Implementing screening and brief Interventions for excessive alcohol consumption in primary health care

O consumo de bebidas alcoólicas é um dos principais fatores de risco da morbilidade e mortalidade prematura a nível mundial. As pessoas que consomem este género de bebidas têm um risco aumentado de vir a desenvolver mais de 200 problemas de saúde diferentes. A maioria do impacto do consumo de álcool na saúde humana é determinado por duas dimensões: o volume total de álcool consumido e o padrão de consumo. Existem várias medidas com comprovada eficácia que podem ser empregues para reduzir o risco associado ao consumo de álcool, entre as quais se encontra a deteção precoce e intervenção breve ao nível dos Cuidados de Saúde Primários. A maioria dos profissionais de saúde neste nível de cuidados considera o consumo de álcool como um importante problema de saúde e manifesta o seu apoio a medidas que visem reduzir o seu impacto. No entanto, poucos são os profissionais dos Cuidados de Saúde Primários que de forma sistemática identificam e aconselham os seus doentes relativamente aos seus hábitos etílicos. Como tal, o objetivo geral desta tese foi investigar como implementar a deteção precoce e intervenção breve no consumo excessivo de álcool nos Cuidados de Saúde Primários. Foi realizada uma revisão sistemática das barreiras e facilitadores à implementação da deteção precoce e intervenção breve no consumo excessivo de álcool nos Cuidados de Saúde Primários. As barreiras e facilitadores identificados nesta revisão foram analisados à luz da teoria de modificação comportamental para compreender a ligação destes fatores aos determinantes da mudança de comportamento, e para identificar as estratégias conceptualmente mais eficazes para abordar as barreiras e facilitadores à mudança de comportamento dos profissionais dos Cuidados de Saúde Primários no sentido de aumentar as taxas de deteção precoce e intervenção breve no consumo excessivo de álcool. Esta metodologia foi utilizada para desenhar um programa de implementação com base em pressupostos teóricos que foi testado num estudo experimental randomizado e controlado em clusters. Esta tese identificou diversas barreiras à implementação, ligadas a todos os domínios teóricos da mudança comportamental. As barreiras mais frequentemente mencionadas pelos profissionais foram: preocupação sobre as suas competências e eficácia para realizar a deteção precoce e intervenção breve; falta de conhecimento específico sobre o consumo de álcool; falta de tempo; falta de materiais; falta de apoio; e atitudes para com o doente com consumos excessivos de álcool. Esta tese mostrou também a existência de dois grupos distintos de médicos de família com base nas suas atitudes para com estes doentes, um com atitudes mais positivas, o outro com atitudes mais negativas. Esta tese mostrou ainda que um programa de implementação da deteção precoce e intervenção breve, desenhado com base em pressupostos teóricos de modificação comportamental, adaptado às barreiras e facilitadores da implementação, aumenta de forma significativa as taxas de identificação precoce dos consumos de álcool. Esta tese contribui para aumentar o conhecimento atual no sentido em que põe à disposição dos investigadores evidência prática sobre como abordar os fatores com influência na implementação da identificação precoce e intervenção breve para o consumo de álcool ao nível dos Cuidados de Saúde Primários. Esta tese contribui também para um melhor entendimento dos mecanismos subjacentes à resistência e à mudança de comportamento dos profissionais dos Cuidados de Saúde Primários no que respeita à implementação da deteção precoce e intervenção breve do consumo de álcool. Os resultados desta tese poderão ser usados por investigadores e decisores políticos para desenhar novos programas de implementação tendo como objetivo modificar esta prática clínica ao nível dos Cuidados de Saúde Primários.Alcohol use is among the leading risk factors for the global burden of disease and premature death. People who drink alcoholic beverages are at risk of developing more than 200 diseases and injury conditions. Most of the impact of alcohol consumption on human health and well-being is determined by two dimensions of drinking: the total volume of alcohol consumed and the pattern of drinking. Several effective strategies exist to reduce the harmful use of alcohol, which includes screening and brief interventions for excessive alcohol use in primary health care. The majority of primary health care providers agree that the excessive consumption of alcohol is an important health issue and express their support to policies for reducing the impact of alcohol on the health of their patients. Notwithstanding, implementation of screening and brief interventions is low at the primary health care level. Therefore, the overall aim of this thesis is to investigate how to implement screening and brief interventions for excessive alcohol consumption in primary health care. This thesis reviewed the barriers of, and facilitators for, the implementation of alcohol screening and brief interventions in primary health care. Behaviour change theory was used to understand how these factors linked to the determinants of behaviour change and how they could be addressed in order to change primary health care providers’ behaviour, i.e. to increase the delivery of alcohol screening and brief interventions. A comprehensive theory-based implementation programme was designed and tested in a cluster randomized controlled trial. This thesis identified several barriers to implementation which were mapped to all the theoretical domains of behaviour change. Primary health care providers concerns about their ability to deliver alcohol screening and brief interventions and to help patients to cut down, lack of alcohol-related knowledge, lack of time, lack of materials and support, and providers’ attitudes towards at-risk drinkers were among the most commonly cited barriers. This thesis found evidence that the attitudes of family physicians could be used to divide practitioners into two distinct groups, one with more positive and the other with more negative attitudes towards at-risk drinkers. This thesis also found that a behaviour change theory-based programme, tailored to the barriers for, and facilitators of, the implementation of screening and brief intervention in primary health care is effective in increasing alcohol screening rates. This thesis contributed to the evidence base by providing researchers with practical evidence on how to address the factors influencing the implementation of screening and brief interventions in primary health care. This thesis also provides researchers with insight into the behavioural mechanisms mediating primary health care providers’ decision to deliver alcohol screening and brief interventions. The results of this thesis could be used by researchers and policymakers to inform the design of novel theory-oriented interventions to support the implementation of alcohol screening and brief interventions in primary health care

