Transcript Treatment system-based data collection

Treatment system-based data collection:
an integrated approach to monitoring
Expert meeting: Implementation of the treatment strategy
EMCDDA Lisbon , 24-26 June 2013
This meeting as part of a process
Treatment working Group (2007)
Cross-unit project on treatment 2010-2012:
Consultant project treatment system maps
Expert meeting on facility surveys
Treatment strategy (2012)
New Cross-unit project on implementation of treatment
strategy 2013-2015
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Late 60s and 70s: changing youth cultures
(cannabis, amphetamines, LSD) and small
heroin sub-cultures
Mid 70s: Increased heroin availability, peaking
during mid-80s into the 90s in western EU
and later in eastern EU (epidemics)
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Specialised providers (often psychiatry-led)
Abstinence-oriented treatment approach
Often detox, residential treatment (e.g. boom of
therapeutic communities)
Stepwise reintegration (TCs then aftercare)
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Heroin epidemics associated with serious
health and social consequences:
HIV epidemics among injectors, mortality, open
drug scenes, etc.
 Need to better understand the drug situation
to develop data-driven responses
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Urgent information needs in the late 80s and
90s
Understanding and assessing the nature, patterns and
extent of drug use at city level, then at Member State
level
Development of epidemiological indicators, including
the treatment demand indicator
Remember: Heroin predominant drug, predominantly
specialist outpatient and inpatient structures,
relatively ‘short’ treatments
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Change of paradigm: “ 2 game changers” mid
90s onwards
1st: New policy priority: A public health approach!
Increase access and availability of drug treatment
Diversification of providers,
Expansion of outpatient, low-threshold treatment services
Ranging from specialised to non-specialised providers (e.g. general
practitioners)
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Year of OST introduction in
Member States
Sources: EMCDDA SB 2011 HSR 1
Emphasis on greater access and availability of
opioid substitution treatment (e.g. methadone,
buprenorphine)
Maintenance treatment -> drug addiction: chronic,
relapsing disorder
‘Life-long treatment’
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Treatment has evolved in Europe:
The 1980s-1990s:
• Opioid substitution develops into the major response to opioid use:
• Strong evidence base;;
• 10-fold increase (1993-2013)
• Diversification of medications and treatment regimes;
• High coverage through involvement of office- based doctors (GPs) or
other primary care system 50% of estimated problem opioid users
reached;
The 2000’s - …
• Closing of “treatment gap” between community and prison;
• Ageing populations of opioid users;
• Decline of heroin epidemic;
• Specialised drug treatment facilities register more demands for
stimulants and other non-opioid treatment.
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Treatment data collection as well …
2001  TDI established as main drug treatment monitoring system
in Europe
2003/4  first ST on treatment responses
- Use of additional data sources: Substitution ‘registries’,
prescriptions databases; health insurance/reimbursement
statistics; sales data
2008 ‘new’ ST 24 - to determine how many are in treatment
2012  treatment systems aproach
Current technological innovations may allow improved monitoring
- EHRs (electronic health records) & hospital admission data
(ICD-codes)
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Treatment system maps
Based on generic model and using already available data
Developed on basis of reported facility types at national level
Follow the broader ‘treatment’ definition of the TDI
Describe structure of national treatment system
Help to improve knowledge of reporting gaps
Provide the basis for estimating treatment coverage
[provide sampling frame for facility survey]
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Low threshold
Specialist
Outpatient
Criminal justice
Primary and
general health
care
Specialist
inpatient
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A system-based approach…
combined with indicators of needs (prevalence
rates, treatment demands, expert opinion on
treatment needs) and characteristics of
services (e.g. facility survey)…
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Helps to identify whether available services match the
needs (nationally, sub-nationally) and improve
system organization
Allows to identify gaps in service provision (especially
between regions) and highlight monitoring gaps
Estimate service utilisation and coverage at population
level
Measure performance longitudinally and resource
allocation as well as continuity of care (inter-agency
collaboration and protocols), access to services
(equity), quality, etc.
Improve communication of findings and monitoring in an
integrated framework
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Treatment prevalence
Project launched in 2005, assessment of feasibility and several pilots
conducted
Aim: to have insight into number and characteristics of the population
staying in treatment (and entering treatment) during a year
Rationale: - large part of treated population stay in treatment longer
than one year (long time clients, often opioid users in OST);
- large part of treatment resources for those clients
Method:
TDI network as starting point; most countries able to
provide TOTAL number on the same facilities providing TDI data
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Facility survey
It is important to know:
Facility surveys can cover:
If people can easily reach
drug treatment
Location, geographical
distribution
If range of treatments
offered corresponds to
current drug problems
If treatments offered are
evidence based and
delivered in good quality
Range of treatment-related
services made available,
capacity, turnover
Qualification of staff,
guidelines in use, QM tools
applied, accreditation
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Facility survey
Section A - Administrative information
Section B - Target population and client
information
Section C – Staffing and Quality Management
Section D – Facility Services
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Treatment prevalence Dagmar
It is important to know:
Treatment prevalence data
can tell us:
If TDI monitoring system
captures representative part
of treatment units / treatments
in a county or which part it
misses out
Number of people who have
been in contact with facilities
reporting to TDI during the
year
What distinguishes those
Core characteristics of
staying in long-term treatment population remaining in
from other clients (to better
treatment
shape the offer for care)
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