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National Drug Treatment Monitoring System
The Annual Client Review
DMRU - Drug Misuse Research Unit
Evidence for Population Health Unit
School of Epidemiology & Health Sciences
University of Manchester
Michael Donmall
Senior Research Fellow & Unit Director
www.medicine.man.ac.uk/epidem/dmru
 DMRU 2002
DMRU
Development of UK Drug
Treatment Information
• 1968-1997 Addicts Index, doctors, opiate/cocaine
addicts
• 1985
Drug Misuse Database (DMD)
• 1990
DH adopted system nationally
» Harmonization
» Definitional
• 1999
Strategic Review
• 2001
National Drug Treatment Monitoring
System (NDTMS)
• 2002
Minimum Data Set for ‘Models of Care’
 DMRU 2002
DMRU
Information Needs
Agency
Agency
Agency
Agency
Agency Agency
Agency
Agency
Referral, Client Details, Initial Assessment
Clinical Management, Full Assessment
[prescriptions, interventions]
AGENCY
Outcomes
Drug Action Teams
Health Authorities
REGIONAL
Dept of Health
NTA
NATIONAL
EMCDDA
 Donmall 2001
DMRU
Drug Misuse Database (DMD)
Incident User Episodes - scale of problem
35000
30000
25000
20000
England
Wales
Scotland
15000
10000
5000
0
93b 94a 94b 95a 95b 96a 96b 97a 97b 98a 98b 99a 00a 00b 01a
 DMRU 2002
DMRU
The New System
Client
Contact Form
First face-to-face
contact after 1
April 2001
Review
Form
Triggered on 31
March 2002
“out of contact”
Next time
client
presents
 DMRU 2002
New Contact
Form
“still in contact”
Review
Form
On 31 March
2003 and each
year after that
DMRU
The Reporting Process
Community-based
drug services,
outpatient clinics
Everybody
from
April 2001
Everybody
from
April 2002
 DMRU 2002
Client
Contact
Client
Review
General
Practitioners
Client
Contact
Client
Review
Residential and
inpatient units
Everybody
from
April 2001
Admission
Everybody
at
discharge
Discharge
DMRU
Client Contacts
Additional Data
• Key dates for waiting times - referral, 1st
Face to Face contact, assessment
• Interventions referred for
• 1st treatment demand data
• Drug leading to presentation
• Lag between drug use & treatment demand
• …… other refinements
 DMRU 2002
DMRU
Client Reviews
Additional Data
• Treatment interventions received (inc. drugs
prescribed, supervised consumption, pickup details, shared
care arrangements,vaccinations)
•
•
•
•
•
 DMRU 2002
Key dates, assessmt, last contact, discharge
Completion of treatment
Length of contact
Reasons for loss of contact
…… other refinements
DMRU
Enormously Greater Relevance
• for Key Performance Indicators and Targets
set at Government level
• for Understanding & Performance
Management at Local level region/ DAT
 DMRU 2002
DMRU
Contact: Individuals in Treatment
2001/2
9000
53%
8000
7000
6000
5000
30%
Individuals = 14,648
4000
3000
17%
2000
1000
0
First Ever
 DMRU 2002
New Demand
Ongoing
DMRU
Waiting times: between referral and
assessment 2001/2
60%
New Clients
Ongoing Clients
50%
40%
30%
20%
10%
0%
<1 week 1 week to
1-3
1 month months
 DMRU 2002
3-6
months
>6
months
DMRU
Time Lag: between first use of heroin
and first ever treatment demand 2001/2
35%
30%
New Clients
Clients
25%
20%
15%
10%
5%
0%
Same year 1-2 years 3-5 years 6-9 years >10 years
 DMRU 2002
DMRU
Contact & Review: Levels of
reporting 2001/02
20000
CLENTS = 17,884
18000
16000
14000
12000
< 83%
return
rate
10000
8000
6000
4000
2000
0
Contact
 DMRU 2002
Review
DMRU
Review: Treatment status at year end
2001/2
4500
4000
3500
3000
2500
2000
1500
1000
500
0
45%
34%
21%
In contact
 DMRU 2002
Number of CLIENTS
(Greater Manchester)
Contact lost
Incomplete
(to date)
DMRU
Review: reasons for loss of contact
1200
41%
1000
Number of CLIENTS
(Greater Manchester)
800
600
400
12%
10%
200
3%
9%
6%
1%
0
Treatment
completed
 DMRU 2002
Treatment
withdrawn
Referred on Dropped out Moved away
Prison
Died
DMRU
Review: treatment interventions
received during 2001/2
4500
Number of CLIENTS
(Greater Manchester)
70%
4000
60%
3500
3000
2500
30%
2000
1500
16%
1000
8%
500
5%
0
Methadone
 DMRU 2002
Benzos
Buprenorphine
Shared care
Daily pickup
Supervised
consumption
DMRU
Issues raised by first review
• Low initial return rate (70%)
• High rate of validation required
– attributors don’t match between contact &
review
– agency client number unreliable
– invalid dates (referral after assessment etc.)
• Effort required to maximise response (83%)
 DMRU 2002
DMRU
Models of Care
for
Substance Misuse Treatment
1. Non-substance misuse specialist services
2. Open access substance misuse services (SMS)
3. Structured community-based SMS
4. Residential SMS
5. Highly specialised non-SMS
 DMRU 2002
DMRU
Example Care Pathway
Community Detoxification
Initial Asses sment date
Who
When
Initial Asses sment by
Initial Asses sment outcome
Prescribing appropriate
%
Referred on to
Full Assess ment by
Refer to prescribing se rvice
Full Assess ment Date
Full Assess ment Outcome
How long
Stabilisation for
Drugs Prescribed
Failur e
Prescription start date
Discharge Date
Why
Discharge Reason
Prescribing not appropriate
Init ial Assessment
When
n
Who
When
Inpatient detox
Full Asse ssment
%
Who
Community Detox %
How long
Car e Plan
Onward Referral date %
Onward Referral to
Stabilisation
When
Which
What
Key
Performance Indicator
Information Need
Data I tem
 DMRU 2002
n
How long
Opioid
Detox %
Alc ohol
Detox %
Ben zod iazepine
%
Detox
Polydrug
detox %
Success
%
Aftercare
Plan
When
Who
DMRU