Digest of the Philadelphia College of Osteopathic Medicine (Winter 2010)

The Winter 2010 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles: Opening Remarks PCOM Updates Development News Wounded Healers Founders’ Day 2010 Mining the Connection between Mind & Body Keeping Healthcare Providers Safe from Youth Gang Violence Class Notes In Memoriam My Turn Essayhttps://digitalcommons.pcom.edu/digest/1204/thumbnail.jp

Volume 05, Number 05

Contents: i | Loma Linda Sanitarium Notes1 | Pioneer Reformers, No. 7 R. F. Cottrell3 | Final Triumph of the Medical Evangelist6 | The Educational Feature of the Sanitarium Work10 | How is it That Ye Do Not Discern This Time 12 | Encouragement—the Remedy for the Blues13 | Be True15 | Medical Evangelical Experiences16 | A Lesson from Nature17 | Responsibility of Workers18 | The True Ministry19 | Table Temperance20 | Editorials22 | Sanitarium Ethics25 | Medical Missionary Home and Childhttps://scholarsrepository.llu.edu/medical_evangelist/1029/thumbnail.jp

The Practice of Texts

The Practice of Texts examines the uses of the Sanskrit medical classics in two educational institutions of India’s classical life science, Ayurveda: the college and the gurukula. In this interdisciplinary study, Anthony Cerulli probes late- and postcolonial reforms in ayurvedic education, the development of the ayurvedic college, and the impacts of the college curriculum on ways that ayurvedic physicians understand and use the Sanskrit classics in their professional work today. His fieldwork in south India illuminates the nature of philology and ritual in the ayurvedic gurukula and showcases how knowledge is exchanged among students, teachers, and patients. The result, Cerulli shows, is that the Sanskrit classics are presented and applied differently in the college and gurukula, producing a variety of relationships with these texts among practitioners. By interrogating the politics surrounding the place of the Sanskrit classics in ayurvedic curricula, this book reveals a spectrum of views about the history and tradition of Ayurveda in modern India

