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Standards and Guidelines in EU countries
EQUS Conference, Brussels, 2011
Roland Simon, Marica Ferri, EMCDDA
2
Introduction
Two terms
The purpose of standardisation and guidelines
The State of development: Treatment guidelines in EU Member States
The role of Europe and the EMCDDA
Practical implications
3
Two terms
Guidelines“Systematically developed statements
to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances”
EQUS Working Document
Standards“Generally accepted principles or sets of rules for the best/most appropriate way to implement an intervention.”
Field and Lohr (1992)
“Expert knowledge stored in rules”
Brunsson et al. (2000). A world or standards
Two terms
Purpose
Treatment guidelines
EMCDDA role
Next steps
4
The purpose of standards and guidelines
Standards Guidelines
Based on - knowledge/evidence- similarities
●more
● less
Effects
- increased efficiency and safety- standardisation
●
●
●
●
Focus Manage-ment
Guidance Advice
Formal adoption ●
Two terms
Purpose
Treatment guidelines
EMCDDA role
Next steps
5
ButIn practice, standards and guidelines may sometimes not be clearly differentiated from each other.
Guidelines may include underlying standards or vice versa.
Two terms
Two terms
Purpose
Treatment guidelines
EMCDDA role
Next steps
6
State of development in EU Member States
Standards Guidelines
Prevention
Treatment
Harm reduction
Social rehabilitation
EQUSEMCDDA
Basis:Study on national guidelinesSI implementation of guidelines
Two terms
Purpose
Treatment guidelines
EMCDDA role
Next steps
7
Treatment Guidelines in the EU
Two terms
Purpose
Treatment guidelines
EMCDDA role
Nest steps
N= 30
Cumulative number of EU countries introducing guidelines in drug addiction
0
5
10
15
20
25
30
<=2000
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
N o
f co
un
trie
s
8
Treatment Guidelines in the EU
N=141
Two terms
Purpose
Treatment guidelines
EMCDDA role
Next steps
Types of Treatment
0
10
20
30
40
50
60
70
Harm
redu
ction
Detox
Psych
osoc
ial
OST
Social
Rein
t.
Alc +
drug
pro
blem
s
Not sp
ecifie
d
N o
f gu
ide
line
s
9
Treatment Guidelines in the EU
N=141
Two terms
Purpose
Treatment guidelines
EMCDDA role
Next steps
Substances
0
10
20
30
40
50
60
70
Opiat
es
Cocai
ne
Stimula
nts
Canna
bis
Sedat
ives
Alcoho
l
not s
pecif
ied
no in
fo
N o
f gu
ide
line
s
10
• All countries are committed to improve quality of treatment – even more so under financial constraints
• Development of guidelines is an expensive and time consuming process: collect evidence ► assess practice ► find consensus ► implement guidelines ► monitoring clinical practice
• Implementation is crucial and needs as much efforts as the production of guidelines
Treatment Guidelines in the EU:National Experiences
Two terms
Purpose
Treatment guidelines
EMCDDA role
Next steps
- collect - appraise - synthesize - grade evidence
11
Scientific evidence Practice/ Experience
Guidelines Standards
MS role in Guidelines and Standards
Consensus seeking
Introduction
Two terms
Purpose
Treatment guidelines
EMCDDA role
Next steps
12
Scientific evidence Practice/ Experience
EU role in Guidelines and StandardsIntroduction
Two terms
Purpose
Treatment guidelines
EMCDDA role
Next steps
Consensus seeking
EU/ International
National
Guidelines
National
Standards
EU/ International
13
“provide information on best practices …
and facilitating exchange” EMCDDA Regulation
• Collect national guidelines and experiences • Provide an inventory and description• Draw common conclusions and recommendations • Provide input for EU discussion and national
development
• Monitor quality of intervention and implementation of standards and guidelines
• Keep track of parallel projects like DECIDE
The role of the EMCDDA
Two terms
Purpose
Treatment guidelines
EMCDDA role
Next steps
15
Next steps here
• Discuss findings from survey and study• Move towards an consensus on Minimum
Quality Standards• Link EU and national level: feedback,
implementation, fine tuning, EUAP
The EMCDDA will support the work done by • Providing a home for the information in the
Best Practice Portal• Help to translate it into practice• Follow the implementation process• Update monitoring instruments where needed
to follow the process
Two terms
Purpose
Treatment guidelines
EMCDDA role
Next steps