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INEBRIA 2009 Newcastle upon Tyne

INEBRIA 2009 Newcastle upon Tyne. Brazilian alcohol and drugs policy of the Ministry of Health and SBIRT implementation. Erikson F. Furtado, MD, PhD – Assist. Prof. USP – University of São Paulo FMRP – School of Medicine of Ribeirão Preto Dept. Neuroscience and Behavior. Objective.

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INEBRIA 2009 Newcastle upon Tyne

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  1. INEBRIA 2009NewcastleuponTyne Brazilian alcohol and drugs policy of the Ministry of Health and SBIRT implementation Erikson F. Furtado, MD, PhD – Assist. Prof. USP – University of São Paulo FMRP – School of Medicine of Ribeirão Preto Dept. Neuroscience and Behavior EFF/PAI-PAD/USP-RP-2009

  2. Objective • To present an overview of the present developments of the Brazilian public policy for alcohol and drugs and its relation to SBIRT implementation in the public health system. EFF/PAI-PAD/USP-RP-2009

  3. Brazil: Country Profile • Population (2009) – 191 millions (mostly urban) • Federative Republic, 5 regions, 26 States (01 FD) • Municipalities - 5,564 • Territory: 8.5 mln sq km (aprox. 22 inh/sqkm) • GNP (2008) US$ 1,991 bi • Per capita GNP (2008) - US$ 10,325 • HDI Rank (2006) - 70th (0.807) EFF/PAI-PAD/USP-RP-2009

  4. Health Policy in Brazil Health Policy – Challenges • Epidemic diseases – Dengue, Tuberculosis, Aids-STD • Neonatal deaths • Chronic diseases - risk factors • Cancer, cardiovascular diseases, diabetes • Obesity • Violence and vehicle accidents • Alcohol and Drug abuse • Health costs • Community participation • Management of health services and health system. 4 EFF/PAI-PAD/USP-RP-2009

  5. HumanDevelopmentIndex EFF/PAI-PAD/USP-RP-2009

  6. Health Policy in Brazil Health Budget and Expenditures Total Health Budget in R$ Billions – Federal, State and County. Brazil, 2000-2005 6 EFF/PAI-PAD/USP-RP-2009 Brasil, Ministério da Saúde. Painel de Indicadores do SUS, Brasília. Ano I, No. I, agosto 2006

  7. Health Policy in Brazil Context: Epidemiologic Transition - Violence Standardized Mortality Rate by Violence (Assault and Homicide) per 100.000 habitants, Region, Brazil, 1980 - 2004 7 EFF/PAI-PAD/USP-RP-2009 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Saúde Brasil 2006 : uma análise da situação de saúde no Brasil. Brasília : Ministério da Saúde, 2006. 620 p. : il. – (Série G. Estatística e Informação em Saúde) http://portal.saude.gov.br/portal/arquivos/pdf/saude_brasil_2006.pdf

  8. Per Capita Alcohol Consumption EFF/PAI-PAD/USP-RP-2009

  9. Alcohol and Injury in Emergency Departments EFF/PAI-PAD/USP-RP-2009

  10. Alcohol and Car Accidents • 53% car crash victims attending the emergency room – HC-Sao Paulo (mostly, young 15-29 ya males) • Mortality due by fatal car accidents responds for 28% of all external causes (about 30,000 deaths/year) • High BAC found among 96.8% of necropsies of fatal victims (IML-SP) • About 50% positive AUDIT in ER Source: Report of the Brazilian Ministry of Health - 2003 EFF/PAI-PAD/USP-RP-2009

  11. Prevalenceofalcoholdependence EFF/PAI-PAD/USP-RP-2009

  12. 80 Cut-off point Audit ≥ 8 60 Frequency 40 23.5% 20 0 0,00 5,00 10,00 15,00 20,00 Score total AUDIT Mean = 4.8 SD = 4.4 N = 464 Alcohol abuse among university students from a medical school Binge Drinking 33.3% EFF/PAI-PAD/USP-RP-2009

  13. Liver disease – Males(Cases / 100.000) State Region of Ribeirão Preto = 75,5 EFF/PAI-PAD/USP-RP-2009

  14. Mortality by TB and comorbidities 64% EFF/PAI-PAD/USP-RP-2009

  15. Alcohol use by pregnant women • Health professionals don't assess risk patterns of alcohol use • Patients with problematic alcohol use are discriminated • Risk groups are not routinely assessed N = 450 N = 100 (22%) Only 9% identified By GO clinicians Fabbri , Laprega & Furtado , Rev SaudePublica 41(6), 2007. EFF/PAI-PAD/USP-RP-2009

  16. Americas: Alcohol – risk factor Nr. 01 Source: Monteiro, M. G. Alcohol y atencion primaria de lasalud. OPS, 2008

  17. Frequency of inpatient admissions EFF/PAI-PAD/USP-RP-2009

  18. Emergency Room Outpatient MH Clinics CAPS-AD Family Health Program Psychiatric Hospitals General Hospital Detoxification GH Structure Basic Care (PHC) AOD Health Care System EFF/PAI-PAD/USP-RP-2009

