Primary Health Care: Combating Alcoholism

Australia’s Primary Health Care

Discuss about the Primary Health Care: Combating Alcoholism.

Primary health care (PHC) was advanced as an important health care policy for the achievement of quality health care for all across the globe following the Alma-Ata Declaration in 1978 as well as the year 2000 ‘Health-for All’ programme (Davies, et al., 2008). PHC represents a World Health Organization (WHO) blueprint for the advancement of universal health care to the entire global population through the implementation of various policies, strategies, and programs through country-specific frameworks. The WHO has earmarked priority healthcare concerns that countries across the globe ought to lay emphasis upon among them including malaria; HIV/AIDS; mental health; alcohol, tobacco and substance abuse; cancer, maternal health, TB, food safety, and diabetes. The implementation of appropriate health systems that meet the demands of these health care concerns is of utmost importance. Excessive alcohol consumption is a PHC priority area and by the virtue of its devastating effects on families, the community and the nation at large becomes the focus of this paper. The paper endeavors to develop a healthcare program meant to combat excessive alcoholism and effectively promise positive change in the nation.

First, in laying the background for this program development, it is important to decipher Australia’s PHC definition and framework. PHC in Australia is recognized at the point of entry into the healthcare system by citizens who fall ill and require medical attention as well as those targeted for particular health care programs. This entry-level constitutes a spectrum of healthcare undertakings and services such as health promotion and prevention, early intervention, patient treatment and management of life-threatening sicknesses and conditions at both public and private setups. As Australia’s frontline health care system, PHC is offered in community health centers and home settings such as in private and general practices, local government, community health set ups, allied health practices as well as through telecommunication technologies like video consultations.

In effecting the care, a broad range of healthcare practitioners is involved including general practitioners, midwives, nurses, Aboriginal health practitioners, dentists, pharmacists and allied health professionals. Services may be directed to target particular populations such as the youth, people living in remote areas, older persons, maternal and child, refugees or populations of specific socio-economic status and cultural backgrounds (Keleher and Hagger, 2007). Moreover, services may be directed to target particular health conditions such as obesity, diabetes, cancer, drugs and substance abuse among others. At the clinical level, patients are often attended to by being provided comprehensive, perpetual and patient-centered care.

Primary Health Care Concern: Australia’s Alcoholism

PHC has been labeled as the most exploited health service in Australia with Australian Bureau of Statistics (ABS) data of Patient Experience Survey 2014-15 indicating that 83% of the populations sort the services of general practitioners during the period. For the fiscal year 2015-16, approximately 117 million medications were given by general practitioners while 13 million more was prescribed directly to the patients [ABS, 2015]. In the same period, approximately $56 billion was spent on PHC representing 35% of the entire health funding [AIHW, 2016].  This makes PHC one of the most funded healthcare programs. In developing intervention programs for primary health care concerns such as alcoholism adequate federal, state, and territory backing with regard to funding, policy, legal and socio-cultural frameworks, is very crucial.

The WHO recognized alcoholism and substance abuse as one of the most crucial health care issues that deserve priority as a primary healthcare concern. Alcohol misuse has been singled out as a costly health care issue with abilities to devastating the society dearly. Deehan, Marshall, and Strang (1998) contend that PHC can be instrumental in laying programs that can help promote and advocate for the prevention of alcoholism, reduce the general alcohol consumption rates as well as treat alcohol addicts who have already contracted mental illnesses. Australia’s National Survey of Mental Health and Wellbeing (NSMHWB) indicate that one in every four Australian’s between ages 16 and 24 have been reported to experience mental disorder which can be attributed directly to alcohol consumption (Reavley et al., 2010).

The National Drug Strategy Household Survey (AIHW 2008) showed that majority of Australians adults have experienced alcohol and a significant number continue to drink in most times of their lives. The survey indicated that approximately 90% have tried drinking alcohol during their lifetime while approximately 83% are bound to consume alcohol in any given year. Windle (2004) observed massive alcohol misuse among adolescence in which alcohol consumption became more common with increased age. Moreover, Windle (2004) found out that though older adults tend to take less alcohol than their junior counterparts; their likelihood of consuming every day is high. Furthermore, the research showcased that the number of pregnant women engaging in excessive alcohol consumption is on the rise. Colvin et al (2007) indicated that 59% of Australian women are likely to drink at a certain time during pregnancy. With regard to the Australian workforce, Berry et al., (2007) deduced that 44% of the total Australian workforce could be active alcohol drinkers with the majority of them being relatively young workers and those working in blue-collar occupations.

