screening and brief intervention in primary care in · pdf filebundesärztekammer...
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![Page 1: Screening and Brief Intervention in Primary Care in · PDF fileBundesärztekammer Arbeitsgemeinschaft der deutschen Ärztekammern EMCDDA - Brief Intervention and Motivational Interviewing](https://reader033.vdocuments.site/reader033/viewer/2022051719/5a732bc97f8b9ab6538e4a96/html5/thumbnails/1.jpg)
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
EMCDDA - Brief Intervention and Motivational Interviewing
for young Alcohol and Cannabis users
– Lisbon, Jan. 23rd 2013 -
Screening and Brief Intervention in Primary Care
in Germany
- Current practices, shortcomings and future developments -
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
What to talk about?
current practice
current shortcomings
open questions
future options
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Germany: • 81.7 Mio. Inhabitants
357.000 km²
Health care system:
• 342.000 practicing doctors (2011)
• 141.000 in private practice
• 56.700 family practitioners
• 3.4 per 1.000 inhabitants (OECD-Ø: 3.0)
• Statutory Health Insurance-System
• free choice of doctors
Expenditures:
• 4,338 US$ (PPP) (OECD: 3.268 US$)
• 11.6% of GDP (2010) (OECD: 9.5%)
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Current Practice: Screening and Brief Intervention
„Haves and have-nots“ in Germany:
• Manuals & Handbooks on BI for doctors
• Training curriculum on addiction medicine (50 h)
For adolescents:
• Printed and online information on psychtropic substances
• intervention and training programs
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Current Practice: Manuals on Brief Intervention
in Primary care
• on smoking,
• hazardous drinking
• misuse of prescription drugs
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Manual on Brief Intervention for
Patients with Alcohol Problems
• doctor-patient communication
• evaluation of alcohol consumption and situations
• ambivalences and motivation to change
• alcohol questionnaire
• identifying drinking stages
• Interventions
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Manual on misuse of prescription drugs
• patient-typologies
• doctor-patient communication
• evaluation of drug consumption and purposes
• stages of and motivation to change
• assessing past and current drug use
• information on problematic substance groups
• detoxification
• quality control measures for doctor´s practice
• recommendations for doctor´s prescription
• professional support systems and agencies
• short version for doctor´s desk
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Manual on misuse of prescription drugs
Short version for doctor´s desk:
• common complaints and physical symptoms
• helpful questions for interaction with patient
• history and amounts of drug use
• recommendations for drug-prescription
• detoxification
according to different substance groups
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Bundesärztekammer | Arbeitsgemeinschaft der deutschen Ärztekammern 9
Manual on misuse of prescription drugs:
Practice-Evaluation – in combination with a training course
Manual utilization (n=267)
Rating results (n=209)
high relevance of contents for
practical work
would recommend manual to a
colleague
used it after the training course on
addiction medicine
changed my behavior
on prescribing drugs
73,2%
78,3%
67,0%
94,7%
31,5%
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Bundesärztekammer | Arbeitsgemeinschaft der deutschen Ärztekammern 10
Knowledge on the topic (Interventiongroup vs. Controlgroup – Self-assessment)
Control-Group Intervention-Group
Relevance of the topic 40,8% 56,5%
Information on the topic 48,0% 56,6%
Ability to identify a problem with
prescription drugs50,4% 57,1%
Ability to treat a dependency on
prescribed drugs29,8% 38,6%
1) very high / high on a 5-step Likert Scale
1)
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Module I10 h
Basics 1 (4 h) Basics 2 (6 h)
Module II8 h
AlcoholTobacco
Module III4 h
Prescription Drugs
Module IV8 h
Illegal Drugs
Topic of choice(Deepening of Module II, III oder IV,
depending on participants professional background and interest)
6 Std.
Module V14 h
Motivational InterviewingPractical Applications
Current Practice:
Training of doctors on substances and BI (50 h)
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Training and intervention programs for adolescents
with problematic alcohol use
Printed and online information,
intervention and training
programs for adolescent
alcohol users
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Training and intervention programs for adolescents
with problematic substance use
Printed and online information,
intervention and training
programs for adolescent
substance users
![Page 14: Screening and Brief Intervention in Primary Care in · PDF fileBundesärztekammer Arbeitsgemeinschaft der deutschen Ärztekammern EMCDDA - Brief Intervention and Motivational Interviewing](https://reader033.vdocuments.site/reader033/viewer/2022051719/5a732bc97f8b9ab6538e4a96/html5/thumbnails/14.jpg)
BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
easy access
no social barriers
long term contact – teachable moments
health is the issue
integration of behavioral and physical aspects
preventive health screenings as gateway
proven effectiveness
Brief Intervention in Primary Care The Pro`s:
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
A broad application of brief intervention is still widely missing
No primary-care-based BI for adolescents is available
Reality of BI in Primary Care in Germany
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Cultural barriers
Self concepts of the medical profession
Cultural barriers of the patient
Fears of economic damage
Lack of incentives: time, money, gratification
Lack of knowledge and training
Brief Intervention in Primary Care
The Con`s:
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
What it takes:
Doctors need to be convinced that BI
• is useful and effective,
• will save time,
• won´t hurt,
• can be applied appropriately as needed
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
What it takes:
• An integrated and ongoing training of doctors in BI
• Practice-oriented materials
• A target-oriented and appropriate remuneration for BI
• A open social environment
• additional services for easy transferrals
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Outlook
• Negotiations with health insurances and Ministry of Health
on BI in primary care
• Draft of a Law on Prevention and Health Promotion
extending Health Check Ups to primary prevention
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BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern
Thank you for your attention !