Learned Physicians and Everyday Medical Practice in the Renaissance

Michael Stolberg offers the first comprehensive presentation of medical training and day-to-day medical practice during the Renaissance. Drawing on previously unknown manuscript sources, he describes the prevailing notions of illness in the era, diagnostic and therapeutic procedures, the doctor–patient relationship, and home and lay medicine

Geographies of Medical and Health Humanities: A Cross-Disciplinary Conversation

In recent years, both within and beyond academic and clinical spheres, medical and health humanities have become increasingly influential. Drawing from interdisciplinary fields in the humanities, social sciences, and the arts, medical and health humanities present unique lenses for considering nuanced spaces and lived experiences of health and health care; they also help challenge traditional ways that medicine and health care are understood and practiced. This collection brings together practitioners and theorists working broadly in medical health humanities, asking them both to consider their work as temporally and spatially located and to position their practices in conversation with a growing uptake of humanities methods and methodologies in other disciplines. The work of nine contributors uses these themes as a starting point for thinking about the future of medical health humanities in new and potentially even more productive ways

Pharmaceutical Lemons: Innovation and Regulation in the Drug Industry

Before a new drug can be marketed, the Food and Drug Administration must be satisfied that it is safe and effective. According to conventional wisdom, the cost and delay involved in this process diminish the incentives to invest in the development of new drugs. Accordingly, several reforms aimed at restoring such incentives have been implemented or advocated. This Article challenges the central argument that drug regulation and drug innovation are necessarily at odds with one another. Although intuitively appealing, the argument that drug regulation negatively affects the incentives to innovate does not fully capture the role that regulation plays in this industry. This Article shows that the regulatory framework is not solely a burden imposed on the industry; it also provides a valuable service to the industry. Specifically, drug regulation provides certification of drug quality. Such certification, which may not be easily achieved by private market-based mechanisms, prevents the market from becoming a market for lemons. Therefore, rather than decreasing the expected returns to innovation, this aspect of regulation contributes to the value of new drugs and may actually encourage innovation. This point has largely been absent from most cost-benefit analyses of drug regulation, yet without it any discussion of the merits of regulation is incomplete

The web 2.0 Internet: Democratized Internet collaborations in the healthcare sector

