Drug Addiction - clinical Guidance in Italy

Transcription

1 Past development and future outlook on clinical guidelines in Italy Augusto Consoli Department for Addiction Prevention and Treatment, National Health Service, Torino 2 Italian Society of Drug Addiction (SITD) Pompidou Group Treatment Conference on Guidelines and Recommendations Nicosia May 2009

2 The considerations that I will try to carry out in this short presentation are oriented to illustrate the work carried out in the course of the last 10 years in Italy, in the difficult process both cultural that professional and organizational relative to the development and the application of clinic and prevention Guide Lines in addiction field.

3 Guidelines International Network Medical Clinical Guidelines (publ ) France 32 Australia 28 Germany 15 United Kingdom 12 USA 11 Spain 10 Netherlands 4 Switzerland 4 Canada 2 Norway 2 Russian Fed. 2 International 29

4 Italian Guidelines Oncology 3 Orthopaedics 2 Surgery 2 Cardiology 2 Epatology 2 Geriatrics 1 Visual diagnostic 1 Pharmachology 1 Virology 1 Psychiatry 1

5 But actually in Italy there are many more Guide Lines in the several fields of medicine and surgery but the fact, as an example, that they are not marked on GIN network is a possible pointer that, in spite of the efforts till now made, the spread and the sharing of the guide lines among the health professionals in Italy is still to develop ulteriorly.

6 Drug Addiction - International guidelines for: Prevention Harm reduction Substitution treatments Psychosocial treatments Treatments for specific groups (e.g. women, migrants, prisoners)

7 In Italy have been carried out some attempts or documents to develop GuideLines in drug addiction field Prevention GL based on: 2002 WHO GL, 2003 NIDA GL, 2005 EMCDDA GL Methadone treatments Studio Vedette Dual diagnosis treatments GL Italian Psychiatry Association on Addiction Residential and psycho-social treatments pointers Piemonte Working Group on Evidence-Based Healthcare GL to promote smoking cessation Istituto Superiore di Sanità

8 but it s not always easy to distinguish between guidelines, protocols, recommendations, best practices, standards, policies; on many issues there is no availability of relevant documents based on clinical evidence, even when already developed by other countries; there is a cultural resistance to the standardization of treatments and low inclination to the use of manuals (except where there are high technical contents) a debate is still ongoing about the real possibility of using the guidelines in clinical practice;

9 What do we mean by Guidelines? Operating instructions on specific, limited and explicit issues (fields of reference and application); based on high quality scientific contents (RCT and meta-analysis); drafted according to progressive levels of consistency; including procedures for periodic evaluation and review.

10 Italian National Project on Guidelines (PNLG) Check-list of criteria used to evaluate guidelines 1. Essential requirements 2. Ethical aspects 3. Relevance and appropriateness 4. Structural quality 5. Acceptability 6. Technical and scientific validity 7. Applicability 8. Outcomes G. F. Gensini, A. Biggeri, A. Caputi, A.A.Conti, A. Liberati e coll.

11 Essential requirements Statement of the followed methodology Statement of purpose and scope of application Support of the best scientific evidence available Presence of multidisciplinary expertise in the team Explanation of the timing and methods of application of the lines and their modification Identification of the recipients and explanation of the transfer process

12 Ethical aspects Absence of potential conflicts of interest (for example funding from industry) Appropriate and relevant topics in terms of social utility Clarification of objectives expected of each treatment Assessment of cost-benefit

13 Relevance and appropriateness Relevance to public health system Risk of applying/not applying the treatment Assessment of costs Prognostic evaluation Clinical significance of GL for the quality of life too The GL make it easier and more objective the decision making process Provides criterion to evaluate the quality of care promoted by GL

14 Points of view on GL after focus groups Pro Cons Fair to the people Appropriateness of care Protection from professional misconducts Support for treatment evaluation Better use of available resources Low elasticity Low pertinence to operational dimension Encouragement of a defensive approach Quickly overcome by research evolution Expensive to build and maintain

15 Despite some risks, and looking for the advantages most Italian professionals now agree that the use of guidelines is essential to improve quality and adequacy of treatments offered. But the selection of the contents of such claims, the process of their preparation and procedures for their implementation and progressive review, should be part of a plan properly constructed and maintained.

16 For this reason we stress the importance of: 1.promoting the adequacy and quality of care, enhancing the availability of diagnostic and therapeutic instruments; 2.fostering the exchange between professionals on best practices and practical operational problems;

17 3.supporting the dissemination of the most updated literature and GL, as North American and WHO guidelines, or those developed in other EU countries, as well as the evidence of researches carried out at national and international level;

18 4.identifying a working group with experienced professionals in drug addiction field, experts in the development of clinical guidelines, members of scientific societies, representatives of key national institutions (eg: Istituto Superiore di Sanità and Dipartimento Nazionale Politiche Antidroga), to support a strategy to develop and disseminate guidelines for the treatment of addictions, even identifying a ranking of topics;

19 5.encouraging regional governments to adopt incentives or rewards for health care centers that use evidence-based practice and follow approved clinical guidelines.

20 Il Dipartimento Nazionale Politiche Antidroga- DNPA The role of the National Department for Anti-drug Policies However it is necessary to develop national policies, that favor a homogeneity in the elaboration and in the spread of GL. In this direction, an ulterior opportunity is given by the the activities of the National Department for Anti-drug Policies (DNPA) structure of the Prime Minister's Office.

21 This structure that will be able to develop in this field important initiatives of sovraregional character has started the elaboration policies addressed in various fields, beginning from the field of prevention and treatment of adolescents, thought as one of the more problematic tasks to face.

22 Pompidou Group Treatment Conference on Guidelines and Recommendations Nicosia May 2009