ABSTRACT
The increasing abuse of the street drug crystal meth (methamphetamine) in many countries worldwide has resulted in a growing demand to treat patients who have acquired a methamphetamine-related disorder. The results of a systematic literature search which led to the consensus-based recommendations by the Working Group of the German Agency for Quality in Medicine (Ärztliches Zentrum für Qualität in der Medizin - ÄZQ) are presented. Pharmacological treatments were reviewed in 58 out of the 103 publications included. They were mainly randomized controlled trials (RCT). Despite increased research activities, none of the medications studied demonstrated a convincing and consistent effect on abstinence rates, despite some having an impact on craving and retention rates or symptom control. In addition, as yet there is no sufficient evidence available for dopamine analogue treatment ("substitution") after the initial withdrawal-period. Methamphetamine-related, post-acute persistent or comorbid syndromes such as methamphetamine-associated psychosis (MAP), depressive syndromes, anxiety, and sleep disorders are usually treated in a symptom-oriented manner. Risks of interactions with methamphetamine have to be taken in account when prescribing medications with doubtful efficacy. Further research is warranted.
Subject(s)
Amphetamine-Related Disorders/drug therapy , Evidence-Based Medicine , Mental Disorders/drug therapy , Methamphetamine/adverse effects , Practice Guidelines as Topic , Psychoses, Substance-Induced/drug therapy , Secondary Prevention/methods , Amphetamine-Related Disorders/epidemiology , Antipsychotic Agents/therapeutic use , Benzodiazepines/therapeutic use , Comorbidity , Humans , Mental Disorders/epidemiology , RecurrenceABSTRACT
For several years patient versions of guidelines have become mandatory in the German Guidelines Program in Oncology (GGPO). Based on the methodology that has been developed for the German National Disease Management Guidelines Program, patient versions of guidelines translate the recommendations of clinical practice guideline into plain language and provide information about the harms and benefits of the interventions being addressed in the guideline. They are developed by a group of guideline authors (experts as well as patients), they are consensus-based and aim to create transparency in recommendations for physicians and their rationales. An automated analysis of readability shows that patient versions of guidelines are specific to the target group of educated lay people. Moreover, the responses to a reader feedback questionnaire indicate that comprehensibility, level of detail and depth of information are considered highly relevant and positive by users. Thus, patient versions of guidelines meet the needs of a specific target group. Nevertheless, the development of other formats for readers with low levels of health literacy or cognitive competencies is desirable. Currently it remains unclear if these simplified formats are able to reflect the complexity of high quality clinical practice guidelines.
Subject(s)
Medical Oncology/organization & administration , National Health Programs/organization & administration , Patient Education as Topic/organization & administration , Practice Guidelines as Topic , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Breast Neoplasms/therapy , Comprehension , Female , Germany , Health Literacy , Humans , Male , Neoplasm Metastasis , Organizational Objectives , Pamphlets , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/pathology , Prostatic Neoplasms/therapy , Quality Assurance, Health Care/organization & administration , Surveys and QuestionnairesABSTRACT
Since 2010, the German Agency for Quality in Medicine has developed so-called short information leaflets for patients that are specifically designed for use in doctor-patient encounters. Physicians, patient representatives and communication specialists were involved in the development of this format. Their implementation aims at enhancing awareness and dissemination of these leaflets amongst the members of the self-governing bodies and other multipliers (like medical specialty societies, patient organisations, other bodies and institutions of the healthcare system). This paper describes the first implementation experiences on the basis of internally collected data on the involvement of multipliers, availability and assessment of their relevance. A first analysis shows that the short information leaflets are broadly available amongst the self-governing bodies and that they are considered to be of high relevance. Due to the direct involvement of the members of specialty societies and patient organisations and other experts, short information leaflets are also gaining acceptance outside the self-governing system. This is emphasised by the rising number of requests to reprint or cite or use the leaflets. Consistency with evidence-based treatment recommendations promotes acceptance of these leaflets among physicians.
