screening and brief intervention in primary care in · pdf filebundesärztekammer...

BundesärztekammerArbeitsgemeinschaft der deutschen Ärztekammern

EMCDDA - Brief Intervention and Motivational Interviewing

for young Alcohol and Cannabis users

– Lisbon, Jan. 23rd 2013 -

Screening and Brief Intervention in Primary Care

in Germany

- Current practices, shortcomings and future developments -


What to talk about?

current practice

current shortcomings

open questions

future options


Germany: • 81.7 Mio. Inhabitants

357.000 km²

Health care system:

• 342.000 practicing doctors (2011)

• 141.000 in private practice

• 56.700 family practitioners

• 3.4 per 1.000 inhabitants (OECD-Ø: 3.0)

• Statutory Health Insurance-System

• free choice of doctors

Expenditures:

• 4,338 US$ (PPP) (OECD: 3.268 US$)

• 11.6% of GDP (2010) (OECD: 9.5%)


Current Practice: Screening and Brief Intervention

„Haves and have-nots“ in Germany:

• Manuals & Handbooks on BI for doctors

• Training curriculum on addiction medicine (50 h)

For adolescents:

• Printed and online information on psychtropic substances

• intervention and training programs


Current Practice: Manuals on Brief Intervention

in Primary care

• on smoking,

• hazardous drinking

• misuse of prescription drugs


Manual on Brief Intervention for

Patients with Alcohol Problems

• doctor-patient communication

• evaluation of alcohol consumption and situations

• ambivalences and motivation to change

• alcohol questionnaire

• identifying drinking stages

• Interventions


Manual on misuse of prescription drugs

• patient-typologies

• doctor-patient communication

• evaluation of drug consumption and purposes

• stages of and motivation to change

• assessing past and current drug use

• information on problematic substance groups

• detoxification

• quality control measures for doctor´s practice

• recommendations for doctor´s prescription

• professional support systems and agencies

• short version for doctor´s desk


Manual on misuse of prescription drugs

Short version for doctor´s desk:

• common complaints and physical symptoms

• helpful questions for interaction with patient

• history and amounts of drug use

• recommendations for drug-prescription

• detoxification

according to different substance groups

Bundesärztekammer | Arbeitsgemeinschaft der deutschen Ärztekammern 9

Manual on misuse of prescription drugs:

Practice-Evaluation – in combination with a training course

Manual utilization (n=267)

Rating results (n=209)

high relevance of contents for

practical work

would recommend manual to a

colleague

used it after the training course on

addiction medicine

changed my behavior

on prescribing drugs

73,2%

78,3%

67,0%

94,7%

31,5%

Bundesärztekammer | Arbeitsgemeinschaft der deutschen Ärztekammern 10

Knowledge on the topic (Interventiongroup vs. Controlgroup – Self-assessment)

Control-Group Intervention-Group

Relevance of the topic 40,8% 56,5%

Information on the topic 48,0% 56,6%

Ability to identify a problem with

prescription drugs50,4% 57,1%

Ability to treat a dependency on

prescribed drugs29,8% 38,6%

1) very high / high on a 5-step Likert Scale

1)


Module I10 h

Basics 1 (4 h) Basics 2 (6 h)

Module II8 h

AlcoholTobacco

Module III4 h

Prescription Drugs

Module IV8 h

Illegal Drugs

Topic of choice(Deepening of Module II, III oder IV,

depending on participants professional background and interest)

6 Std.

Module V14 h

Motivational InterviewingPractical Applications

Current Practice:

Training of doctors on substances and BI (50 h)


Training and intervention programs for adolescents

with problematic alcohol use

Printed and online information,

intervention and training

programs for adolescent

alcohol users


Training and intervention programs for adolescents

with problematic substance use

Printed and online information,

intervention and training

programs for adolescent

substance users


easy access

no social barriers

long term contact – teachable moments

health is the issue

integration of behavioral and physical aspects

preventive health screenings as gateway

proven effectiveness

Brief Intervention in Primary Care The Pro`s:


A broad application of brief intervention is still widely missing

No primary-care-based BI for adolescents is available

Reality of BI in Primary Care in Germany


Cultural barriers

Self concepts of the medical profession

Cultural barriers of the patient

Fears of economic damage

Lack of incentives: time, money, gratification

Lack of knowledge and training

Brief Intervention in Primary Care

The Con`s:


What it takes:

Doctors need to be convinced that BI

• is useful and effective,

• will save time,

• won´t hurt,

• can be applied appropriately as needed


What it takes:

• An integrated and ongoing training of doctors in BI

• Practice-oriented materials

• A target-oriented and appropriate remuneration for BI

• A open social environment

• additional services for easy transferrals


Outlook

• Negotiations with health insurances and Ministry of Health

on BI in primary care

• Draft of a Law on Prevention and Health Promotion

extending Health Check Ups to primary prevention


Thank you for your attention !

screening and brief intervention in primary care in · pdf filebundesärztekammer...

Documents