Information on drug use, markets and related problems, European policies on drugs and practices: these are the trends that the European Drug Report 2016 has collected, with the collaboration of the European Commission, Europol, the European Centre for Disease Prevention and Control (EMCDDA), and the European Medicine Agency.
“This year’s analysis once more highlights how Europe increasingly faces a more complex drug problem, in which stimulants, new psychoactive substances, misused medicines and problematic cannabis use all play a greater part”, Laura d’Arrigo, chair of EMCDDA Management Board and Alexis Goosdeel, director of EMCDDA, wrote in the preface. They also stated that “some of the problems of the past remain with us — even if the challenges they are now presenting for both policy and practice are changing. Europe’s opioids problem remains a central issue in the 2016 analysis, reflecting the significant impact these drugs still have on mortality and morbidity. We see now an increasingly complex relationship between use of heroin and synthetic opioids, accompanied by a worrying increase in overall estimates of opioid-related deaths”. Whereas among the new challenges for drug policy, Internet’s role both as a communication medium and a source of drug supply.
The European Drug Report 2016 can be downloaded here
The basic health service has always been prioritised in preventive work. As early as in the 1940s we had our network of maternity and childcare instruction clinics. The Finnish mortality rate in maternity and perinatal groups is very low, even inside the European Union (EU). As the family doctor system emphasised the availability of medical care, at least in its beginning, there was a fear of preventive care decreasing. Fortunately this did not happen. Basic healthcare has taken responsibility for most of the preventive activities. The family doctors have understood the significance of this work for the welfare of the citizens. More than half the Finns already belong to the family doctor system, so the availability of the medical care has improved and there are no more queues for general practitioner (GP) consultation. Medical care takes place mostly in the hours of consultation and home visits are rare. There is a home care system in our health centres where nurses, together with the family doctor and with social care home helpers if needed, try to support very sick people in living at home. Home visits of doctors are still very rare, but the aim is to increase them in the future. Our system is also more focused on hospitals than any other systems in the EU, but this will be changed. Our family doctors function in health centres comprising several doctors, with x-ray and laboratory services produced by the health centres themselves at their disposal. Finland is very sparsely populated and particularly in the north of the country the health centres function more like hospitals. There are no common borders for the developing functions, even with expertise, so there are many healthcare units where the GPs operate more as if for specialised care. In more crowded areas, the health centres and the hospitals will increasingly co-operate, unified by the lab and x-ray functions, when the data systems develop and the same unit can serve both health centre and the central hospital.In developing healthcare, the pressure of increasing costs is high and the quality requirements have emerged. There are more and more investigations done to solve the overlapping and interpenetrating functions of hospital care, basic healthcare and social care. The evidence-based care has come where the medical care is always based on evidence. There are regional medical programmes increasing the quality and emphasising the differentiation, improving the co-operation and data chains. The regional care programmes are done in co-operation with specialists, GPs and nurses.Several quality programmes and projects have been started. Instead of regional care-taking programmes, the thinking is moving towards care chains, especially including the problems of interfaces. The aim is to improve the status of patients, offering high quality care and good co-operation between health and social care systems. The patient should always be in the right place to be taken care of and so the economic gain would be clear. The real time data change is obligatory for good care.Our healthcare system is based on strong basic healthcare in the health centres. The availability of services can be more important than the right to choose the doctor. The GP’s position as a gatekeeper has been emphasised and the family doctor system has made it possible. In the doctors salary system the availability of medical services has been emphasised, meaning that only a part of doctor’s income is salary: the rest is comprised of fees for service and fees for capitation. The fee for service system will direct the activities of the GP and emphasise preventive activities, especially in the last salary contracting movement.
