Transcript Mixed Bag of Everything – Interpreting the Finnish TDI

Continuous treatment in Finland
Martta Forsell, the Finnish Focal Point
17/07/2015
Martta Forsell
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Data collection in Finland
• Voluntary for the treatment centers
• Separate client questionnaire, not (yet) part of electronic
patient record.
– When entering treatment
– If client continues in treatment, new questionnaire in January (or
springtime..)
• Covers an estimated one third of the drug-related treatment
– In 2012, 85 units providing drug-related treatment participated in
the information collecting, submitting data on 2,688 clients.
– No obvious biases
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Finnish National Treatment Data 2012
(n= 2 688)
in continuous
treatment
32%
TDI, previously
treated
55%
TDI, first
timers
13%
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Finnish National Treatment Data 2012
(n= 2 688)
in OST
27%
Misuse of
other drugs
than opioids
28%
Misuse of
opioids
45%
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Finnish National Treatment Data 2012
Continuous 2012 (n = 875)
TDI 2012 (n= 1 812)
in OST
16%
Misuse of
other
drugs than
opioids
22%
Misuse of
other drugs
than
opioids
31%
in OST
50%
Misuse of
opioids
28%
Misuse of
opioids
53%
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Length of the treatment (in years since start of treatment)
on continuous treatment
450
400
350
300
250
200
150
100
50
0
over 10
years
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8-10 years 6-7 years
5-4 years
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3 years
2 years
one year
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Length of the treatment as ‘episodes’ (columns)
and the OST for clients (black)
450
400
350
300
250
200
150
100
50
0
over 10
years
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8-10 years 6-7 years
5-4 years
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3 years
2 years
one year
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Renewed questionnaire 2014 onwards
The Finnish survey and guidelines needed improving + TDI 3.0
 The questionnaire has been revised 2012-2013 and fully
renewed questionnaire will be implemented 2014.
– Will be 100% TDI 3.0 compatible
• Rethinking on (among others)
– ‘primary drug’ on continuous treatment
– Continuous treatment in an in-patient facility
– OST information
• More ‘re-launch’ than ‘fine-tuning’. Overall aims:
– better data quality
– better coverage
– better understanding of the coverage
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Primary drug
• Defining the primary drug at the start of treatment is straight
forward enough
• But on continuous treatment the primary problem can change
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Primary drug?
Primary drug?
Secondary drug?
Route of admistration?
Frequency?
Intrest on treatment inputs
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Intrest on epidemiology
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Primary &
secondary drug
- Route
- Frequency
Primary drug
Secondary drug
- route
-frequency
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Primary (secondary) drug in Finland from 2014
onwards
• Primary drug now (~30 days prior entering treatment)
OR
• Long-standing problem drug which
– contributed to the entering treatment or
– is emphasized in the current treatment
~ drug the client is addicted to (whether at the moment active drug
use)
• The OST clients are always addicted > opioid as longstanding drug
• Frequency is always the very last 30 days (except in-patient..)
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In-patient client
• Enters treatment 1.Dec
• Questionnaire: use of drugs in Nov
• New questionnaire in Jan: use of drugs in Nov
• > the copy of previous questionnaire
• Client checks out in Feb
• New questionnaire in Feb in an out-patient facility: use of
drugs in Jan-Feb
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Primary (secondary) drug in Finland from 2014
onwards
• Primary drug now (~30 days prior entering treatment)
OR
• Long-standing problem drug which
– contributed to the entering treatment or
– is emphasized in the current treatment
~ drug the client is addicted to (whether at the moment active drug
use)
• The OST clients are always addicted > opioid as longstanding drug
• Frequency is always the very last 30 days (except in-patient..)
• NO more in-patient continuous questionnaire
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Primary (secondary) drug in Finland from 2014
onwards
• Primary drug now (~30 days prior entering treatment)
OR
• Long-standing problem drug which
– contributed to the entering treatment or
– is emphasized in the current treatment
~ drug the client is addicted to (whether in remiss or not)
• Which we should put forward as we report the primary drug
for the EMCDDA?
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