PHEPA II INTERIM COUNTRY REPORT - SLOVENIA

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1 PHEPA II INTERIM COUNTRY REPORT - SLOVENIA Istanbul, October 2007 Dr. Marko Kolšek Department of Family Medicine Medical faculty University of Ljubljana, Slovenia

2 Current policies and activities: 1. Alcohol Legislation The new legislation to reduce alcohol related harm was brought in It decreases the availability of alcohol by restricting hours and by putting age limit of 18 years for sale of alcohol. Serving of alcohol to intoxicated customers has been already prohibited before. But unregistered alcohol home production still remains a problem as it is out of control half of families produce wine or/and spirits at home. It is still possible to advertise beer or wine on TV and in newspapers or posters if a specific warning is added: The Minister of health is warning that immoderate alcohol drinking can harm your health. Sponsorship by alcohol industry for sport and some cultural events is still possible. E.g. our best basketball and handball teams known also in Europe carry the names of two biggest slovenian beer producing companies.

3 Current policies and activities: 1. Legislation (2) GOOD SIDE OF THE STORY: AUDIT C is included in preventive questionnaire for cardiovascular diseases for adults. Every adult patient has the right for a preventive check-up at his GP every 5 years. BAD SIDE OF THE STORY: Many GPs and even more nurses are still not skilled for interpretation of AUDIT C questionnaire results

4 Current policies and activities: 2. Interventions in Primary Health Care EIBI are not yet a regular part of GPs everyday work. Anyway, not so small percentage of patients have been asked about alcohol drinking (35%) but was not documented in their medical records regularly (10%) Advise to reduce alcohol drinking has been given to harmful drinkers and alcoholics (some of them have been referred) There are big differences between GPs: younger GPs that finished specialisation of family medicine perform and document EI much more frequently (80%) and are familiar with Prochaska&DiClemente model of change and motivational techniques (which is still usually not documented) Nurses are still not familiar with EIBI except some of them who are specially trained for preventive work.

5 1. Principles Early identification and brief interventions should slowly become a part of everyday work of GP s team. In first 5 years EIBI will be performed mainly among patients in middle age group (35 to 65 years), new patients and patients with chronic conditions (e.g. diabetes, hypertension). Focus should be put more on hazardous and harmful drinking, patients with alcohol addiction should mainly be referred to psychiatrists and self-help groups. Nurses will be invited to actively participate at EIBI.

6 2. Practice based guidelines, protocols and aids Pocket manual for managing alcohol related problems at primary health care Self-help booklet for patients with hazardous or harmful drinking Booklet for patients and population with basic information on alcohol Posters for waiting rooms and other public places

7 Translation and adaptation of clinical guidelines at country level and its dissemination to many experts, professionals, institutions and organizations (2006)

8 3. Training Training for EIBI a part of curriculum of specialization for family medicine. The use and interpretation of AUDIT C questionnaire a part of curriculum for undergraduate medical students Some trainers for EIBI have been trained Some pilot CME courses on EIBI already performed Some nurses have been trained, too

9 Main good sides of the story - 2 Translation and adaptation of training manual at country level and its dissemination to many experts, professionals, institutions and organizations (2006)

10 4. Engaging Primary Health Care Providers Information on importance of EIBI Good and bad things of EIBI How to overcome barriers for implementing of EIBI in everyday practice Training for EIBI How to put it into practice How to continue performing EIBI Outside help (e.g. incentives, support, evidence, results) Many GPs are still not aware that they are the most important link in a chain for early identification of hazardous and harmful drinking and they don t seek for training.

11 5. Funding Some help from CINDI project Some help also from National health insurance company Even some help from the Ministry of health Some special incentives for BI are possible (about 45 EUR for 5 x 15 minutes) but many of GPs are not skilled to perform it and even not informed that they exist Not enough funding for wide implementation of EIBI courses and not enough men power for marketing Not enough enthusiastic GPs to pull the carriage and keep moving it Any awareness among health politicians on importance of EIBI?

12 6. Specialist support and knowledge centres Collaboration between GPs and addiction specialists exists. The common understanding of alcohol related problems is shared with them. A lack of collaboration and common understanding with other clinical specialists (emergency units, cardiologists, gastroenterologists, etc.)

13 7. Monitoring the Programme Still not enough funding and man power for regular monitoring of performance of EIBI (patients screened and helped) and its

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