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Kokole D, Mercken L, Anderson P, Mejía-Trujillo J, Perez-Gomez A, Bustamante I, Piazza M, Natera Rey G, Arroyo M, Pérez De León A, Bautista Aguilar N, Medina Aguilar PS, Schulte B, O'Donnell A, de Vries H, Jané-Llopis E. Country and policy factors influencing the implementation of primary care-based alcohol screening: A comparison of Colombia, Mexico and Peru. Glob Public Health 2023; 18:2207410. [PMID: 37156224 DOI: 10.1080/17441692.2023.2207410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Health Psychology, Open University, Heerlen, Netherlands
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | | | | | - Bernd Schulte
- Department of Psychiatry and Psychotherapy, Centre for Interdisciplinary Addiction Research (ZIS), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- ESADE, Universitat Ramon Llull, Barcelona, Spain
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Natera Rey G, Arroyo Belmonte M, Medina Aguilar PS, Solís FB, Bautista Aguilar N, Pérez De León A, Anderson P. [Detection of alcohol consumption at the first level of care in Mexico during the COVID-19 pandemicDetecção do consumo de álcool no nível da atenção primária no México durante a pandemia de COVID-19]. Rev Panam Salud Publica 2023; 47:e22. [PMID: 36909798 PMCID: PMC9976269 DOI: 10.26633/rpsp.2023.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/29/2022] [Indexed: 03/05/2023] Open
Abstract
Objective To measure the impact of the COVID-19 pandemic on the implementation of a program for timely detection, brief intervention, and referral for treatment of alcohol consumption in health centers at the first level of care in Mexico City. Methods The data were collected at 18 health centers in Mexico City between 2019 and 2021, as part of a larger study. A total of 287 participating health professionals measured their patients' alcohol consumption using the AUDIT-C test. The patients' demographic aspects and consumption patterns were analyzed, as well as care actions (detection, brief intervention, provision of leaflets, monitoring, and referral) at three points in time: before the COVID-19 pandemic, during confinement, and after confinement. Parametric and nonparametric tests were performed to identify the relationship and differences between the variables at the three points. Results A total of 9090 people who consumed alcohol were identified; detection of consumption fluctuated in the three periods studied (26%, 53%, and 37%, respectively). Medium- and high-risk consumption was more frequent among young men with higher schooling during and after confinement. In the post-confinement period, monitoring and referral actions increased. Conclusions Measuring the impact of the pandemic on the implementation of a program for timely detection of alcohol consumption, brief intervention, and referral for treatment in health centers helps to develop health policies by age, gender, schooling, and type of consumption at the first level of care.
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Affiliation(s)
- Guillermina Natera Rey
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz Ciudad de México México Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Miriam Arroyo Belmonte
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz Ciudad de México México Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Perla Sonia Medina Aguilar
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz Ciudad de México México Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Feliciano Bartolo Solís
- Servicios de Salud Pública de la Ciudad de México México Servicios de Salud Pública de la Ciudad de México, México
| | - Natalia Bautista Aguilar
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz Ciudad de México México Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Alejandra Pérez De León
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz Ciudad de México México Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Peter Anderson
- Departamento de Promoción de la Salud Instituto de Investigación en Salud Pública y Bienestar Universidad de Maastricht Países Bajos Departamento de Promoción de la Salud, Instituto de Investigación en Salud Pública y Bienestar, Universidad de Maastricht, Países Bajos
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