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