World Health Organization Collaborative Project on Identification and Management of Alcohol-related Problems

 in Primary Health Care: Phase IV

 

Development of Country-wide Strategies for Implementing Early Identification and Brief Alcohol Intervention in Primary Health Care.

Florence

[Customisation] [Communications] [Strategic Alliance] [Demonstration Project]

Collaborative Centre:

Centro Alcologico Integrato, Florence Health Agency, Firenze

Chief Investigators:

Dr Allaman Allamani - Centro Alcologico Integrato, Firenze (Co-ordinator)

Dr Gabriele Bardazzi - Centro Alcologico Integrato, Firenze

Dr Vittorio Boscherini - Cooperativa Medica, Firenze

Dr Francesco Cipriani  - Epidemiology Unit, Florence Health Agency, Firenze

Geographical Area in which Implementation Strategy will be Applied:

The geographical areas will be two, one in the southern and one in the western part of the province of Florence: Scandicci, a residential town west of Florence with 55,000 inhabitants; a group of three contiguous towns in the rural northern Chianti area, south of Florence, i.e. Impruneta (15,000 inhabitants), San Casciano val di Pesa (16,000) Tavarnelle (6,900).

Starting Date (i.e. overall Phase IV project):

The Centro Alcologico took the first contacts both with the Medical Associations and with some Institutions in Scandicci at the end of 1997; however a positive feedback and an active agreed on the involvement of both came in autumn 1998. More specifically the Florence Medical Cooperative early identification and brief intervention (EIBI) in October 1998, while the Scandicci Municipality approved the overall Community Project in November 1998.

Completion Date:

The overall Project, including Demonstration project and maintenance strategies, is expected to be completed in 2003.

Project Strands and Milestones:

Strand I:

Alliance building and communication strategies:

The following actions were already accomplished:

1. Presentation of the Project to the responsibilities of National and local Medical Association

2. Presentation of the Project to the Florence Medical Cooperative (including a great part of GPs in Florence and its southern and western province)

3. Presentation of the Project (EIBI + Community Action) to one Scandicci District responsible and to Scandicci Municipality Assessors

4. Presentation of the Project to the Florence Municipality

5. Presentation of the Project to the responsible of Health Education at the provincial School Education Office

6. Presentation of the Project to the responsible for Driving Schools in the province of Florence.

7. A Training course for community prevention involving health and social professionals employed in the Florence Health Agency including those ones working in the two above mentioned areas has been approved and will start on January 1999. It is supposed to involve other local professionals into the Project.

In the very next future it is planned:

  1. a greater involvement of Regione Toscana Health Authority
  2. presentation of the Project in the north Chianti Municipalities
  3. general information meetings in the towns involved in the Project
  4. information through local media (TV newspapers)
  5. starting qualitative analysis by means of interviewing key informants in Scandicci (as part of strand 2)

Materials Customisation and re-framing alcohol issues

  1. Training the GPs trainers (in co-operation with the Udine Centre) and starting the customisation of materials.
  2. Customisation of materials.
  3. Community consultation on best strategies.

Strand II:

Demonstration project. Scandicci will be the place where early identification and brief intervention (EIBI) will be integrated in a full community action Project planned to involve the School sector and the Traffic sector, besides the Health one. The north Chianti area will implement EIBI with a minor communication strategy.

Strand III:

Depending on the results of the demonstration project, they should be disseminated throughout the Regione Toscana.

Formulation of a National Early Identification and Brief Intervention Plan will be performed in accordance with Udine Centre.

Proposed Funding Sources:

Florence Health Agency, Regione Toscana Administration, Scandicci Municipality, Private Institution as Florence COOP consumers’ association, Provincial of Florence traffic assessor.

Local Support:

Municipalities, Districts, local COOP branch, and local stakeholders and resources to be elicited during the strand 1.

CUSTOMIZING MATERIALS AND SERVICES

Brief Intervention Package, including delivery systems:

-"training the trainers" for GPs representatives all the alcohol experts

-as a consequence GPs will be trained on early detection and "brief intervention" next year

-Focus groups will be started with the GPs . None of them had implemented Strand III "pilot".

-It was decided that, according to Strand III results, mail will be the main delivery system.