Les col•laboracions democratitzades a Internet, entenent-les com les eines participatives de la xarxa, o la Web 2.0, afecten en l'actualitat a nombrosos aspectes la nostra vida. Els acadèmics destaquen el potencial de la Web 2.0 per millorar l’aprenentatge o la salut, així com el seu continu impacte en sectors com el de la tecnologia de mitjans de comunicació. També plantegen un gran nombre de qüestions importants als professionals i estudiosos. Per exemple, la consideració crítica de la Web 2.0 com una bombolla o bé com un element més del màrqueting, que necessita d'una determinació del seu abast i naturalesa. Aquest mateix punt és aplicable a l'ús de la Web 2.0 en el sector sanitari, també anomenat com Medicina 2.0 o Sanitat 2.0. Referent a això, considerant el risc que el contingut generat per altres usuaris sigui utilitzat per prendre decisions relatives a la salut, i tenint en compte l'eficàcia no provada de la Web 2.0 com a instrument de la política sanitària, els acadèmics del tema conviden a la definició de millors models que es puguin aplicar a l'ús pràctic d'aquesta eina. Aquesta tesi es centra en l'estudi d'aquestes qüestions fonamentals, en un camp que es mou a gran velocitat, per darrera de la pràctica real, i que requereix la concertació d'una investigació interdisciplinària. Per tant, aquesta tesi incorpora set obres diferents que ofereixen àmplies perspectives sobre l'ús d'eines de col•laboració en la xarxa en el camp de l'atenció sanitària, cadascuna analitzant el tema amb una profunditat suficient com per seguir sent rellevant en un camp en ràpida evolució. Aquestes obres inclouen un examen d'(1) la Web 2.0 i (2) la Medicina 2.0, utilitzant l'anàlisi del contingut de milions de converses de la xarxa per identificar les principals qüestions pràctiques o teòriques i les tensions subjacents a cada concepte. Dos estudis addicionals analitzen (3) com i per què els metges fan servir les eines de la Web 2.0, i (4) com els metges busquen la informació en aquest context en constant moviment com és el d'Internet. Aquests dos estudis es basen en enquestes, diaris i entrevistes amb els metges que treballen en el Servei Nacional de Salut del Regne Unit. Tots dos destaquen resultats importants com ara models per a l'ús de la Medicina 2.0, o contribucions importants a la literatura com la connexió de la recerca cognitiva en la xarxa i la valoració de la informació en xarxa, tots dos camps sense connexió amb anterioritat a aquest treball. Tres estudis addicionals analitzen la web 2.0 des d'una perspectiva organitzacional, incloent (5) un estudi dels models de disseny de l'ús de la Web 2.0 en el sector farmacèutic, el qual detalla els millors models de pràctiques d'ús, i la seva clara relació amb els models de disseny de codi obert, i (6) també les estratègies d'innovació oberta al sector farmacèutic, on les eines de col•laboració en la xarxa permeten aquest tipus d'estratègies. Els dos últims estudis fan servir entrevistes amb 120 executius del sector farmacèutic analitzats a través d'anàlisi temàtic. Tots dos fan contribucions importants a la literatura mitjançant la caracterització de les estratègies d'innovació oberta i les implicacions per generar la capacitat d'absorció en el context d'innovació oberta. L'últim estudi (7) examina la Medicina 2.0 des de la perspectiva dels proveïdors de serveis de salut, per ajudar a la gestió d'ús de la Web 2.0 com un instrument per a millorar l’atenció sanitària. En general, hi ha moltes contribucions importants a la literatura, que en conjunt aconsegueixen ampliar el panorama de la Web 2.0 en l'assistència sanitària, i aporten consideracions especifiques a la literatura que abasta els sistemes d'informació, les ciències de la informació i la informàtica mèdica , així com la innovació oberta i l'estratègia. Las colaboraciones democratizadas en Internet, entendiéndolas como las herramientas participativas de la red o la Web 2.0, afectan en la actualidad a numerosos aspectos nuestra vida. Los académicos destacan el potencial de la Web 2.0 para mejorar el eAprendizaje o la salud, así como su continuo impacto en sectores como el de la tecnología de medios de comunicación. También plantean un gran número de cuestiones importantes a los profesionales y estudiosos. Por ejemplo, la consideración crítica de la Web 2.0 como una burbuja o bien como un elemento más del marketing, que necesita de una determinación de su alcance y naturaleza. Este mismo punto es aplicable al uso de la Web 2.0 en el sector sanitario, también denominado como Medicina 2.0 o Sanitad 2.0. A este respecto y considerando el riesgo de que el contenido generado por otros usuarios sea utilizado para tomar decisiones relativas a la salud, y la eficacia no probada de la Web 2.0 como instrumento de la política sanitaria; los académicos del tema invitan a la definición de mejores modelos que se puedan aplicar al uso práctico de esta herramienta. Esta tesis se centra en el estudio de estas cuestiones fundamentales, en un campo que se mueve a gran velocidad, por detrás de la práctica real, y que requiere la concertación de una investigación interdisciplinaria. Por lo tanto, esta tesis incorpora siete obras distintas que ofrecen amplias perspectivas sobre el uso de herramientas de colaboración en la red en el campo de la atención sanitaria, cada una analizando el tema con una