Brief intervention in primary care Study of Kristensson et al in Sweden

No alcohol problems, approx 8 million Swedes  national alcohol policy  primary prevention Risk behaviour,  secondary prevention Dependent,  Tertiary prevention Treatment Target group: people with hazardous consumption

Brief intervention example: study of Kristensson et al in Sweden Randomised trial: Results after 5 years

Brief intervention  Screening: the AUDIT questionnaire  Motivate patients to change behaviour

Brief advice: FRAMES  Feedback  Responsibility  Advice  Menu  Empathy  Self-efficacy

Motivational Interviewing Two main components  Understand patient’s readiness to change behaviour  Communications skills

How should screening be organised? Who should be screened? All patients All new patients All patients within certain time period Patients with certain diagnoses Individual decision from case to case How? AUDIT distributed by reception staff AUDIT distributed by doctor at consultation Part of general life style assessment Screening questions asked by doctor at consultation Screening questions asked by nurse or other staff What should be done with the repsonses? Advice from doctor or nurse  motivational enhancement Patient offered new appointment for alcohol advice

Training program for brief intervention 3 hours training:  Basics about alcohol  effects of alcohol on health  drinking habits in the population  effective treatment  evidence for SBA  Methods for screening and brief advice WHO manual:

The Swedish national risky drinking project National center for training and dissemination In Primary Health In the work place

National center for training and dissemination Project areas 1.Family medicine 2.Maternal health 3.Primary health nurses with focus on child health care 4.Occupational health 5.Motivational Interviewing

The Swedish national risky drinking project The Risky Drinking Project at SNIPH Combining National Center with support for local action in 21 counties