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SBI Integration into Friuli-Venezia Giulia Health Policy: From Small Municipalities to Regional Government and More

This article discusses the process of integrating Screening and Brief Intervention (SBI) into the health policy of Friuli-Venezia Giulia. It highlights the implementation of SBI in various settings, such as regional government, general practice teaching, and community health promotion. The article also explores the training and willingness of healthcare professionals to adopt SBI as a tool for secondary and primary prevention.

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SBI Integration into Friuli-Venezia Giulia Health Policy: From Small Municipalities to Regional Government and More

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

  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. Is it possible to create a tool for secondary and primary prevention accessible to GPs, cardiologists and other specialists? FRIULI VENEZIA GIULIA REGION 6 HEALTH UNITS, 20 HEALTH AREAS . REGIONAL PLANNING & IMPLEMENTATION Population 1,2 million inhabitants

  6. Zente de Cuor Gente di Cuore Ljudje s Srcem Int di Cûr Leute mit Herz Hearty People Promoting healthy lifestyles, evaluating and monitoring cardiovascular risk to reduce it

  7. Dedicated website

  8. Drugs delivered by NHS

  9. CV risk evaluation

  10. Hospital discharges in FVG

  11. How many cigarettes a day do you smoke? How soon after you wake up do you smoke your first cigarette? Brief questionnaire on nicotine addiction

  12. highly dependent

  13. 78 179 24 Audit-C

  14. Psycho-social risk

  15. Minimal advice

  16. Brief Motivational Inteviewing

  17. 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 Thank you for your patience!

  18. 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

  19. Early Identification and Brief Intervention • 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

  20. Early Identification and Brief Intervention • 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

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

  22. 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

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

  24. Interested in further training in motivational interviewing • Training GPs 86,7% • Cardiologists 87,5% • Public Health 100 %

  25. 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

  26. 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

  27. 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

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