Transcript Piotr JABLONSKI

Building an EU consensus for
minimum quality standards in the
prevention, treatment and harm
reduction of drugs
Quality Standards - Policy Perspectives
Boguslawa Bukowska
Piotr Jablonski
National Bureau for Drug Prevention, Poland
15-17 June 2011, Brussels
Basic Assumptions
1.
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Improvement of the quality of drug care system
instead of quantity development (apart from
substitution treatment):
Code of Ethics for drug treatment therapists,
Approved by Ministry of Health System of Training
for specialists and instructors dealing with drug
treatment & rehabilitation,
Accreditation system of treatment facilities,
Basic Assumptions
2. Accreditation system common for drugs and alcohol
dependency,
3. Accreditation for drugs and alcohol facilities is built in
the general accreditation system of health care in
Poland.
How many care centres (alcohol/drugs) might
be involved in the accreditation process?
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In-patient centres – 170
Detoxification wards - 94
Out-patient centres - 706
Day-care wards - 76
Total: 1 046 units
How many patients might (hopefully) benefit
from the quality standards?
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318 290 patients in alcohol treatment facilities
(2009 data)
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47 153 patients in drug treatment facilities
Target group of quality standards and
accreditation process
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Health care centres delivering alcohol/drug treatment
and harm reduction,
Public and NGO-based health care centres,
Out-patient and in-patient health care centres
(rehabilitation centres incl. therapeutic communities,
hospital wards, detoxification centres, ambulatory
and day-care units).
Structure of health services for drug
users covers:
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Public health care units of the national, regional and
local governments – about 30%,
Non–public care units - mostly NGOs – about 70%
Why accreditation is important for the
substance abuse system ?
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Improvement of treatment and care quality,
Increasing safety (both patients and professionals),
Supporting the increase of staff qualification,
Optimization of expenditure related to treatment and
care for drug/alcohol users,
Improvement of care effectiveness,
Increasing public trust in drug/alcohol care and
treatment,
Promotion of „good practice”.
Who defined the quality standards?
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Working Group set up by the Ministry of Health in 2004,
Members:
National Bureau for Drug Prevention,
The State Agency for the Prevention of Alcohol-Related
Problems,
National Center for Quality Assessment in Health Care
(NCQA)
and the staff of treatment services.
How were the quality standards defined?
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Based on:
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knowledge of the „good practice” and what works in treatment
and care (evidence-based),
human rights (including patient rights),
experience of experts involved,
contemporary management science,
legislation (accreditation requirements are higher than the law).
Agreed on the consensus basis between experts and
practitioners.
What has been achieved so far?
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Quality standards developed for the out-patient and
in-patient drug/alcohol dependence care,
Pilot testing of quality standards in 7 treatment facilities,
Further modification involving results of pilot site visits,
Development of the accreditation procedure,
Training of accreditation surveyors,
Presentation of quality standards for approval of the
Accreditation Council (Ministry of Health),
Applications for accreditation survey.
Type of standards
I. Process of Care
1.
2.
3.
4.
Patient Rights (PP)
Continuity of Care (CO)
Patient Safety (BP)
Patient Care (OP)
Type of standards
II. Organizational functions
1.
2.
3.
4.
5.
6.
Quality Improvement
General Management and Human Resources
Management
Information Management
Environment of Care Management
Infection Control
Pharmacotherapy
Process of accreditation
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Based on voluntary basis,
Application form sent to NCQA, which functions as
Accreditation Center (plans the survey, conducts it,
provides the accreditation report),
Site surveys to verify the standards compliance,
Survey report presented to Accreditation Council to
recommend (or not) the accreditation for the
organization to the Minister of Health,
Possible outcomes: „not recommended = refusal of
accreditation” or „approval of accreditation”
(certificate for 3 years)
Legal grounds for standards and
accreditation
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National Programme for Counteracting Drug
Addiction 2001 – 2005, 2006 – 2010 and 2011-2016
adopted by the Council of Ministers
Priority 1.5. introduction of accreditation procedure for
facilities dealing with substance abuse, approved by
Accreditation Council and National Centre for Quality
Assessment in health care.
Law on accreditation (2008)
Quality standards and accreditation process
- state of art in Poland
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First version of standards was presented to
Accreditation Council of the Ministry of Health in 2010,
Standards are in the process of amendments, taking
into account the Accreditation Council remarks
Steps planned in 2011
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Pilot visits to verify the final version of quality
standards,
Accreditation surveyors training,
Official opening of the accreditation process for care
centers,
Further work to verify the standards set up for outpatients centres.
Potential cons
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Standards are used against the interests of treatment
providers by National Health Fund (to eliminate from the
market or limit the financial coverage),
Quality standards do not contribute to care improvement,
Standards will kill the spirit of treatment (particularly
raised by Therapeutic Community).
The above might result in the resistance
of addiction treatment centers
to undergo the accreditation procedure.
Summary
Elaboration of quality standards was more time
consuming and demanding that it was expected,
 Lack of experience and insufficient access to the
experience in this field in other countries slowed
down the process of elaboration of quality standards.
Currently we observe:
- increasing level of awareness concerning the role
and importance of quality standards,
– increasing interest of health care units to apply for
accreditation.
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Thank you!