1. 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

2. Municipality of Udine 1998 Municipality of Martignacco 2004 How to implement BI ? BI on Alcohol 76 GPs BI On Alcohol & Tobacco Community Health Promotion Local health Unit 70 GPs -Qualitative research -Community involvement -Needs and Resources -Empowerment Province of Udine 32 Municipalities Regional centre for the training in PHC CME General practice teaching Faculty of Medicine BI & BMI on Lifestyles and CV diseases 790 Gps WHO Venice Office on Health Promotion GPs Cardiologists Public Health

3. 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

4. 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

5. 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 accessible to GPs, cardiologists and other specialists?

6. 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

15. How soon after you wake up do you smoke your first cigarette? How many cigarettes a day do you smoke?

16. highly dependent

20. 78 179 24

22. Psycho-social risk

24. Minimal advice

25. Brief Motivational Inteviewing

26. To integrate BI into primary care 1) Provide training and support 2) Pay for quality service 3) Pay for services as a investment 4) Community involvement Peter Anderson

28. 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

29. 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

30. Brief Interventions A)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

31. Training the trainers Two days of training 57 experts participating –20 Cardiologists –20 Teaching GPs –17 Public health experts

32. Evaluating the training Pre - 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

33. Pre-post test self efficacy n.s.

34. Interested in further training in motivational interviewing –Training GPs86,7% –Cardiologists87,5% –Public Health100 %

35. 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

36. 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

37. 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