  19. AOD Psychosocial Centers Short hospitalization wards: 4 EFF/PAI-PAD/USP-RP-2009 Datasus Tabwin/Access 09-15-2009

  20. CAPS-AD Distribution – 2009 EFF/PAI-PAD/USP-RP-2009

  21. Cumulativenumberof CAPS byyear EFF/PAI-PAD/USP-RP-2009

  22. Health Policy in Brazil Family Health Care Program 22 EFF/PAI-PAD/USP-RP-2009 Brasil, Ministério da Saúde. Painel de Indicadores do SUS, Brasília. Ano I, No. I, agosto 2006

  23. FamilyHealthTeams – PHC level EFF/PAI-PAD/USP-RP-2009

  24. Urgency AOD Policy Plan EFF/PAI-PAD/USP-RP-2009

  25. New AOD beds in general hospital wards EFF/PAI-PAD/USP-RP-2009

  26. AOD Policy - Chronology • 2003 – Basic Guidelines for a National Public Policy for Alcohol and Drugs, Prevention, Treatment and Health Promotion • First insertion of Brief Interventions EFF/PAI-PAD/USP-RP-2009

  27. BRASILIA DECLARATION ON ALCOHOL PUBLIC POLICIES, 2005 - PAHORecommendations • Preventing and reducing alcohol consumption-related harms be considered a public health priority for action in all countries of the Americas. • Regional and national strategies be developed, incorporating culturally appropriate evidence-based approaches to reduce alcohol consumption related harm. • These strategies are supported by improved information systems and further scientific studies on the impact of alcohol and the effects of alcohol policies in the national and cultural contexts of the countries in the Americas. EFF/PAI-PAD/USP-RP-2009

  28. BRASILIA DECLARATION ON ALCOHOL PUBLIC POLICIES, 2005 • Alcohol policies whose effectiveness has been established by scientific research are implemented and evaluated in all countries of the Americas. • Priority areas of action need to include: heavy drinking occasions, overall alcohol consumption, women (including pregnant women), indigenous peoples, youth, other vulnerable populations, violence, intentional and unintentional injuries, underage drinking and alcohol use disorders. EFF/PAI-PAD/USP-RP-2009

  29. SBIRT among ER patients: Segatto, Rev Psiq Clínica, 2008. SBIRT among Firemen periodical health evaluation: Ronzani, Est Psicologia (Natal), 2007. SBIRT among university students: Kerr-Côrrea, Alcohol Alcohol, 2008 SBIRT among adolescents attending a community health clinic: De Micheli, Rev Assoc Médica Bras, 2004 SBIRT among imprisoned adolescents : Andretta, EstPsicologia (Campinas), 2008 Recent Brazilian effectiveness studies

  30. Implementation Process EFF/PAI-PAD/USP-RP-2009

  31. Trained Health Professionals PAI-PAD: Trainings Network Supervision Evaluation EFF/PAI-PAD/USP-RP-2009

  32. Stigma is a barrier 69(7):1080-1084, 2009 EFF/PAI-PAD/USP-RP-2009

  33. Changing attitudes after training • SBIRT knowledge after training correlates with reduction of alcohol expectancies • N = 185; • r = 0.215; • P < 0,005 EFF/PAI-PAD/USP-RP-2009

  34. Implementationprocess • 2008 MinistryofHealth, threemetropolitanareaspilotproject for SBIRT implementation in theFamilyHealthProgramandthe matricial supportteams. • 2009 Annualplan, AlcoholandDrugsCoordination, Stateof São Paulo • Extendingthe PAI-PAD couvertureof SBIRT training for all 17 regional healthdepartments, reachingthe total populationofthestate (~41mi). EFF/PAI-PAD/USP-RP-2009

  35. References Brasil. Ministério da Saúde. As Causas Sociais das Iniqüidades em Saúde no Brasil. Relatório Final da Comissão Nacional sobre Determinantes Sociais da Saúde (CNDSS). Brasília. 2008. Brasil, Ministério da Saúde. Painel de Indicadores do SUS, Brasília. Ano I, No. I, agosto 2006. Cornwall, A., Shankland, A. Engaging citizens: Lessons from building Brazil’s national health system. Social Science & Medicine 66 (2008) 2173 – 2184. Barreto, ML, Aquino, R. Recent Positive Developments in the Brazilian Health System. American Journal of Public Health. January 2009, Vol 99, No. 1. Camargo, KR. Celebrating the 20th Anniversary of Ulysses Guimarães’ Rebirth of Brazilian Democracy and the Creation of National Health Care System. American Journal of Public Health. January 2009, Vol 99, No. 1. 35 EFF/PAI-PAD/USP-RP-2009

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