Transcript Ambros UCHTENHAGEN & Michael SCHAUB

EQUS
European quality standards in drug
demand reduction: Project Overview
EQUS Conference - Brussels, June 15, 2011
Ambros Uchtenhagen, Michael Schaub
Contact:
[email protected]
www.isgf.ch
The main tasks
2
The main tasks of EQUS project
1.
To establish an expert group
2.
To identify, map and review existing quality standards and benchmarks (in
prevention, early detection and early intervention, treatment, harm reduction and
social rehabilitation) and to provide a gap analysis
3.
Set up a consultation and consensus building mechanism
4.
To develop a design for a framework of minimal quality standards and benchmarks
(structure, key aspects, type and level of specification). This design should also
reflect on potential risks, uncertainties and other factors
5.
To present options and suggestions for minimal quality standards and benchmarks
as a discussion basis between experts and policy makers
6.
To prepare for the Commission a final report consisting of options on EU minimum
quality standards and benchmarks in the field of drug demand reduction
3
The expert group: project partners
•
Prevention
– Separate expert group of EU project
– Coordinated at John Moore University, Liverpool
– Special advisors and consultants
•
Treatment / rehabilitation
–
–
–
–
•
European core group
Collaborating partners
International partners (USA, CA, AU)
Coordinated at ISGF, Zurich University
Harm reduction
– European core group
– Special advisors and consultants
– International contributions from Kent University
4
Inventory of existing quality
standards & benchmarks
(in Member States and
internationally)
5
Inventories: general procedures
•
3 separate inventories for quality standards in
– Prevention interventions and systems
– Treatment & rehabilitation interventions, services and systems
– Harm reduction interventions, services and systems
•
Identification of relevant documents
– Detailed instructions on inclusion and exclusion criteria
– Identification of “reference documents”
•
•
Establishing national lists of included and excluded documents
Extracting contents from included documents
– Using prepared structured templates (in English)
– No translation of integral documents from national language into English
– Supervision by senior scientists
6
Inventories: drug prevention
•
•
•
•
In the field of drug prevention, the development of minimum quality
standards has taken a different approach. In 2009, the Commission
provided funding for a project titled 'European Drug Prevention Quality
Standards'
This project was carried out by the Prevention Standards Partnership, led by
the UK Liverpool John Moores University, and completed in November 2010.
This project systematically reviewed drug prevention programmes and
interventions in the EU and at international level and developed a set of
process quality standards in the field of drug prevention. The experience
and information produced through this project has been adapted for the
development of the EQUS project.
See http://www.cph.org.uk/drugprevention/
7
EQUS: document search criteria
•
•
•
Include published documents providing information on quality
standards on specific interventions, on specific settings of intervention
delivery, and of regional / national intervention networks
Exclude
– unpublished grey literature, documents on local standards and
documents without declaration of their origin
– standards/guidelines not focusing exclusively on the drugs field
(e.g. general standards in health or social care)
– International documents if not made relevant at national level
Priority is given to
- official documents (e.g. by health authorities, professional
associations, major service providers, insurances)
- research reviews / reports, indicating the grade of evidence for the
findings
8
EQUS: template structure
•
General descriptors
–
–
–
–
–
•
Template ID: country code, document nr, template nr, author,date
Publication details
Mandating body (stakeholder)
Legal status of document
Methods used for identifying standards and benchmarks
Specific descriptors
– Specifications of interventions, services, systems
– Specific structural, process and outcome standards
– Grading of evidence per standard
9
EQUS: grading of evidence
(developed from Atkins 2004)
•
•
•
•
•
•
•
A highest degree of evidence: meta-analysis or review of randomised
controlled studies (RCT)
B very high degree of evidence: review from multiple RTC with convergent
results
C high degree of evidence; results from single RCT and controlled clinical
studies
D moderate degree of evidence: prospective comparative longitudinal
studies without control design
E low degree of evidence: single intervention/service follow-up studies,
case studies
F very low degree of evidence: non-systematic observations
Z not known
10
EQUS: Criteria for „reference documents“
• It should be a national document
• It should have an evidence grade A or B for
treatment/rehabilitation, evidence grade A or B or C for harm
reduction
