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EFF/PAI-PAD/USP-RP-2009 1 INEBRIA 2009 Newcastle upon Tyne Brazilian alcohol and drugs policy of the Ministry of Health and SBIRT implementation Erikson.

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Presentation on theme: "EFF/PAI-PAD/USP-RP-2009 1 INEBRIA 2009 Newcastle upon Tyne Brazilian alcohol and drugs policy of the Ministry of Health and SBIRT implementation Erikson."— Presentation transcript:

1 EFF/PAI-PAD/USP-RP INEBRIA 2009 Newcastle upon Tyne Brazilian alcohol and drugs policy of the Ministry of Health and SBIRT implementation Erikson F. Furtado, MD, PhD – Assist. Prof. USP – University of São Paulo FMRP – School of Medicine of Ribeirão Preto Dept. Neuroscience and Behavior

2 EFF/PAI-PAD/USP-RP Objective To present an overview of the present developments of the Brazilian public policy for alcohol and drugs and its relation to SBIRT implementation in the public health system. To present an overview of the present developments of the Brazilian public policy for alcohol and drugs and its relation to SBIRT implementation in the public health system.

3 EFF/PAI-PAD/USP-RP Population (2009) – 191 millions (mostly urban) Federative Republic, 5 regions, 26 States (01 FD) Municipalities - 5,564 Territory: 8.5 mln sq km (aprox. 22 inh/sqkm) GNP (2008) US$ 1,991 bi Per capita GNP (2008) - US$ 10,325 HDI Rank (2006) - 70 th (0.807) Brazil: Country Profile

4 EFF/PAI-PAD/USP-RP Health Policy in Brazil Epidemic diseases – Dengue, Tuberculosis, Aids-STD Neonatal deaths Chronic diseases - risk factors Cancer, cardiovascular diseases, diabetes Obesity Violence and vehicle accidents Alcohol and Drug abuseAlcohol and Drug abuse Health costs Community participation Management of health services and health system. Health Policy – Challenges

5 Human Development Index EFF/PAI-PAD/USP-RP-20095

6 6 6 Health Policy in Brazil Brasil, Ministério da Saúde. Painel de Indicadores do SUS, Brasília. Ano I, No. I, agosto 2006 Health Budget and Expenditures Total Health Budget in R$ Billions – Federal, State and County. Brazil,

7 EFF/PAI-PAD/USP-RP Health Policy in Brazil Context: Epidemiologic Transition - Violence Standardized Mortality Rate by Violence (Assault and Homicide) per habitants, Region, Brazil, Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Saúde Brasil 2006 : uma análise da situação de saúde no Brasil. Brasília : Ministério da Saúde, p. : il. – (Série G. Estatística e Informação em Saúde)

8 EFF/PAI-PAD/USP-RP Per Capita Alcohol Consumption

9 EFF/PAI-PAD/USP-RP Alcohol and Injury in Emergency Departments

10 EFF/PAI-PAD/USP-RP Alcohol and Car Accidents 53% car crash victims attending the emergency room – HC-Sao Paulo (mostly, young ya males) 53% car crash victims attending the emergency room – HC-Sao Paulo (mostly, young ya males) Mortality due by fatal car accidents responds for 28% of all external causes (about 30,000 deaths/year) Mortality due by fatal car accidents responds for 28% of all external causes (about 30,000 deaths/year) High BAC found among 96.8% of necropsies of fatal victims (IML-SP) High BAC found among 96.8% of necropsies of fatal victims (IML-SP) About 50% positive AUDIT in ER About 50% positive AUDIT in ER Source: Report of the Brazilian Ministry of Health

11 EFF/PAI-PAD/USP-RP Prevalence of alcohol dependence

12 EFF/PAI-PAD/USP-RP Alcohol abuse among university students from a medical school 20,0015,0010,005,000,00 Score total AUDIT Frequency Mean = 4.8 SD = 4.4 N = 464 Cut-off point Audit % Binge Drinking 33.3%

13 EFF/PAI-PAD/USP-RP State Liver disease – Males ( Cases / ) Region of Ribeirão Preto = 75,5

14 Mortality by TB and comorbidities ConditionN TB treatment p None (n;%)Some (n;%) Diabetes4423(52.3)21(47.7).05 Cancer64(66.7)2(33.3).05 COPD3923(59)16(41).05 HIV1511(73.3)4(26.7).005 Smoking6439(60.9)25(39.1).05 Alcoholism14282(57.7)60(42.3).01 Lindoso et al., Rev Saude Publica 42(5), 2008 EFF/PAI-PAD/USP-RP %

15 EFF/PAI-PAD/USP-RP Health professionals don't assess risk patterns of alcohol use Patients with problematic alcohol use are discriminated Risk groups are not routinely assessed Fabbri, Laprega & Furtado, Rev Saude Publica 41(6), N = 450 N = 100 (22%) Only 9% identified By GO clinicians Alcohol use by pregnant women

16 16 Americas: Alcohol – risk factor Nr. 01 Source: Monteiro, M. G. Alcohol y atencion primaria de la salud. OPS, 2008

17 Frequency of inpatient admissions In-patient admissions Alcohol Dependence 57,789 Alcoholic Liver Disease 14,188 Total71,977 EFF/PAI-PAD/USP-RP

18 EFF/PAI-PAD/USP-RP Structure CAPS-AD Emergency Room Outpatient MH Clinics General Hospital Family Health Program Psychiatric Hospitals Detoxification GH Basic Care (PHC)AOD Health Care System

