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

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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

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“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

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The role of the EMCDDA : The Best Practice Portal

as clearing house

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

16

More details at:

www.emcdda.europa.eu

www.emcdda.europa.eu/best-practice