Erica Cruvinel

Screening and brief intervention for alcohol and other drug use in primary care: associations between organizational climate and practice

BackgroundNumerous studies have demonstrated that positive organizational climates contribute to better work performance. Screening and brief intervention (SBI) for alcohol, tobacco, and other drug use has the potential to reach a broad population of hazardous drug users but has not yet been widely adopted in Brazil’s health care system. We surveyed 149 primary health care professionals in 30 clinics in Brazil who were trained to conduct SBI among their patients. We prospectively measured how often they delivered SBI to evaluate the association between organizational climate and adoption/performance of SBI.MethodsOrganizational climate was measured by the 2009 Organizational Climate Scale for Health Organizations, a scale validated in Brazil that assesses leadership, professional development, team spirit, relationship with the community, safety, strategy, and remuneration. Performance of SBI was measured prospectively by weekly assessments during the three months following training. We also assessed self-reported SBI and self-efficacy for performing SBI at three months post-training. We used inferential statistics to depict and test for the significance of associations.ResultsTeams with better organizational climates implemented SBI more frequently. Organizational climate factors most closely associated with SBI implementation included professional development and relationship with the community. The dimensions of leadership and remuneration were also significantly associated with SBI.ConclusionsOrganizational climate may influence implementation of SBI and ultimately may affect the ability of organizations to identify and address drug use.

Metodologia de implementação de práticas preventivas ao uso de drogas na atenção primária latino-americana

OBJETIVO: Desenvolver uma metodologia para implementacao de praticas de prevencao ao uso de alcool e outras drogas no âmbito da atencao primaria a saude (APS) que contribua com o debate sobre acoes e politicas nos paises latino-americanos. METODOS: Trata-se de uma pesquisa-intervencao realizada em um municipio brasileiro de pequeno/medio porte. O processo foi avaliado atraves da observacao participante, visando adequacao as necessidades locais e ressaltando pontos de facilitacao e dificuldade na implantacao. RESULTADOS: Foi desenvolvido um modelo com seis etapas: contato inicial e planejamento, diagnostico e mapeamento, sensibilizacao, capacitacao, acompanhamento e devolutiva. Foram percebidos os seguintes pontos de dificuldade: insuficiencia de recursos (humanos, financeiros, infraestrutura), falta de integralidade e intersetorialidade da rede assistencial, falta de participacao dos medicos, formacao calcada no saber medico, participacao insuficiente da gestao de saude, falta de mobilizacao e participacao da sociedade civil, ausencia de momentos onde a populacao fosse convidada a participar do planejamento e execucao das politicas publicas. Pontos fortes foram: participacao dos agentes comunitarios e enfermeiros na aplicacao, organizacao e planejamento das praticas, alem da realizacao de praticas educacionais e preventivas nas escolas e comunidades pelas equipes de saude. Isso indica que e possivel implementar iniciativas de triagem, intervencao breve e encaminhamento para tratar (SBIRT) no contexto da APS latino-americana. CONCLUSOES: A metodologia desenvolvida neste estudo pode ser util para paises latino-americanos desde que sejam consideradas as necessidades locais. Entretanto, os resultados serao observados apenas a medio e longo prazo, sem mudancas instantâneas.

Clima organizacional e atividades de prevenção ao uso de risco de álcool

Abstract The aim of this paper was to evaluate the link between organizational climate and strategies to prevent alcohol consumption, among 97Primary Health Care professionals. The organizational climate was measured by means of a scale involving the foll owing factors:decision-making, chaos/stress and communication. Prevention activities were measured using AUDIT (screening test) and brief int erventionscarried out in the six-month period following the on-site qualification. The Spearman test was used, with a 95% level of confid ence, to assesscorrelation. The results showed a correlation between brief intervention and Decision Making (p=0.337; p= 0.001) and Communication(p=0.281; p=0.005). The number of AUDITs applied were also related to DM ( p =0.288; p=0.004 ) and Communication ( p =0.215; p=0.035 ). The results suggest that environments with better perceptions of Organizational Climate can enhance the prevention of alcohol use inPrimary Health Care.Uniterms : Alcohol abuse. Primary health care. Organizational climate. Prevention.