• It should be based on systematic literature search or expert
consensus
On the basis of these criteria, 29 documents for
treatment/rehabilitation and 9 documents for harm reduction
were identified as “reference documents”
11
The inventory
• 349 relevant documents were included in the
electronic masterfile
– 259 documents on quality standards for treatment /
rehabilitation, from 28 countries
– 90 documents on quality standards for harm reduction,
from 18 countries
12
Main findings from inventory: Treatment /
rehabilitation
•
General information
– Majority of documents are national and from public origin at all 3 levels, for all
interventions and settings
– Interventions cover all types of target populations and of substances
•
Specific information
– Broad range of structural, process and outcome standards are well covered at all 3
levels
– Clear deficit in documents for benchmarks
– Basis of standards: expert consensus, expert opinion and literature review prevail
on all 3 levels
– Interventions: best covered are psychosocial and substitution interventions
– Settings: best covered are outpatient services
– Limited availability of evidence grades across all standards and levels
13
Main findings from inventory: harm reduction
• General information
– Majority of documents at national level and of public origin
– Broad range of interventions, of target populations and of
substances is covered, but few documents only for safe injection
rooms and pill testing
– Settings: few documents on office-based, pharmacy-based and clubbased interventions
• Specific information
– Structural, process and outcome standards are covered at all 3
levels
– Overall limited availability of evidence grades, but frequent
indication of recommended or mandatory standards
14
Model-design for a framework
of EU minimal quality
standards
15
Types of quality standards
Level 1:
interventions
Level 2:
services
Level 3:
systems
Structural
standards
Setting
standards
Resource
standards
Legal/ethical
adequacy
standards
Process
standards
Implementation
standards
Procedural
standards
Cooperation /
networking
standards
Outcome
standards
Effectivity
standards
Effectiveness
standards
Coverage
standards
Benchmarks
Cost-benefit ratio
Cost-utilisation
ratio
Costeffectiveness
16
ratio
Level 1: Treatment interventions
•
•
•
•
•
•
•
Counselling and early interventions
Psychosocial interventions
Substitution maintenance
Heroin-assisted treatment
Detoxification
Vocational rehabilitation
Other rehabilitation
17
Level 1: Harm reduction interventions
•
•
•
•
•
•
•
•
•
•
Needle exchange program
Supervised injection room
Outreach work / street work
Pill testing
Blood borne virus infection testing
Vaccination
Referral to other services if needed
Safer sex education
Safer use education
Sheltered housing
18
Level 2: Types of services
For treatment/rehabilitation
•
•
•
•
•
•
Out-patient services for ambulatory treatment
In-patient services for residential treatment
Prison-based services for intramural treatment
Office-based services for treatment in private practice
Teams specialised in addiction treatment
Teams not specialised in addiction treatment
For harm reduction
•
•
Same as those in treatment / rehabilitation
Additional categories are pharmacies and clubs
19
How to identify minimum quality standards
• Prepare comprehensive lists of available quality standards
from inventory (separate for structural, process and outcome
standards, for treatment/rehabilitation and harm reduction)
• Identify degree of consensus through stakeholder surveys
• Information basis provided to stakeholders
– List of countries mentioning each standard in how many documents
– For each standard the number of documents labelling it as
mandatory
– Source of each standard
– Evidence grade for each standard
• Minimum quality standards are identified through high level
of consensus in stakeholder surveys (>80%)
20
Main gaps of quality standards in inventory
Level 1:
interventions
Level 2:
services
Level 3:
systems
Structural
standards
Setting
standards
Resource
standards
Legal/ethical
adequacy
standards
Process
standards
Implementation
standards
Procedural
standards
Cooperation /
networking
standards
Outcome
standards
Effectivity
standards
Effectiveness
standards
Coverage
standards
Benchmarks
Cost-benefit ratio
Cost-utilisation
ratio
Costeffectiveness
21
ratio
Framework for a consultation
& consensus building
mechanism
22
Consensus building process
•
Stakeholder survey:
– Definition of stakeholders to be involved in the consensus
building process
– Results of stakeholder and expert consultation (including
perceived obstacles, resource implications, legal implications)
•
Proposals for next steps
– Detailed gap analysis for the research agenda
– Recommendations for future updating of standards
•
Implementation by National Authorities.
– Identification and discussion of implementation obstacles
– Options for implementation strategies (local / regional
conferences, interactive internet consultations, guidance and
incentives for services)
23