Cost-effectiveness evaluation of a program to detect substances users and to do brief interventions directed to health professionals, from public health services in São Paulo

• Grant number: 07/02634-6
• Support Opportunities: Scholarships in Brazil - Master
• Start date: November 01, 2007
• End date: November 30, 2008
• Field of knowledge: Health Sciences - Medicine - Psychiatry
• Principal Investigator: Maria Lucia Oliveira de Souza Formigoni
• Grantee: Thiago Pavin Rodrigues
• Host Institution: Departamento de Psicobiologia. Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil

Abstract

Alcohol and other drugs abusive use has been an increasing problem, both at the public and individual levels. In Brazil about 11.2% of the adult population fulfill criteria for alcohol dependence, a problem associated with 3.2% of deaths. Tobacco dependence is associated with 9% of deaths. Illicit drugs use has been reported by 19.4% of Brazilian adult population, being associated with 0.4% of total deaths. However, health professionals, mainly those who work in PHC services, are not enough trained to cope with alcohol/other drugs abusive users. This is due mainly to two factors: the professionals do not feel they are enough trained to carry out detection and treatment of abusive users of psychoactive substances and they have negative beliefs and attitudes regarding the user which creates a barrier between them and the patient. The lack of identification of users in the initial phase of substance abuse hinders an adequate intervention that could prevent progression to levels of abuse or dependence. Therefore, many programs and public policies regarding drug abuse do not achieve their goals or drift apart from the preventive focus. The WHO (World Health Organization) supported the development of screening instruments to be used in PHC services: the AUDIT (Alcohol Use Disorders Identification Test) and the ASSIST (Alcohol, Smoking and Substance Involvement Screening Test). Both are reliable and their administration can be done in few minutes. Previous studies show that Brief Interventions applied immediately after the detection of abusive patterns of psychoactive substance use are effective, reducing alcohol and/or other drugs consumption as well as related problems. These interventions, which consist of 15-30 minutes orientation sessions, can be performed by different types of professionals, not just medical doctors, and they are not time consuming. Relatively brief training of public health professionals seem to be a good solution to enable those professionals in the use of detection instruments and in the performance of brief interventions. Between the end of 2006 and beginning of 2007 about 500 professionals working in S. Paulo State received this kind of training through a Long Distance continuing education course (LDE) called SUPERA (System to detect abusive use and dependence on psychoactive substances: referral, brief intervention, social reinsertion and follow-up), sponsored by SENAD (Secretaria Nacional Antidrogas). Considering there are no studies on the cost-effectiveness of this kind of training (defined as the actual use of the methodology proposed) the present project aims at adapting a classic methodology of cost-effectiveness evaluation to evaluate this training. The adaptation and/or development of a technology to evaluate cost-effectiveness may also be useful to evaluate other kinds of training and can even be a model to be implemented all over the country. (AU)