The Netherlands Drug Situation 2010 - Trimbos-instituut

For most guidelines, the rate of implementation (i.e. percentage of organizations thatuse these products routinely (in most cases without adaptations) increased when comparingthe outcomes of the 2005- and 2008-evaluation. Table 11.2 shows that, for theearly published guideline on comorbidity, the implementation rate increased from 50% in2005 to 64% in 2008. For the guidelines on compulsory discharge and on detoxificationthere was an increase from 42% to 46% and from 42% to 64% respectively. Finally, forthe later published guidelines on methadone maintenance treatment and (intensive) casemanagement, only 2008 data were available showing implementation rates of 91% and64% respectively. The implementation rate of the client profiles guideline decreased between2005 and 2008, namely from 42% to 36%, possibly indicating a lack of interest orusability.According to the authors, the implementation of the guidelines on comorbidity anddetoxification still needed reinforcement in 2008. Suboptimal implementation rates arereported for compulsory discharge and client profiles. Some organizations adapted aguideline to the local situation before implementing it, sometimes because the guidelinewas not satisfactorily specified for the target group (see for instance § 11.3.3). Otherorganizations decided not to implement the guideline. However, the general conclusionwas that the products from Scoring Results have become better known in the field andalso better implemented compared to the earlier evaluations (Spits et al. 2009b).It should be noted that these evaluations were based on self-reports via interviews bytelephone. Besides, these interviews were often conducted with only one and in somecases only a few professionals in each institute for addiction care. Furthermore, the outcomes(the degree of application of a product) are prone to interviewer and intervieweebias. The validity of these evaluation results is therefore limited. It should also be notedthat for each separate guideline, available for not longer than three years, the answerswere categorized in pre-defined stadia of implementation: orientation, insight, acceptance,change (or adaptation), and maintenance (Grol et al. 2006). In several organizationsthe guidelines were changed before implementation, and in some other organizationsthe guidelines were not implemented at all. Finally, recommendations were presentedfor updating several guidelines and other products, because they are either outdatedor not implemented (Spits et al. 2009b).The researchers also studied opinions about the factors that influence the implementationof guidelines. These factors were divided into: 1) individual factors (cognitive, motivationaland behavioural) that refer to the patient, the professional, the manager andothers who use the guideline; 2) social factors like professional training, teams and networks;3) organizational factors like structures and processes and means; and 4) societalfactors such as funding and legal measures (Grol et al. 2006). The individual factors thatwere mentioned most frequently were the attitude of professionals in addiction care, characteristicsof the guideline, and the way of introducing the guideline. A social factor ofimportance appeared to be the degree of cooperation within teams of professionals. Cleardivision of responsibilities and working pressure were often mentioned as organisationalfactors. The societal factors that were mentioned were mainly financial factors like fundingand facilities. Successful implementation of guidelines was also reported to be enhancedby guidelines being brief and clear for professionals and management. Implementationalso needs a planned strategy and increased information sharing (Spits et al.2009a;Spits et al. 2009b).Besides these more general studies on the implementation of guidelines in mentalhealth care and addiction care, separate reports have been published on the implementationof the guideline for detoxification and the guideline for methadone maintenance172