Primary Health Care Program for Combating Alcoholism

Against the foregoing background on what constitutes comprehensive primary health care provision and the current stance in Australia’s national alcohol abuse, a formidable healthcare promotion program can be developed to fight the vice. However, Davies et al., (2008) observe that formulating and coordinating healthcare programs presents significant challenges depending on the characteristics of those targeted by interventions and the kind of interventions to be implemented. Raak et al., (2005) in a Commonwealth Fund survey observed that Australia is among five developed countries in which patients are likely to experience high deficiencies in care coordination, medical and communication failures. To this end, PHC plays a major role in filling this gap by advancing promising programs and strategies that can improve coordination of care.

Planning for a PHC involves establishing a needs assessment of the targeted group of people upon which program goals and objectives can be built on.

Determining the scope of the assessment. This will involve working with key stakeholders and informants to assess the scope of work and the purpose of the needs assessment. Such key stakeholders may include government health agenesis, hospitals, key healthcare practitioners, and non- governmental organizations personnel, community health workers among others. Key questions regarding the alcoholism will be deciphered upon by this multidisciplinary team to exploit the depth of the concern.

Gathering data. Key data and information leading to the deduction of critical decisions include important statistics relating to Australia’s alcohol abuse levels, the groups involved, most vulnerable groups, socio-economic implications and the types of liquor that are most abused. Data can be mined from both primary as well as secondary sources.

Analyzing the data. Data analysis will majorly be descriptive where discussions and decisions on priorities areas of the program will be advanced by the assessment team. However, quantitative analysis will be conducted to establish relationships between different data facets and conclusions deduced if necessary. Data may be grouped to reflect the level of severity, various behavior risk factors as well as non-behavior risk factors such as social, environmental and physical factors.

Reporting findings to inform implementation. A comprehensive report will inform the aftermath of this planning exercise. The report will effectively constitute the blueprint of the implementation of the interventions needed to avert alcoholism in Australia. In publishing the report, specific brochures will be produced targeting specific groups of stakeholders and individuals. Moreover, the report will be posted on the Web besides informing key stakeholders of its existences through board and staff meetings, e-mails, social and mainstream media.

Planning the Program

The goal of the program will read;

“A goal of the National Health and Medical Research Council’s (NHMRC) freedom from alcoholism is to minimize the number of new alcohol drinkers and helping those who are already ardent drinkers to stop drinking”

The objectives following this goal will include;

Action (or behavioral) objective

“At the tail end of the program, three-quarters of the targeted populations will significantly minimize their alcohol consumption and fewer new entrants into alcoholism will be recorded”

“Alcohol abuse among the youth aged 16 and 25 will minimize their alcohol uptake for up to 50% in the next two years”

This program’ plan is most effective when it is culturally appropriate and premised on health theories and models. Heaney and Israel (2008) observe that the social network and social support theory advance that social facets posit great impacts on the adoption of healthcare interventions besides influencing people’s behaviors. Constructs in this theory such as emotional support, appraisal, information support, points of view sharing, and instrumental support can have a far-reaching impact on any healthcare intervention. As such, adequate measures ought to be put in place to meet the demands of social networks before actually rolling out a healthcare intervention program.

In implementing this action plan, the 2009 National Health and Medical Research Council (NHMRC) guidelines come in handy in advancing insights for the promotion of what is legally acceptable with regard to alcohol consumption. They advance Australians an opportunity to make informed decisions on the same. These guidelines constitute the reduction of the risks posed by alcohol over people’s lifetime and on single drinking occasions besides barring children under the age of 18 and pregnant women from drinking alcohol.

Implementation involves the rolling out of the inputs of the action plan into the planned activities for the desired outcomes and goals to be realized. This input includes earmarked stakeholders, funding, equipment needed, partnerships entered, technologies deemed necessary, supplies and materials. Activities for creating promotion and advocacy may include both mainstream and social media platforms and literacy programs targeting vulnerable youth. At high school and college platforms, life skills training and education about the dangers of alcoholism can be implemented. Moreover, relevant government agencies ought to come up with formidable policy regulations for stricter restriction of alcohol sale to minors.

