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![Page 1: From small municipalities to the regional government and more…: a process of SBI integration into Friuli – Venezia Giulia health policy Dr Pierluigi Struzzo.](https://reader030.fdocuments.us/reader030/viewer/2022020417/56649eba5503460f94bc2ad6/html5/thumbnails/1.jpg)
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
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Municipalityof Udine
1998 Municipalityof Martignacco
2004
How to implement BI ?
BIon
Alcohol 76 GPs
BIOn Alcohol
& Tobacco
CommunityHealth
Promotion
Local health
Unit70 GPs
-Qualitative research-Community involvement-Needs and Resources-Empowerment
Province of Udine
32 Municipalities
Regional centre for the
training in PHCCMEGeneral practice
teaching
Faculty of Medicine
BI & BMIon
Lifestylesand
CV diseases790 Gps
WHOVenice Office
onHealth Promotion
GPsCardiologistsPublic Health
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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
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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
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REGIONAL PLANNING &
IMPLEMENTATION
6 HEALTH UNITS, 20 HEALTH AREAS
Population 1,2 million inhabitants
.
FRIULI VENEZIA GIULIA REGION
Is it possible to create a tool for secondary and primary prevention accessibleto GPs, cardiologists and other specialists?
![Page 6: From small municipalities to the regional government and more…: a process of SBI integration into Friuli – Venezia Giulia health policy Dr Pierluigi Struzzo.](https://reader030.fdocuments.us/reader030/viewer/2022020417/56649eba5503460f94bc2ad6/html5/thumbnails/6.jpg)
Promoting healthy lifestyles, evaluating and monitoring cardiovascular risk to
reduce it
Gente di Cuore
Leute mit Herz
Int di Cûr
Zente de Cuor
Ljudje s Srcem
Hearty People
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How soon after you wake up do you smoke your first cigarette?
How many cigarettes a day do you smoke?
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highly dependent
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78
179
24
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Psycho-social risk
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Minimal advice
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Brief Motivational
Inteviewing
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To integrate BI into primary care
1) Provide training and support2) Pay for quality service3) Pay for services as a investment4) Community involvement
Peter Anderson
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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
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• 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
Early Identification and Brief Intervention
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• Brief InterventionsA) 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
Early Identification and Brief Intervention
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Training the trainers
Two days of training 57 experts participating– 20 Cardiologists– 20 Teaching GPs– 17 Public health experts
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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
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0
1
2
3
4
5
6
7
8
9
Alcohol Tobacco Food Physic Act.
PRE Cardiologists
PRE Public Health
PRE Training GPs
POST Cardiologists
POST Public health
POST Training GPs
Pre-post test self efficacy
n.s.
n.s.n.s.
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Interested in further training in motivational interviewing
– Training GPs 86,7%– Cardiologists 87,5%– Public Health 100 %
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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
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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
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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