 GPs (77%) participated to the training
Willingness to implement the method– 162 (20%) minimal advice– 171 (21,2%) motivational interview– 160 (19,8%) motivational int. + action
research
REGIONAL PLANNING &
IMPLEMENTATION
6 HEALTH UNITS, 20 HEALTH AREAS
Population 1,2 million inhabitants
.
FRIULI VENEZIA GIULIA REGION
Is it possible to create a tool for secondary and primary prevention accessibleto GPs, cardiologists and other specialists?
Promoting healthy lifestyles, evaluating and monitoring cardiovascular risk to
reduce it
Gente di Cuore
Leute mit Herz
Int di Cûr
Zente de Cuor
Ljudje s Srcem
Hearty People
How soon after you wake up do you smoke your first cigarette?
How many cigarettes a day do you smoke?
highly dependent
78
179
24
Psycho-social risk
Minimal advice
Brief Motivational
Inteviewing
To integrate BI into primary care
1) Provide training and support2) Pay for quality service3) Pay for services as a investment4) Community involvement
Peter Anderson
Training the GPs for CV diseases reduction (low-risk)
Training the trainers– 20 Health Districts,each with
• One Cardiologists• One Teaching GP• Public health specialist
• Early identification • Global Cardiovascular risk • Lifestyles Risks
– Food, Alcohol and tobacco, cholesterol, hypertension etc.
• Psychosocial risk (school, job, living alone, perception of health, Lickert scale)
• Stages of change
Early Identification and Brief Intervention
• Brief InterventionsA) Minimal advice (10 seconds)
B) Motivational interview (5-10 minutes)
• Stages of change• Willingness to change
– Self-efficacy (importance + self-esteem)(Lickert scales)– Individual and community assets
• Action research
Early Identification and Brief Intervention
Training the trainers
Two days of training 57 experts participating– 20 Cardiologists– 20 Teaching GPs– 17 Public health experts
Evaluating the trainingPre - Post test
• Knowledge evaluation on:– CV Global Risk– Lifestyles– Psychosocial risk – Minimal advice– Motivational interviewing
• Significant variations only for cardiologists
• Attitudes evaluation, 4 Qs on– Self efficacy in motivating people to change
0
1
2
3
4
5
6
7
8
9
Alcohol Tobacco Food Physic Act.
PRE Cardiologists
PRE Public Health
PRE Training GPs
POST Cardiologists
POST Public health
POST Training GPs
Pre-post test self efficacy
n.s.
n.s.n.s.
Interested in further training in motivational interviewing
– Training GPs 86,7%– Cardiologists 87,5%– Public Health 100 %
Where are we now?
• BI included into regional social and health policies
• BI is considered a tool to empower patients and doctors
• BI closely linked to health promotion and community research
• Regional start-up incentives and web connection with National Health Institute in Rome with online real time data
Customization• Alcohol only
• Alcohol, tobacco & other lifestyles
• From identification of health risks to the understanding of the conditions that create risks
• From health needs to health assets (Empw)
• Cardiovascular risk
• Health policy
Why was this possible?
• Brief intervention is a flexible instrument– Good for the patient– Good for the doctor– Good for public health – Good for health promotion