Capacitação em álcool e outras drogas para profissionais da saúde e assistência social: relato de experiência

Como alternativa ao panorama deficitario de formacao profissional para atuacao na area do uso de alcool e outras drogas, e visando a incorporacao de mudancas praticas, sao criados os Centros Regionais de Referencia sobre Drogas (CRRs). Faz-se necessario compreender e refletir sobre o papel dos CRRs nos cenarios de formacao e atuacao sobre a tematica. A partir disso, o presente artigo pretende discutir aspectos sobre a capacitacao de profissionais do Sistema Unico de Saude e Assistencia Social, por meio do relato de experiencia de um CRR de Minas Gerais. A implantacao do presente CRR possibilitou a qualificacao de profissionais em direcao a abordagens integrais e reflexivas sobre a tematica. Contudo, sao necessarias reformulacoes sobre o seu modelo, com uma posicao mais bem definida e atuante dentro das politicas sobre drogas, garantindo continuidade nas acoes e auxiliando na reformulacao das praticas.

Developing a method of implementation of screening, brief intervention, and referral to treatment in primary health care settings of Brazil and Latin America

Screening, brief intervention, and referral to treatment (SBIRT) appears to be an important tool in Brazil and Latin America to address the use/abuse of alcohol and other drugs and to help implement and organize preventive activities, particularly in the services of primary health care (PHC). Nevertheless, there are few studies evaluating the implementation of SBIRT in PHC of Latin American countries, identifying elements that promote positive results in the prevention and/or reduction of consumption according to each situation. Therefore, this study presents a method for implementing SBIRT developed in the PHC of a small/medium Brazilian city, highlighting challenges and possibilities for its dissemination in other cities and countries in Latin America. This is a research intervention, with data collection and evaluation through participant observation. The entire process was evaluated to the suitability to local needs, determining factors that could facilitate or impede its implementation. The method developed consisted of six stages: initial contact and planning, diagnosis and mapping, raising awareness, training and monitoring. In the process of implementation the hindering points detected were: insufficient resources (human, financial, infrastructure), shortage of integration and intersectional health care settings, lack of participation by physicians, focus in dependence, scarcity of participation of civil society and absence of spaces where this population could participate. However, the participation of community health workers and nurses in the implementation and organization of SBIRT, the actions implemented by health teams, such as educational and preventive practices in schools and discussion groups with communities, are positive prospects for the implementation of SBIRT in the Latin American PHC context. Finally, the method presented is considered a useful model to other Latin American cities and countries, with necessary adaptations. Despite the advances, progress is needed in preventing alcohol and other drug abuse in Latin America, with long-term measures.

How Do Interventions and Brief Psychotherapies Work? Evaluating the Change Processes in Drug User’s Interventions

The brief intervention was firstly proposed in 1972, in Canada, by Sanchez-Craig and collaborators as a reference to a psychotherapy approach supposed to motivate alcohol users to change their drinking behavior in the short term. The four-session intervention is based on the cognitive and behavioral theories, and it presented better results among alcohol dependents under treatment than among those who have received no treatment. A series of studies conducted in the last decades assessed the effects of different interventions using this nomenclature. However, it is necessary to separate the brief intervention from the brief psychotherapy. The brief intervention is focused on prevention; i.e., it helps abusive or under-risk users to reduce or stop consuming due to its motivational profile. The brief therapies, in their turn, focus on substance-dependent treatments. Marques and Furtado (Rev Bras Psiquiatr 26(Suppl 1):28–32, 2004) describe these modalities as an attention continuum, which changes depending on the individual’s substance consumption severity. We will address in the current text two modalities that, along with other modalities, are usually called “brief interventions.”

