Development and implementation of Evidencebased patient pathways for substance abuse

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1 Development and implementation of Evidencebased patient pathways for substance abuse Birger Pedersen MBA R.N. Department of clinical health promotion centre & University hospital Skåne (Scania) Sweden

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4 Background The organisation of psychiatry has a long story of changes and cut backs in the past. The psychiatry division where under surgical or/ and medical management Only one center for addiction and abuse are present in the region (since 1968) In 2009 all the psychiatric care, including abuse and addiction was organized in one organization.

5 Background Diversity of management Developt different: cultures structures criteria for access collaboration with social care treatment programmes lack of follow up systems

6 Background One big issue is that the care of the addiction and abuse patients are handled by two principles. Medical issues is handled by the health care system Psycho/social issues is handled by social services The interface between the principals are complicated

7 Project specialised abuse and addiction care The aim for this project was: Make an inventory of the existing abuse and addiction functions and care Produce golden standards (guidelines/health care programs Implement the standards Organize a center of excellence for abuse and addiction

8 Best Evidence-Based HP Includes three parts Best Evidence Staff expertise Patient preference (Sackett, DL, Strauss SE, Richardson WS et al. Evidence-based medicine. Churcill Livingstone 2000)

9 Australia, Austria, Belgium, Brazil, Canada, Denmark, Estonia, Finland, France, Germany, Hong Kong, Ireland, Italy, Japan, Kasakhstan, Korea, Malaysia, Mexico, Moldova, Netherlands, New Zealand, Norway, Portugal, Romania, Slowenia, Spain, Sudan, Sweden, Switzerland, Taiwan, United Kingdom, United States of America ART - The AGREE Research Trust; The ADAPTE Collaboration, UEMS (EUR) - European Union of Medical Specialists ; WCPT (BE) - European Region of the World Confederation of Physical Therapy ; WHO - World Health Organisation; WMA - The World Medical Association 78 organized ( organizations) members, from 37 countries, such as WHO

10 Metodologisk kvalitet + II + May

11 Inventory During three months this was carried out We found big differences between the hospitals Ranging from nothing and a full range of different programs.

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13 Work groups We organized eleven different working groups In total we had around 70 people working in these groups All hospitals had at least 3 persons present in these groups We made sure that all personal categories was represented In some of the groups we also had representatives from the user organizations A special group for users was established, the main purpose was rehabilitation issues A steering group directed the work on a global perspective

14 Cannabis ADHD + substance abuse Areas Substitution treatment national guidelines available Alcohol national guidelines available Pain patients with an addiction iatrogen Tablet abuse and or addiction benzodiazepines and opiates Central stimulants Youth group Comorbidity Rehabilitation Designer drugs

15 Golden standards We produced in total nine different guidelines including flow charts (golden standards) Some twenty steering documents were produced to support the golden standards We where not able to have a consensus regarding the total need for hospital beds

16 Patienten blir godkänd för behandling Kriminalvår den LARO Patienten finns på en anstalt eller häkte. Skall sedan tidigare stå i kö för läkemedelsassisterad behandling. Patienten kan också ställa sig i kö under strafftiden. Bedömning görs av kriminalvården om det finns några hinder för att starta en behandling. Bedömning görs av sjukvården om det finns en spärrtid eller andra hinder för att starta en behandling. Patienten tar själv kontakt med aktuell mottagning. Frivårdkonsulenten tar kontakt med aktuell mottagning Utökat bedömningssamtal skall anordnas av sjukvården i samarbete med kriminal-vården. Patienten blir inte godkänd för behandling

17 Implementation in progress Several seminars have been hold Special programme for training and education Every clinic has to appoint three or four persons with a special responsibility in this area Several networks is established Central website

18 Follow up In every guideline we have indicators These indicators focus on, Performance Outcome of treatment Follow up Long term results

19 Follow up In the golden standards we have at least five indicators in each These indicators and result will be presented every third months Will be able to detect several things such as effects, competence and lack of We will post this data so all departments can be compared A data base will be built so we can use the data in future research

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