Was meint „good practice” in der Suchtarbeit?

Zusammenfassung

Eine gute (präventive, beraterische, therapeutische) Arbeit mit Menschen, die Suchtprobleme haben, geht über eine auf wissenschaftliche Evidenz abgestützte Praxis hinaus, indem sie auch auf situative Faktoren abstellen muss. Die „Güte” einer Praxis bemisst sich an ihren Ergebnissen, also daran wie weit sie die generellen und individuellen Ziele der Suchtarbeit zu erreichen vermag, und dies auf der Mitarbeiter-, der Institutions-, der Netzwerk- und der Politikebene. Dies wird anhand von Kriterien und Beispielen dargelegt. Auf der anderen Seite ist zu berücksichtigen, dass die Evidenzbasis von unterschiedlicher Qualität und für den konkreten Fall nicht immer hilfreich ist. Und schliesslich werden Strategien der Umsetzung von guter Praxis besprochen, von den Ansprüchen an die Weiterbildung bis zur Öffentlichkeitsarbeit, die der guten Praxis die nötige Unterstützung sichern soll.

Abstract

Good practice is more than best practice which is based on scientific evidence about the efficacy and effectiveness - eventually cost-effectiveness - of a given method or approach. Good practice has to take into account situational factors as well, such as the availability, acceptability and affordability of a treatment. The objectives of good practice are diverse on the levels of staff, of services, of the treatment system or network in a given region, and of policy and the community. All levels have to be considered, if good practice is not merely focusing on the well-being of the individual patient, but as well on a satisfactory coverage of all in need of treatment. In regard to the evidence base, the practitioners need reliable information about the quality and specificity of the evidence and of the respective recommendations. Finally, some deficits in knowledge transfer are discussed, as well as recent models to match services to patients and to make best use of the available resources. The role of addiction specialists in the future world is to be shaped accordingly.

Schlüsselwörter

Suchttherapie - Qualitätskriterien - Weiterbildung

Key words

addiction treatment - quality criteria - continued education

Literatur

• 1 Roche A, Freeman T. Brief interventions: good in theory but weak in practice.  Drug and Alcohol Review. 2004;  23 11-18
• 2 Lohr KN. Guidelines for clinical practice: applications for primary care.  International Journal for Quality in Health Care. 1994;  6 17-25
• 3 Katz DA. Barriers between guidelines and improved patient care: an analysis of AHCPR's unstable angina clinical practice guideline.  Health Services Research. 1999;  34 377-389
• 4 Grol R, Dalhuijsen J, Siep T. et al . Attributes of clinical guidelines that influence use of guidelines in general practice: observational study.  British Medical Journal. 1998;  317 858-861
• 5 Atkins D, Briss PA, Eccles M. et al . Systems for grading the quality of evidence and the strength of recommendations II: pilot study of a new system.  BMC Health Services Research. 2005;  5 25
• 6  . Matching patients with alcohol disorders to treatments: clinical implications from Project MATCH.  Journal of Mental Health. 1998;  7 589-602
• 7 Ball JC, Ross A. The Effectiveness of Methadone Maintenance Treatment. Springer, New York 1991
• 8 Hser YJ, Polinsky ML, Maglione M, Anglin MD. Matching clients needs with drug treatment services.  Journal of Substance Abuse Treatment. 1999;  16 299-305
• 9 MacLellan AT. The role of Psychosocial Services in Drug Abuse Treatment. In: Waal H, Haga E (Eds) Maintenance Treatment of Heroin Addiction. Evidence at the crossroads. Cappelen, Oslo 2003 pp. 265-295
• 10 Gerstein DR, Zhang Z. The effects of matching comprehensive services to patient's needs on drug use improvement in addiction treatment.  Addiction. 2004;  99 962-972
• 11 Mee-Lee D, Shulman GD, Fishman M. et al .ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders Second Edition-Revised. Chevy Chase, Maryland, American Society of Addiction Medicine, Inc 2001
• 12 Magura S, Staines G, Kosanke N. et al . Predictive validity of the ASAM Patient Placement Criteria for naturalistically matched vs. mismatched alcoholism patients.  Am J Addict. 2003;  12 386-397
• 13 Schippers GM, Schramade M, Walburg JA. Reforming Dutch substance abuse treatment services.  Addictive Behaviors. 2002;  27 995-1007
• 14 Murphy SA, Collins LM, Rush AJ. Customizing treatment to the patient. Adaptive treatment strategies. Drug and Alcohol Dependence.  . 2007;  88 1-3
• 15 Breslin FC, Sobell MB, Sobell LC, Cunningham JA, Sdao-Jarvie K, Borson D. Problem drinkers: evaluation of a stepped-care approach.  Journal of Substance Abuse Abuse. 1999;  10 217-232
• 16 Sobell MB, Sobell LC. Stepped care as a heuristic approach to the treatment of alcohol problems.  Journal of Consulting and Clinical Psychology. 2000;  68 573-579
• 17 Ali R, Aumphornoun B, Chiamwongpaet S. et al . WHO collaborative study on substitution therapy of opioid dependence and HIV/AIDS.  Abstract, CPDD meeting Ottawa. 2007;  , Publications pending
• 18 West S, King V, Carey TS, Lohr KN. et al .Systems to rate the strength of scientific evidence. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ publication 2002 No 02-E016, 64-88)
• 19 Atkins D, Best D, Briss PA, Eccles M. et al . Grade Working Group: Grading quality of evidence and strength of recommendations.  BMJ. 2004;  328 1490
• 20 Falck-Ytter Y, Antes G, Oxman A. Qualität der Evidenz und Stärke von Empfehlungen für medizinische Entscheidungen.
• 21 MacLellan AT, Carise D, Kleber HD. Can the National Addiction Treatment Infrastructure Support the Public's Demand for Quality Care?.  Journal of Substance Abuse Treatment. 2003;  25 117-121
• 22 Uchtenhagen A, Stamm R, Huber J, Vuille R. (zur Publikation angenommen) . A review of systems for continued education and training in the substance abuse field.  Journal of Substance Abuse.
• 23 Kirkpatrick DL. Evaluating Training Programs: The Four Levels, 2nd Edition. Berrett-Koehler Publishers, Inc, San Francisco 1998
• 24 ENQA .European Association for Quality Assurance for Higher Education. Helsinki 2007 http://www.enqa.eu
• 25 World Health Organisation .Health professional education on psychoactive substance use issues. Report based on a WHO consultation. WHO, Geneva 1996
• 26 International Think Tank on Continued Education and Training on Addiction.  http://www.i-theta.org
• 27 Abdulrahim D. National Treatment Agency for Substance Misuse, UK . Harm reduction findings from the NTA's 2006 survey of user satisfaction in England.  August 2007; 
• 28 Nabitz UW, Aarse HR, Brink W van den. Consumer satisfaction as a quality indicator for mental health and addiction treatment services in the Netherlands.  2006;  , Unpublished research report ([e-mail]).
• 29 Calafat A, Fernandez C, Juan M. et al . Enjoying the nightlife in Europe. The role of moderation. 2003;  , IREFREA ESPANA.
• 30 Miller WR, Weisner CM. (Eds) Changing substance abuse through health and social systems. Kluwer New York 2000

Korrespondenzadresse