The future of treatment policy European alcohol treatment policy

1. Annual Symposium 2009 The future of treatment policyEuropean alcohol treatment policy Antoni Gual Alcohol Unit. Neurosciences Institut Hospital Clínic. Barcelona

2. Index • Europe, a building under construction • Mapping the treatment of hazardous and harmful alcohol use (HHAU) accross Europe • Recent tendencies • Personal experiences • Ongoing and future research

3. What is Europe?

4. The Seduction of Europa Tiziano, circa 1560

5. What is Europe?

6. What is Europe?

7. Ulysses and the Sirens Herbert J. Draper, 1909

9. TITLE XIII PUBLIC HEALTH Article 152 • Community action in the field of public health shall fully respect the responsibilities of the Member States for the organisation and delivery of health services and medical care.

10. Index • Europe, a buildingunderconstruction • Mappingthetreatment of hazardous and harmful alcohol use (HHAU) accrossEurope • Recenttendencies • Ongoing and futureresearch

11. www.phepa.net

12. Phepa II. Specific objectives PHEPA • To create a sustained European Platform of health professionals and brief interventions • To develop an assessment tool and a registry to assess and document the current status of services for brief interventions • To build an Internet based resource centre for health professionals, policy makers and providers • To roll out a training programme throughout Member States to harmonize the skills of European health professionals • To roll out clinical guidelines throughout Member States toharmonize the quality of brief interventions.

13. PHEPA

14. Development of the Assessment Tool • Based on the World Health Organization questionnaires to assess smoking cessation services and enhanced in three phases, including a focus group and an examination by a European expert panel. • The feasibility of implementation was assessed by 14 individuals, and piloted in 18 countries. • It was adapted for hazardous and harmful alcohol consumption by Peter Anderson in 2004 with assistance from the partners of the PHEPA project.

15. Description of the Assessment tool 24 questions distributed across 7 key sections: • presence of a country coalition or partnership, • community action and media education, • health care infrastructures • support for treatment provision • intervention and treatment (availability and accessibility) • health care providers (clinical accountability and treatment provision) • health care users (knowledge and help seeking behaviour)

16. Data collection • The participating countries were requested to complete the questionnaire by the end of September 2008. • 15 partners, collecting data from 13 countries and 2 country regions sent their data on time for the final report. • For 9 of these countries and 1 region the information had also been collected in 2004

17. 2008

18. Description of the questionnaire 24 questions distributed across 7 key sections: • presence of a country coalition or partnership, • community action and media education, • health care infrastructures to manage HHAU • support for treatment provision • availability and accessibility of BI and treatment • health care providers (clinical accountability and treatment provision) • health care users (knowledge and help seeking behaviour)

19. Description of the questionnaire 24 questions distributed across 7 key sections: • presence of a country coalition or partnership, • community action and media education, • health care infrastructures to manage HHAU • support for treatment provision • availability and accessibility of BI and treatment • health care providers (clinical accountability and treatment provision) • health care users (knowledge and help seeking behaviour)

20. Health Care Infrastructures for the management of HHAU • Integration into the health care system • Structures to support quality of care • Research and knowledge programmes • Health care policies and strategies • Structures to manage the implementation of treatment within health services • Funding strategies

21. Management of HHAU integrated into the health care system Scale 0-10 Mean 3,86 ± 2,4 Health Care Infrastructures

22. Structures to support quality of care in the treatment of HHAU Existence of a formal governmental organization, or organization appointed by the government with responsibility of: Health Care Infrastructures

23. Formal Research Programme on HHAU England Italy Czech Rep. Finland Greece Hungary Ireland Lithuania Slovenia Belgium Germany Poland Portugal Spain Health Care Infrastructures

24. Education in the curriculum of professional training Health Care Infrastructures

25. Written Health care policies and strategies to manage HHAU England Germany Hungary Ireland Lithuania Slovenia Spain Italy Finland Belgium Czech Republic Poland Greece Portugal Health Care Infrastructures

