1 guidelines as a way of harmonisation in europe: pro’s and con’s prof. dr. jan. a. swinkels...
TRANSCRIPT
![Page 1: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/1.jpg)
1
GUIDELINES as a way of harmonisation in Europe: Pro’s and
Con’s
Prof. Dr. Jan. A. Swinkels
PsychiatristProfessor in clinical guideline development in health care
![Page 2: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/2.jpg)
Harmonisation Europe and health care
• Driven by ideals:– It is our moral duty to realise the 'idea of Europe' -
Europe founded on the values of democracy, rule of law, respect for human rights, prosperity and stability" concluded Mr. Cox, chairman of the European parliament
• Drive ideological: – Where is the power?
• Driven by facts and an ideal:– there are great inequalities in the health care it’s our
moral duty to diminish them, can guidelines helps?
![Page 3: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/3.jpg)
3
Good healthcare
• Good standard (EB guidelines)• Effective (the size of the effect)• Safe (side effects, troublesome or dangerous)• Accepted (effect= quality x acceptation• Applicable (in and exclusion criteria)• Feasible (available, in time)• Patient directed (patient involvement)• Meets the real objective needs of the patients• Efficiency (value for money)
effectiveness
![Page 5: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/5.jpg)
5
CLINICAL GUIDELINES
Definition:
Systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.
Institute of Medicine, Field and Lohr (1992)
![Page 6: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/6.jpg)
Evidence based?
• Evidence ≠ proof
• A guideline is called evidence based after a search for the evidence even when there is not enough evidence
• Why?– No evidence is not the same for doing nothing
• Mono of multidisciplinary
![Page 7: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/7.jpg)
7
WHY EB GUIDELINES?
• It’s difficult (impossible?) to keep up with the literature and judge the validity and implications of the research findings for there use in clinical practice– problems with information management
• There is considerable evidence of a gap between evidence and practice
![Page 8: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/8.jpg)
8
![Page 9: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/9.jpg)
9
BARRIERS RELATING TO INFORMATION MANAGEMENT
Identifying effective health care interventions.Health care professionals have difficulty in identifying and comprehending literature due to:– It’s to much– Poor presentation of research findings– No ‘just in time information’ and a lack of time to
search for information– Dispersion or scatter of relevant literature across a
large number of journals (ICT and search engines)– Difficulties in interpreting published evidence (new
knowledge is necessary)
![Page 10: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/10.jpg)
10
![Page 11: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/11.jpg)
Are EB guidelines needed?
• From research it’s clear that a considerable part of our patients didn’t get evidence based treatment (Wang e.a.2005, Young e.a.2001, Fernandez e.a. 2007, Lehman e.a. 2004, Leslie e.a. 2004, Weinmann e.a. 2005)
• So what, are EB treatments better than care as usual?
• EB treatments diminishes the burden of diseases. It’s possible to get an average profit of 25 % (Andrews e.a. 2004, Issakides 2004 e.a.)
![Page 12: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/12.jpg)
Are EB guidelines needed?
• The last conclusion is on statistical epidemiological research, but is it confirmed by clinical studies?
• Yes: (Bauer e.a.2002, Adli e.a.2006, Supes e.a. 2004, Dennehy e.a.
2005), by the treatments themselves and by ‘measurement based care’
• Is this confirmed by implementation research of an EB guideline?
![Page 14: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/14.jpg)
14
IMPLEMENTING GUIDELINES
• Largely ineffective strategies - dissemination of written educational materials, didactic educational sessions
• Variable effectiveness - audit and feedback, local consensus conferences, opinion leaders consensus conferences
• Largely effective - reminders, educational outreach (for prescribing), patient mediated interventions, interactive educational workshops, multi-faceted interactive interventions(Grol e.a. 2001, 2003)
![Page 15: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/15.jpg)
Disappointing results?
• We need more research findings to improve the implement ability of the guidelines– There is a high generalisation level, we need
information on subgroups• We need more research with effect modificators
(age ethnicity, co morbidity etc.)
• So more research in needed despite the circumstantial evidence
![Page 17: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/17.jpg)
Can we adopt a guideline developed elsewhere?
• Yes– But try to reduce ideological thinking– Use scientific evidence in the guideline– Adopt a coherent frame work for action
![Page 18: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/18.jpg)
Con’s and pro’s
• Not simple select the best clinic or provider
• Private provision of care is not inherently better
• Not exclude the professionals
• Not exclude costs• Impossibilities
• Try to develop data and make them public
• Optimize the use of available evidence about what works and doesn’t works (use the Dutch guideline!)
• Use ADAPTE to make your own guideline
• Use effective implementation strategies
![Page 19: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/19.jpg)
![Page 20: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/20.jpg)
20
![Page 21: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/21.jpg)
21
MEDICO-LEGAL ISSUES
• Do not in principle represent a barrier to implementation
• Use of guidelines protect against liability• Compliance with clinical guidelines is unlikely to
prove decisive in a medical negligence action, unless the intervention concerned is so well established that no responsible doctor acting with reasonable skill would fail to comply with it
• Non compliance is possible or sometimes necessary but needs to be documented
![Page 22: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/22.jpg)
![Page 23: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/23.jpg)
Take home messages
• EB Guidelines can help to improve the quality and safety of care in Europe
• Transparency is needed• For the public to make choices• Professionals are stimulated to work better• Economic reasons: value for money
• Make a plan to make use of the Dutch guideline by using ADAPTE and effective implementation methods
23
![Page 24: 1 GUIDELINES as a way of harmonisation in Europe: Pro’s and Con’s Prof. Dr. Jan. A. Swinkels Psychiatrist Professor in clinical guideline development in](https://reader030.vdocuments.net/reader030/viewer/2022032600/56649dc75503460f94abbb6c/html5/thumbnails/24.jpg)
Literature