19 EFF/PAI-PAD/USP-RP Datasus Tabwin/Access AOD Psychosocial Centers Short hospitalization wards: 4

20 EFF/PAI-PAD/USP-RP CAPS-AD Distribution – 2009

21 Cumulative number of CAPS by year EFF/PAI-PAD/USP-RP

22 EFF/PAI-PAD/USP-RP Health Policy in Brazil Family Health Care Program Brasil, Ministério da Saúde. Painel de Indicadores do SUS, Brasília. Ano I, No. I, agosto 2006

23 Family Health Teams – PHC level EFF/PAI-PAD/USP-RP

24 Urgency AOD Policy Plan EFF/PAI-PAD/USP-RP

25 New AOD beds in general hospital wards EFF/PAI-PAD/USP-RP

26 AOD Policy - Chronology 2003 – Basic Guidelines for a National Public Policy for Alcohol and Drugs, Prevention, Treatment and Health Promotion 2003 – Basic Guidelines for a National Public Policy for Alcohol and Drugs, Prevention, Treatment and Health Promotion –First insertion of Brief Interventions EFF/PAI-PAD/USP-RP

27 BRASILIA DECLARATION ON ALCOHOL PUBLIC POLICIES, PAHO Recommendations Preventing and reducing alcohol consumption-related harms be considered a public health priority for action in all countries of the Americas. Preventing and reducing alcohol consumption-related harms be considered a public health priority for action in all countries of the Americas. Regional and national strategies be developed, incorporating culturally appropriate evidence-based approaches to reduce alcohol consumption related harm. Regional and national strategies be developed, incorporating culturally appropriate evidence-based approaches to reduce alcohol consumption related harm. These strategies are supported by improved information systems and further scientific studies on the impact of alcohol and the effects of alcohol policies in the national and cultural contexts of the countries in the Americas. These strategies are supported by improved information systems and further scientific studies on the impact of alcohol and the effects of alcohol policies in the national and cultural contexts of the countries in the Americas. EFF/PAI-PAD/USP-RP

28 BRASILIA DECLARATION ON ALCOHOL PUBLIC POLICIES, 2005 Alcohol policies whose effectiveness has been established by scientific research are implemented and evaluated in all countries of the Americas. Alcohol policies whose effectiveness has been established by scientific research are implemented and evaluated in all countries of the Americas. Priority areas of action need to include: heavy drinking occasions, overall alcohol consumption, women (including pregnant women), indigenous peoples, youth, other vulnerable populations, violence, intentional and unintentional injuries, underage drinking and alcohol use disorders. Priority areas of action need to include: heavy drinking occasions, overall alcohol consumption, women (including pregnant women), indigenous peoples, youth, other vulnerable populations, violence, intentional and unintentional injuries, underage drinking and alcohol use disorders. EFF/PAI-PAD/USP-RP

29 29 Recent Brazilian effectiveness studies SBIRT among ER patients: SBIRT among ER patients: –Segatto, Rev Psiq Clínica, SBIRT among Firemen periodical health evaluation: SBIRT among Firemen periodical health evaluation: –Ronzani, Est Psicologia (Natal), SBIRT among university students: SBIRT among university students: –Kerr-Côrrea, Alcohol Alcohol, 2008 SBIRT among adolescents attending a community health clinic: SBIRT among adolescents attending a community health clinic: –De Micheli, Rev Assoc Médica Bras, 2004 SBIRT among imprisoned adolescents : SBIRT among imprisoned adolescents : –Andretta, Est Psicologia (Campinas), 2008

30 EFF/PAI-PAD/USP-RP Implementation Process

31 EFF/PAI-PAD/USP-RP Trained Health Professionals PAI-PAD:TrainingsNetworkSupervisionEvaluation

32 Stigma is a barrier EFF/PAI-PAD/USP-RP (7): , 2009

33 EFF/PAI-PAD/USP-RP Changing attitudes after training SBIRT knowledge after training correlates with reduction of alcohol expectancies SBIRT knowledge after training correlates with reduction of alcohol expectancies –N = 185; –r = 0.215; –P < 0,005

34 Implementation process 2008 Ministry of Health, three metropolitan areas pilot project for SBIRT implementation in the Family Health Program and the matricial support teams Ministry of Health, three metropolitan areas pilot project for SBIRT implementation in the Family Health Program and the matricial support teams Annual plan, Alcohol and Drugs Coordination, State of São Paulo 2009 Annual plan, Alcohol and Drugs Coordination, State of São Paulo –Extending the PAI-PAD couverture of SBIRT training for all 17 regional health departments, reaching the total population of the state (~41mi). EFF/PAI-PAD/USP-RP

35 EFF/PAI-PAD/USP-RP References Brasil. Ministério da Saúde. As Causas Sociais das Iniqüidades em Saúde no Brasil. Relatório Final da Comissão Nacional sobre Determinantes Sociais da Saúde (CNDSS). Brasília Brasil, Ministério da Saúde. Painel de Indicadores do SUS, Brasília. Ano I, No. I, agosto Cornwall, A., Shankland, A. Engaging citizens: Lessons from building Brazils national health system. Social Science & Medicine 66 (2008) 2173 – Barreto, ML, Aquino, R. Recent Positive Developments in the Brazilian Health System. American Journal of Public Health. January 2009, Vol 99, No. 1. Camargo, KR. Celebrating the 20th Anniversary of Ulysses Guimarães Rebirth of Brazilian Democracy and the Creation of National Health Care System. American Journal of Public Health. January 2009, Vol 99, No. 1.


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