profundidad suficiente como para seguir siendo relevante en un campo en rápida evolución. Estas obras incluyen un examen de (1) la Web 2.0 y (2) la Medicina 2.0, utilizando el análisis del contenido de millones de conversaciones de la red, para identificar las principales cuestiones prácticas o teóricas y las tensiones que subyacen a cada concepto. Dos estudios adicionales analizan (3) cómo y por qué los médicos usan las herramientas de la Web 2.0, y (4) cómo los médicos buscan la información en este contexto en constante movimiento como es el de Internet. Estos dos estudios se basan en encuestas, diarios y entrevistas con los médicos que trabajan en el Servicio Nacional de Salud del Reino Unido. Ambos destacan resultados importantes tales como modelos para el uso de la Medicina 2.0, o contribuciones importantes a la literatura como la conexión de la búsqueda cognitiva en la red y la valoración de la información en red, ambos campos sin conexión con anterioridad al presente trabajo.Tres estudios adicionales analizan la Web 2.0 desde una perspectiva organizacional, incluyendo (5) un estudio de los modelos de diseño del uso de la Web 2.0 en el sector farmacéutico, el cual detalla los mejores modelos de prácticas de uso, y su clara relación con los modelos de diseño de la open source, y (6) y también las estrategias de innovación abierta en el sector farmacéutico donde las herramientas de colaboración en la red permiten este tipo de estrategias. Los dos últimos estudios emplean entrevistas con 120 ejecutivos del sector farmacéutico analizados a través de análisis temático. Ambos hacen contribuciones importantes a la literatura mediante la caracterización de las estrategias de innovación abierta y las implicaciones para generar la capacidad de absorción en el contexto de innovación abierta. El último estudio (7) examina la Medicina 2.0 desde la perspectiva de los proveedores de servicios de salud, para ayudar a la gestión de uso de la Web 2.0 como un instrumento para la gestión de una mejor atención sanitaria. En general, hay muchas contribuciones importantes a la literatura, que en conjunto logran ampliar el panorama de la Web 2.0 en la asistencia sanitaria, y aportan consideraciones específicas a la literatura que abarca los sistemas de información, las ciencias de la información, la informática médica, así como la innovación abierta y la estrategia.Democratized internet collaborations, referring to participatory online tools or Web 2.0, now impact many aspects of people’s lives. Scholars note Web 2.0’s potential to improve eLearning or healthcare, and its ongoing impact in sectors such as tech-media. They also raise a plethora of important questions for practitioners and scholars, such as the criticism of Web 2.0 as hype or marketing term, which necessitates some determination of the scope and nature of Web 2.0. This holds equally for Web 2.0’s use in health care, denoted as Medicine 2.0 or Health 2.0. Moreover, given the risks of people using user-generated content for health decisions, and its unproven effectiveness as a health policy tool, scholars have called for best practice models of use. This thesis addresses these fundamental issues, in a field that is fast moving, behind actual practice, and that requires concerted inter-disciplinary research. Therefore, this thesis incorporates seven distinct works that provide broad perspectives on the use of online collaboration tools in healthcare, each analyzing a specific topic in enough depth to remain relevant in a fast moving field. These works include an examination of (1) Web 2.0 and (2) Medicine 2.0, using content analysis of millions of online conversations to surface the major practical or theoretical issues and tensions that underpin each concept. Two further studies examine (3) how and why doctors use Web 2.0 tools, and (4) how doctors search or forage for information in this evolving internet environment. These two studies rely on surveys, diaries and interviews from doctors working in the UK’s National Health Service (NHS). Both highlight important results, such as models for Medicine 2.0 use, or make important contributions to literature such as connecting the previously separate cognitive online search and internet information judgment literatures. Three further studies examine Web 2.0 from an organizational perspective, including (5) design patterns of Web 2.0’s use in global Pharma, which details best practice models of use and its clear link to Open Source design patterns, and (6) global Pharma’s Open Innovation strategies, where online collaboration tools enable these strategies. The latter two studies employ interviews with 120 pharmaceutical executives analyzed through thematic analysis. They make major contributions to literature by characterizing open innovation strategies and gleaning implications for Absorptive Capacity in the Open Innovation context. The final study (7) examines Medicine 2.0 form the perspective of health service providers, informing management using eHealth as an instrument for improved healthcare management. Overall, there are many major contributions to literature, which together achieve both a broad overview of Web 2.0 in healthcare, but also make specific additions to literature encompassing information systems, information science, medical informatics, and open innovation and strategy