26. Central structures to manage the implementation of treatment for HHAU within health services Belgium Czech Republic England Finland Italy Lithuania Portugal Spain-Catalonia Germany Greece Hungary Ireland Poland Slovenia Health Care Infrastructures

27. Areas included in the governmental policy on managing HHAU Health Care Infrastructures

28. Description of the questionnaire 24 questions distributed across 7 key sections: • presence of a country coalition or partnership, • community action and media education, • health care infrastructures to manager HHAU • support for treatment provision • availability and accessibility of BI and treatment • health care providers (clinical accountability and treatment provision) • health care users (knowledge and help seeking behaviour)

29. Support For Treatment Provision • screening systems • quality assessment systems • protocols • guidelines • reimbursement for health care providers

30. Screening & Quality assessment Support for treatment provision

31. Multidisciplinary clinical guidelines for managing HHAU Support for treatment provision

32. Description of the questionnaire 24 questions distributed across 7 key sections: • presence of a country coalition or partnership, • community action and media education, • health care infrastructures to manager HHAU • support for treatment provision • availability and accessibility of BI and treatment • health care providers (clinical accountability and treatment provision) • health care users (knowledge and help seeking behaviour)

33. Availability and accessibility to treatments for HHAU Availability & accessibility

34. Description of the questionnaire 24 questions distributed across 7 key sections: • presence of a country coalition or partnership, • community action and media education, • health care infrastructures to manager HHAU • support for treatment provision • availability and accessibility of BI and treatment • health care providers (clinical accountability and treatment provision) • health care users (knowledge and help seeking behaviour)

35. Clinical accountability: Estimation of advice for HHAU as a clinical routine

36. Description of the questionnaire 24 questions distributed across 7 key sections: • presence of a country coalition or partnership, • community action and media education, • health care infrastructures to manager HHAU • support for treatment provision • availability and accessibility of BI and treatment • health care providers (clinical accountability and treatment provision) • health care users (knowledge and help seeking behaviour)

37. Studies & Surveys on patients’ knowledge of the risks of alcohol

38. Index • Europe, a buildingunderconstruction • Mappingthetreatment of hazardous and harmful alcohol use (HHAU) accrossEurope • Recenttendencies • Personal experiences • Ongoing and futureresearch

39. 20042008 Longitudinal changes across 10 countries

40. Structures for quality care Existence of a formal governmental organization, or organization appointed by the government with responsibility of:

41. Formal research programme

42. Index • Europe, a buildingunderconstruction • Mappingthetreatment of hazardous and harmful alcohol use (HHAU) accrossEurope • Recenttendencies • Personal experiences • Ongoing and futureresearch

43. The opinion of clinicians

44. A 40-year old male patient has an appointment for the first time with his GP. Will he be asked about his alcohol consumption? 6% 29% 35% 29%

45. If he is asked about his drinking, do you think that the GP or nurse will use a standardized instrument? 18% 6% 6% 12% 59%

46. If the patient refers that he needs help for his drinking and the GP diagnoses a severe alcohol dependence that needs to be referred for specialized treatment, what will the GP do? • Refer to outpatient specialized service (10) • Refer to inpatient centre (6) • Give him contact details of agencies (2) • Refer to A & E for outpatient detox (1) Huge diversity between regions (8)

47. Index • Europe, a buildingunderconstruction • Mappingthetreatment of hazardous and harmful alcohol use (HHAU) accrossEurope • Recenttendencies • Personal experiences • Ongoing and futureresearch

48. www.amphoraproject.net

49. What is AMPHORA? • A four-year €4million project co-financed by the Seventh Framework Programme for research of the European Commission What is the purpose of AMPHORA? • To add European knowledge to alcohol policy and to disseminate this knowledge to those engaged in making policy

50. Who are the AMPHORA partners? • 13 European countries • 33 partner organizations • More than 50 researchers with a wide range of professional backgrounds and expertise in research methodology