Portuguese contribution to the World Health Organization - early detection and brief intervention regarding excessive alcohol consumption within the Community
Alcohol consumption is the cause of over 60 diseases and stands in third place in the ranking of risk factors for mortality globally. If we only consider people aged between 15 and 49, alcohol consumption is the main risk factor in the world, ahead of smoking, hypertension, and overweight. Excessive consumption of this substance may be present in 15-30% of the adult population.
Primary Health Care, given its unique characteristics, is ideally positioned to address this important public health problem. No other level of health care presents such strong evidence that the early detection and counselling (brief intervention) of individuals who consume alcohol in excess is a highly successful cost effective measure, and, in certain situations, it may even generate not only health gains but also economic gains. Despite the proven effectiveness of these practices, they are poorly implemented in Primary Health Care. It is therefore urgent to reinforce the importance of the problem among GPs.
It was with this in mind that in 2013 a Ph.D. project was started at the Institute of Preventive Medicine of the Faculty of Medicine of Lisbon, conducted by GP Dr Frederico Rosário, with the guidance of Professor Cristina Ribeiro of the same Institute, and Doctor Niamh Fitzgerald of the University of Stirling in Scotland. The aim of this project is to implement these good practices in health centres, in an attempt to address the difficulties experienced by professionals in the field when trying to implement the screening and brief intervention of excessive alcohol consumption. This project is based on two fundamental pillars. The first pillar aims at the training of health professionals in Health Centres, and an original training programme was designed to that end. The second pillar aims to support the clinical practice of professionals in the field. Both pillars were designed based on the assumptions of adult learning theory and of the Behaviour Change Wheel/Theoretical Domains Framework.
The quality of the training conducted by Dr Frederico Rosário has been recognized by the World Health Organization, consubstantiated in his participation in workshops in Europe. To date, there have been three training events in countries whose alcohol-related problems take on dramatic contours: Montenegro in 2015, Moldova and Serbia in 2016. The success of these training events has recently led the World Health Organization to publish on its official website an account of the evolution of the implementation of early detection and brief interventions in Serbia after the workshop
(news available at http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/news/news/2017/06/strong-commitment-in-serbia-to-expand-screening-and-brief-interventions-on-alcohol-consumption).
Dr Frederico Rosário conducts his work in parallel with his clinical activity in the cluster of health centres (ACeS) Dão Lafões, one of the regions of the country with the highest mortality rate due to liver cirrhosis. In this sense, he was appointed by the Directorate of the ACeS Dão Lafões as Team Coordinator of the Pilot Project on Problems Related to Alcohol Consumption. Within the scope of this project, he is testing the effectiveness of the training programme to support clinical practice carried out in his PhD. This is an example of how academic work can be linked to clinical practice by means of projects that aim to provide answers to problems experienced by professionals in the field.
Professor Cristina Maria Ribeiro