For patients that have turned out to be alcohol addicts or those with mental deficiencies as a result of the same, then safe and sober programs will be implemented to rehabilitate them. Prevention and promotion mechanisms would constitute advocacy for wellbeing services, youth outreach, setting medical clinics, counseling services, and community health education. These implementation interventions are reinforced by Bandura (1986) social cognitive theory in which he asserts that human behavior constitutes the interaction of personal, environmental, and behavioral factors. Individuals will respond to the alcohol intervention program and effectively change their behaviors based on their viewpoints of these factors. As such, in line with the ecological model, health promotion programs’ implementation of this nature ought to exploit settings such as family and social peer circles, communities, workplaces, schools and healthcare organizations (Brower, 1988) for utmost outcomes

Conducting a needs assessment

Evaluation of the program will majorly be anchored on the how successful the program’s strategies are against set guidelines, objectives and goals. All the types of evaluation will be of utmost help to this end. Formative evaluation advances that the implementing team ought to gather information during planning and implementation stages for the purposes of understanding need assessment data much better. Process evaluation is instrumental in helping to understand facets that contribute to the program’s success and how it can be enhanced to achieve better results. The impact and outcome evaluations on the other will assist to measure immediate impacts of the primary health care program and the changes in people during and after the program.

Evaluation is underpinned by the health belief model in which Hochbaum, Rosenstock, and Kegels (1952) posit that individuals’ decisions to consume health care programs depend on their perceptions of the threat posed by a particular healthcare concern, the advantages of evading the threat, and factors manipulating the decision to act. As such, the implementing team ought to carefully take care of the constructs informing these concerns in order to achieve utmost outcomes and attain the goals set. Moreover, in line with the transtheoretical model, the implementing team need to journey with patients and targeted populations throughout the various stages of implementations. This is in a bid to effect relevant potential change strategies in relation to their program’s perception ( Prochaska, 2013).

References

AIHW (2008) 2007 National Drug Strategy Household Survey – First Results.AIHW cat. no.

PHE 98 (Drug Statistics Series No. 20) Australian Institute of Health and Welfare, Canberra.

Australian Bureau of Statistics (ABS) 2015. Patient experiences in Australia: summary of findings 2014­–15. ABS Cat. No. 4839. Canberra: AIHW.

Australian Institute of Health and Welfare (AIHW) 2016. Health expenditure Australia 2014–15 Health and welfare expenditure series no. 57. Cat. no. HWE 67. Canberra: AIHW.

Brower, A. M. (1988). Can the ecological model guide social work practice?. Social Service Review, 62(3), 411-429.

Berry, J. G., Pidd, K., Roche, A. M., & Harrison, J. E. (2007). Prevalence and patterns of alcohol use in the Australian workforce: findings from the 2001 National Drug Strategy Household Survey. Addiction, 102(9), 1399-1410.

Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory.

Englewood Cliffs, NJ, US: Prentice-Hall, Inc.

Colvin, L., Payne, J., Parsons, D., Kurinczuk, J. J., & Bower, C. (2007). Alcohol consumption during pregnancy in nonindigenous west Australian women. Alcoholism: Clinical and Experimental Research, 31(2), 276-284.

Davies, G. P., Williams, A. M., Larsen, K., Perkins, D., Roland, M., & Harris, M. F. (2008).

Coordinating primary health care: an analysis of the outcomes of a systematic review. Medical Journal of Australia, 188(8), S65.

Deehan, A., Marshall, E. J., & Strang, J. (1998). Tackling alcohol misuse: opportunities and obstacles in primary care. Br J Gen Pract, 48(436), 1779-1782.

Hochbaum, G., Rosenstock, I., & Kegels, S. (1952). Health belief model. United States Public Health Service.

Heaney, C. A., & Israel, B. A. (2008). Social networks and social support. Health behavior and health education: Theory, research, and practice, 4, 189-210.

Keleher, H., & Hagger, V. (2007). Health literacy in primary health care. Australian Journal of Primary Health, 13(2), 24-30.

Prochaska, J. O. (2013). The transtheoretical model of behavior change. In Encyclopedia of behavioral medicine (pp. 1997-2000). Springer New York.

Reavley, N. J., Cvetkovski, S., Jorm, A. F., & Lubman, D. I. (2010). Help-seeking for substance use, anxiety, and affective disorders among young people: results from 2007 Raak, A. V., Meijer, E., Meijer, A., & Paulus, A. (2005). Sustainable partnerships for integrated

care: the role of decision making and its environment. The International journal of health planning and management, 20(2), 159-180.

Windle, M. (2004). Suicidal behaviors and alcohol use among adolescents: a developmental psychopathology perspective. Alcoholism: Clinical and Experimental Research, 28(s1).