The Netherlands Drug Situation 2010 - Trimbos-instituut

published in the Netherlands from 2000 to 2008 (Sinnema et al. 2009). This study wasbased on a literature review, interviews by mail and interviews by telephone. The meanresponse rate was low (27%), that is 406 interviews by mail from a total of 1,526 thatwere sent to selected professionals. The response was the highest among nurses andpsychologists, followed by psychotherapists and psychiatrists. Very low response rateswere reported for general practitioners, managers, and social workers. Interviews by telephonewere held among directors of professional organizations who were or are activewith guideline construction for mental health care. These interviews targeted 1) the useof these guidelines within their own organization, 2) the way they have tried to stimulatethis use, and 3) their opinion about the best way of stimulating the use of guidelines inthe future. Although the non-response rate was considerable, both the literature reviewand the two interviews largely revealed the same factors that influence the implementationof the guidelines.Sinnema et al. (2009) concluded that the guidelines were used by only a minority ofthe professionals (28%). The use was the highest among psychiatrists (somewhat lessthan 50%), followed by the psychologists (around one third), the psychotherapists, generalpractitioners, and nurses. The use of the guidelines was the lowest among socialworkers and psychotherapists. A clear cut implementation policy and organised supportwithin the organization are considered the most important factors for stimulating the useof these guidelines. On the other hand, the results showed that especially psychiatristsand psychologists feel unsatisfactorily pressed by measures taken by health insurancecompanies and the National Health Inspectorate to use guidelines. According to the experienceof psychiatrists and psychologist these pressures mainly result from economic motivesand are not concerned with the content and the quality of care.A general conclusion is that the energy during the past decade was mainly focused ondeveloping guidelines. This conclusion is also drawn by Fleuren et al. (2009). Accordingto the authors, the impetus of the energy spent during the coming years should be redirectedtoward an increased implementation rate of these guidelines. The study recommendsthe use of computer software programs for increasing the efficiency of careprocesses and for advice, evaluation and feedback. A second recommendation advocatesbrief summaries and overviews that are easy to read for the different professional usergroups, and present clear guidance in which professionals should do what and when.Another important point of attention is investing in (accreditation) training in interactiveworkshops for professionals in using the guidelines, for example in using specific measurementinstruments. Furthermore, not only scientific knowledge should guide the updatingof existent guidelines, but also knowledge about daily experiences should be collectedand reviewed for this purpose. The patient should be more involved in the decisionmaking about diagnosis and treatment options (shared decision making) because untilnow this is rarely done. It is finally recommended to connect the Dutch guideline trajectoryto another trajectory running in (mental) health care, namely the development andimplementation of performance indicators. It is assumed that this will enhance a morestimulating environment for improving the quality of professional practice (Sinnema et al.2009).In mental health care the so-called "break through series" (doorbraakprojecten) havebeen realized to accelerate improvements in patient care for specific disorders or problems.Break through series were developed some fifteen years ago in the USA by DonBerwick, a pediatrician who was inspired by Total Quality Management and wanted toreduce existing resistances among fellow physicians against new (evidence-based) developmentsin medical care. The method has been introduced in the Netherlands by the169