Early Identification (Screening):

A preliminary request from the GPs involved in the project would be to use a Q/F questionnaire and other relevant items (plasma laboratory items) however this process will be discussed with all the GPs at the training sessions

Brief Intervention Process:

This process will be discussed with all the GPs at the training sessions however a multi-level approach would be recommended.

Training of Primary Health Care Staff:

The Scandicci Project include primary health care (PHC) staff (nurses, and other professionals) who are generally not working in the GP office. In fact in Italy while GPs are private professionals with conventions with the public regional Health system, PHC staff usually are employees of the public regional Health system. PHC staff will be trained by the Project trainers.

Focus groups will be performed also in collaboration with Udine Centre.

Data Analysis:

There will be two levels of data analysis:

  1. The overall analysis (process, outcome and economical) will be performed at central (Centro Alcologico, Unità di Epidemiologia, Health Agency in Florence, Health Agency in Florence)
  2. A national data analysis will be performed in collaboration with Udine Centre

REFRAMING UNDERSTANDING OF ALCOHOL ISSUES

General Public:

  • The results of the Rifredi Community action Project (1992-1997) will be presented by the Rifredi healthy lifestyle co-ordinating committee, including representatives of GPs and of primary health care professionals . That will start a series of comments from the general public and local health and social professionals as well as the representatives of community institutions. Also self help groups for treating alcoholism may be involved at a later stage
  • Focus groups with some categories of the general public may be started in order to disseminate the new methodology

Health Professionals:

The Florence Medical Cooperative and the Regional Medical Association agree on the early identification and brief intervention project. Connections with other Regional groups may support the diffusion of the project among other GPs.

Focus Groups will be run with previously involved GPs.

Other Stakeholders:

Involving local stakeholders (health and social services, leading people, health volunteers and HGO groups.

Media Advocacy:

Establishing links with local newspapers and TV journalists

Control of Communications Strategy:

Creation of local municipalities co-ordinating groups.

ESTABLISHING LEAD ORGANIZATION(S) AND BUILDING STRATEGIC ALLIANCES

Lead organisation(s):  

Centro Alcologico Integrato, Medical co-operative group (Cooperativa Medica Fiorentina), Italian Medical Association, Health Educational Department of Florentine Health Agency, Municipality of Scandicci.

Building Strategic Alliances:

Tuscany Region Health Department, Private Sponsors, Municipal Districts, Medical and Psychology colleges, Municipalities, Italian Medical Association

DEMONSTRATION PROJECT(S)

Location(s):

Scandicci, a residential town west of Florence with 55,000 inhabitants; a group of three contiguous towns in the rural northern Chianti area, south of Florence, i.e. Impruneta (15,000 inhabitants), San Casciano val di Pesa (16,000) Tavarnelle (6,900).

Scandicci would include at least 10 GPs and Northern Chianti area at least 11

Those are minimal figures coming from the cooperative. Strategies with the Regional Medical Association are done in order to have at least 50% more.

Projected Start Date:

Autumn 1999

Projected Completion Date:

2003

Design of Project:

A "quasi-experimental design"(1 area with full community action project) and another one with limited communication strategies. A evaluation will be done before and after the study.

All the GPs of the two areas will participate to the project.

Scandicci will be the site of a Community action; GPs and other primary health care professionals will receive the material, instructions and will be asked to send a periodical report on the activity.

In Northern Chianti Area GPs and other primary health care professionals will receive the material, instructions and will be asked to send a monthly report on the activity

Differences between the two areas will be studied by the Co-ordinating centre, the Epidemiology Unit and consultants from the Turin University of Sociology.

Outcome Measures:

  1. N° of GPs and primary health care professionals involved: screening and counselling patients
  2. Changing attitude and knowledge counselling alcohol issues
  3. Changes in alcohol consumption in the general population of the two areas (mail-questionnaire.

Process Measures:

Qualitative analysis of Community needs, personal interviews with patient samples, N° of stakeholders involved, participation of General population at conferences and local initiatives.

Economic Analysis:

Changes in:

1. working days lost

2. use of health services in patient who tried early identification and brief intervention

3. Community wide-indices of alcohol related harm (hospitalisation rates of alcohol related harm). 

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