Capacitación sobre alcohol y otras drogas para profesionales de la salud y asistencia social: relato de experiencia

Como alternativa ao panorama deficitario de formacao profissional para atuacao na area do uso de alcool e outras drogas, e visando a incorporacao de mudancas praticas, sao criados os Centros Regionais de Referencia sobre Drogas (CRRs). Faz-se necessario compreender e refletir sobre o papel dos CRRs nos cenarios de formacao e atuacao sobre a tematica. A partir disso, o presente artigo pretende discutir aspectos sobre a capacitacao de profissionais do Sistema Unico de Saude e Assistencia Social, por meio do relato de experiencia de um CRR de Minas Gerais. A implantacao do presente CRR possibilitou a qualificacao de profissionais em direcao a abordagens integrais e reflexivas sobre a tematica. Contudo, sao necessarias reformulacoes sobre o seu modelo, com uma posicao mais bem definida e atuante dentro das politicas sobre drogas, garantindo continuidade nas acoes e auxiliando na reformulacao das praticas.

Training on alcohol and other drugs for health and social care professionals: report on experience

Como alternativa ao panorama deficitario de formacao profissional para atuacao na area do uso de alcool e outras drogas, e visando a incorporacao de mudancas praticas, sao criados os Centros Regionais de Referencia sobre Drogas (CRRs). Faz-se necessario compreender e refletir sobre o papel dos CRRs nos cenarios de formacao e atuacao sobre a tematica. A partir disso, o presente artigo pretende discutir aspectos sobre a capacitacao de profissionais do Sistema Unico de Saude e Assistencia Social, por meio do relato de experiencia de um CRR de Minas Gerais. A implantacao do presente CRR possibilitou a qualificacao de profissionais em direcao a abordagens integrais e reflexivas sobre a tematica. Contudo, sao necessarias reformulacoes sobre o seu modelo, com uma posicao mais bem definida e atuante dentro das politicas sobre drogas, garantindo continuidade nas acoes e auxiliando na reformulacao das praticas.

Relationship between organizational climate and activities to prevent the risky use of alcohol, tobacco, and other drugs among professionals in primary health care

Studies have shown that professionals working in organizations with a more positive organizational climate (OC) perform better at work. The aim of this study was to evaluate the association between preventive practices in relation to risky use of alcohol, tobacco, and other drugs and perceived OC among 149 professionals in Brazilian primary health-care (PHC) settings. The OC was measured by a scale involving the following factors: leadership, professional development, team spirit, relationship with the community, workplace safety, strategy, and reward. Prevention activities were measured by counting the number of drug and alcohol screenings conducted using the Alcohol, Smoking, and Substance involvement Screening Test (ASSIST) and the number of brief interventions (BIs) held within three months after theoretical training. We also used scales to examine self-efficacy and confidence in performing screening and BI and a structured questionnaire about drug-use prevention activities. To verify the proximity of the variables, we used multiple correspondence analysis and correlation analysis with 95% confidence intervals. The teams that had higher scores on OC also had the best performances in prevention activities for drug use. The OC factors most associated with performance of preventive activities were professional development and relationship with the community. The dimensions of leadership and rewards also showed significant positive associations. Findings suggest that a more positive OC can facilitate drug-use prevention activities in PHC settings.

Factors that facilitate diagnosis and brief intervention for risky alcohol use in Brazilian primary health care settings

Strategies of diagnosis and brief intervention (SDBI) have been presented as means of preventing ongoing risky alcohol use among Brazilian primary-care patients. To identify factors that facilitate the implementation of SDBI measures in primary care, we conducted a qualitative analysis among 10 community health workers from Zona da Mata, Minas Gerais, Brazil. Participants were divided into two groups: successful outliers (those who regularly administered the Alcohol Use Disorders Identification Test [AUDIT] to patients) and unsuccessful outliers (those who did not regularly administer the AUDIT). We used semistructured interviews and thematic content analysis to identify personal SDBI facilitators (good relationship with the community, satisfaction and commitment to work, feeling prepared to visit patients, feeling comfortable talking about alcohol) and organizational SDBI facilitators (planning, activities organization, and involvement of a multidisciplinary team). We concluded that the factors facilitating successful SDBI implementation were related to both participants’ personal characteristics and organizational factors.