The XaROH settlement Network of alcohol reference figures in primary health care settings and specialized settings

Lidia Segura Olga Montserrat Encarna Moreno

Lisbon, Portugal, 26-27 october 2006 The implementation of the “Beveu Menys” Program ITERATION PROCESS

Customization of the Training the Customization of the training manual trainers (n=84) intervention package

DISSEMINATION 2002-2005 347 PHC Centres 7915 PHC professionals

Settlement of XaROH

IMPLEMENTATION

2005-2008 Training the Customization of the Customization of trainers intervention package the training manual XaROH Origin

□ PHASE I Qualitative evaluation ƒ Focus groups with Primary Health Directors and professionals ƒ Meetings with stakeholders (PHC professionals, policy makers, Scientific societies, professional associations, health providers, etc.) during meetings of the Alcohol and Primary Health Group (GAAP) □ Other similar experiences in other health promotion programs (tobacco, hypertension, etc.) XaROH Objective

□ Iteration step towards the “Beveu Menys” program implementation □ To empower PHC teams to overcome the difficulties in introducing and mantaining EIBI strategies in daily work. □ Improvement of the alcohol prevention activities in each PHC and drug addiction treatment settings XaROH Recruitment

□ Result from the first phase (natural involvement most motivated professionals) □ Communication through letter to all PHC directors □ Regular communication through the bulletins □ Presentations and posters in conferences and meetings □ Invitation to specific training-the-trainer 10-hour courses □ Inclusion and adaptation of the initiative to the publich health system reform and mental healh policy

□ AT LEAST 1 PROFESSIONAL FROM EACH PHC AND ADDICTION CENTRE BY THE END OF 2008 (400) XaROH Members

Val d’Aran

Pallars Alta Sobirà Ribagorça1 1 ALT PIRINEU-ARAN Alt Ripollès Alt Empordà GIRONA Pallars Pla de Jussà Berguedà l’Estany Solsonès 10 2 Gironès Baix Empordà CENTRAL 4 2 Selva LLEIDA 36 specialists from 28 Pla Vallès d’Urgell Oriental Segrià Vallès Urgell Occidental CAS (48%) Conca BARCELONA de Barberà 9 1 Alt Penedès Barcelonès Alt (mainly physicians) Ribera PrioratTARRAGONA d’Ebre Baix Penedès Tarragonès 39 19 Terra Camp Alta

Baix Ebre 5 2 1TERRES 1DE L'EBRE 100 professionals from 68 PHC (20%) Montsià (37.2% nurses, 62.8% physicians) XaROH Activities

□ Facilitate continuous medical education of its members □ Facilitate sharing experiences (online and in situ) □ Promote coordination between PHC and drug addiction centers and professionals □ Promote participation in scientific meetings and conferences (posters, oral presentations, etc.) □ Promote action research CME strategies

□ Training the trainers (4 per year): ƒ XaROH members as trainers ƒ Provide them with the necessary skills to continuously train the PHC team ƒ Alcohol specialist as a supporting figure, especially for the management of alcohol dependents ƒ Encourage the use of SBI tools in daily clinical work among their colleagues ƒ Mental Health Support team will also be trained □ Continuous thematic trainings (3 per year) ƒ Training on specific topics and sharing experiences Trainings and thematic meetings Number Dates professionals 1st workshop training the trainers PHC 6 oct. & 15 nov. 2005 32 (10 h) 2nd workshop training the trainers PHC 20 oct. & 22 nov. 2005 35 (10 h) Workshop training the trainers 26 jan 2006 31 Specialists Centers (5 h) 3rd workshop training the trainers PHC 27 april 2006 11 (10 h) Annual nurses training (10 h) May 2006 10 XaROH Thematic Meeting (5 h) 8 jun 2006 61 4th workshop training the trainers PHC 27 sept 2006 10 (10 h) XaROH Thematic Meetings (5 h) 30 nov 2006 30?? Related meetings: Motivational Interview 14-15 nov 2006 25?? (10 h) The training packages

Administrative Guidelines for Work documents and evaluation trainers for trainees documents New courses in PHC settings: structure and contents

□ Part 1: ƒ Theorical aspects about Early Identification and Brief Intervention of the Hazardous and Harmful Drinking . By the PHC Alcohol Referent

□ Part 2: ƒ Clinical cases about Hazardous and Harmful Drinking . By the PHC Alcohol Referent

By the PHC professional New courses in PHC settings: structure and contents

□ Part 3: ƒ PHC intervention criteria and Specialist Drug Center referrals in alcohol dependence ƒ Detoxification ƒ Pharmacological treatment of alcohol dependence ƒ Motivational approach with alcohol dependent patients ƒ Motivational approach with the family of the alcohol dependent patient ƒ Clinical cases of the PHC ƒ Working a clinical example case

By the drug addiction specialist New courses in PHC settings

Val d’Aran

Pallars Actually... Alta Sobirà Ribagorça ALT PIRINEU-ARAN Cerdanya Ripollès Alt Empordà GIRONA Pallars Garrotxa Pla de Jussà l’Estany Berguedà Solsonès Gironès Osona Baix Empordà Noguera CENTRAL Selva LLEIDA Segarra Bages Pla Vallès Oriental • 8 PHC centers d’Urgell Segrià Anoia Vallès Urgell Maresme Occidental Conca BARCELONA Garrigues de Barberà Alt Penedès Barcelonès Alt Baix Camp Baix Llobregat Ribera PrioratTARRAGONA Garraf d’Ebre Baix Penedès • 3 Drug Treatment centers Terra Camp Tarragonès Alta

Baix Ebre TERRES DE L'EBRE

Montsià XaROH Evaluation

XaROH members □ Attitudes □ Knowledge □ Behaviour □ Needs Courses □ Trainers perception □ Participants □ Implementation Agreement Strenghts

□ Results from a participative process □ Takes into account the differences of each center and professionals’ needs □ Prevention promoted from inside the PHC centers □ Continuos training adapted to real settings including own clinical cases. □ Includes a PHC implementation agreement Weaknesses

□ Nation wide project, large number of centers, professionals and stakeholders to be involved □ Big differences between centers, health regions and providers: needs, goals, facilities, different computerized medical records. □ Extreme workload to maintain the network. □ Need more efforts and integration in health system to achieve the recruitment rate planned http://www.gencat.net/salut/beveumenys.htm

Thank you!!!