Transcript PowerPoint-presentasjon

Data Coverage Assessment
Erik Iversen, Norway
Workshop at the annual TDI expert meeting
EMCDDA, Lisbon
25 September 2006
Partially based on a paper by Erik Iversen1, Arvid Skutle1, Linda Montanari2, Roger Holmberg3, Mette T. Eriksen4,
Kristiina Kuussaari5, Bert Gren6, Mikael Dahlberg6, and Vera Segraeus7.
1)
The Bergen Clinics Foundation (Norway); 2) European Monitoring Centre for Drugs and Drug Addiction; 3) National
Board of Health and Welfare (Sweden); 4) The Danish National Board of Health; 5) STAKES (Finland); 6) IKMDocumentation (Sweden); 7) The National Board of Institutional Care (Sweden)
The Bergen Clinics Foundation, Erik Iversen, 2006
Are national treatment data comparable?
If so, can they be used meaningfully?
•
Process and format
– Comparability of national data sets
• selection of population(s)
• selection of variables
• modes of data gathering
• types of data: individual, case or aggregate
– Validity and reliability of the data
– Coverage issues
•
European standards:
– EMCDDA: Treatment Demand Indicator (TDI) Standard protocol 2.0
•
Examples for utilization of data
– Cannabis as a primary substance
– Cocaine use as an emerging trend in Europe
– Patient populations: reflecting poverty issues
The Bergen Clinics Foundation, Erik Iversen, 2006
EMCDDA: Treatment Demand Indicator (TDI) Standard protocol 2.0
Definitions of key terms:
Which ‘cases’ should
be included?
When
does
treatment
‘start’?
What ‘drugs’
should be
included?
What is ‘treatment’?
A case is a person who starts treatment for their drug use at a treatment centre
during the calendar year 1 January to 31 December.
What does
‘drug use’
mean?
TDI / E.I. 2006
Which types of
treatment centres
should be
included?
Norway: Addiction treatment sector
The Bergen Clinics Foundation
•
•
•
•
About 200 institutions/units:
Publicly and privately owned
Scientific, idealistic, religious bases
“Treatment” spanning
– from mere “bed and breakfast”
– to specialist work by psychologists/psychiatrists
• Capacity from 4 to above 200 patients/clients
• Detox, in-patient, out-patient, day care treatment,
social-pedagogic long term collectives, care
The Bergen Clinics Foundation, Erik Iversen, 2006
90
80
70
60
50
40
30
20
10
0
81,7
77,9
70,7
69
67,1
32,9
31
29,3
*
Eu
ro
pe
th
er
ar
k
18,3
Women
Men
O
D
en
m
an
d
Fi
nl
Sw
N
or
w
ed
en
22,1
ay
Percent
Treatment by gender 2004, percent
*Other Europe: Range male percent 67 (Hungary) to 87 (Italy, Cyprus), mean 82,9
N = 11,287 / 4,389 / 1,195 / 4,087 / 356,827
TDI / EI, 2006
Country
Pop2003 N. of clients
% male
% injection
Norway
4,6
11,287
67.1
46.0 (estimation)
Sweden
8,9
4,389
69,0
41.0
Finland
5,2
1,195
70.1
57.4
Denmark
5,4
4,087
77.9
12.9
Czech Republic
10,2
8,845
69.1
67.3
Germany
82,5
44,448
80.0
20.0
Greece
11,0
4,269
84.0
44.4
Italy
57,3
162,230 (0.28% of pop.)
87.0
67.0
Cyprus
0,7
450
87.0
52.4
Lithuania
3,5
5,011
82,0
91.9
Luxembourg
0,4
389
70.0
62.0
Hungary
10,1
14,165
67.0
12.0
Malta
0,4
667
84.8
?
Netherlands
16,2
9,887
82.0
3.2
Austria
8,1
6,995
71.0
100
Slovenia
2,0
1,130
78.1
61.1
Slovakia
5,4
2,315
79.2
45.2
UK
59,3
99,482
72.0
40.2
Bulgaria
7,8
2,037
81.0
75.9
Romania
21,2
1,502
69.0
62.0
(0.097% of pop.)
TDI/EI 2006
Most used substance 2004
Women
100
90
80
Norway
Sweden
Finland
Denmark
Germany
Hungary
Netherlands
UK
Greece
Italy
70
Percent
60
50
40
30
20
10
0
Opiates
Cannabis
Amphetam.
Cocaine
Ecstasy
Hypn/sed
Other
N = 3715 / 1359 / 350 / 902 / 8890 / 4674 / 1780 / 27855 / 683 / 21090
TDI / EI, 2006
Most used substance 2004
Men
100
90
80
Norway
Sweden
Finland
Denmark
Germany
Hungary
Netherlands
UK
Greece
Italy
70
Percent
60
50
40
30
20
10
0
Opiates
Cannabis
Amphetam.
Cocaine
Ecstasy
Hypn/sed
Other
N = 7572 / 3030 / 845 / 3185 / 35558 / 9491 / 8107 / 71627 / 3586 / 141140
TDI / EI, 2006
Main coverage issues
• the participation percentage of the different types of
treatment centres that are intended in the systems
• if there are types of services that are excluded from
the systems
• the participation percent of the clients within each of
the treatment centres intended to participate
• if there are client groups (populations) that are
excluded from the systems (gender/age/substance)
The Bergen Clinics Foundation, Erik Iversen, 2006
Exploring coverage of the TDI - 1
The current knowledge (within TDI) of the relevant coverage
types
Target population(s) of the monitoring system
– types of treatments/clients to be included (according to
TDI)
– identifying the centres/services in the field
(nationally/regionally)
– data management (national registers)
compared with
Coverage information required for meaningful data
comparison
– using existing information
– collecting basic other information
– updating over time
The Bergen Clinics Foundation, Erik Iversen, 2006
Exploring coverage of the TDI – 2a
If there is identified a need for improved coverage
monitoring, further issues must be addressed:
• Obtaining examples of good and poor
national/regional coverage monitoring systems and
coverage situations
• Information on the centres covered (and not covered)
by the data collection:
– what type of treatment do they provide?
– what is the target population: is there a defined target
population?
– to what extent the actual population in treatment match the
target population?
The Bergen Clinics Foundation, Erik Iversen, 2006
Exploring coverage of the TDI – 2b
• Estimating coverage
–
–
–
–
estimation based on the number/types of facilities
estimation based on the number/types of clients
how to deal with missing information?
double counting: estimation of the level of double
counting within an agency (temporal) and between
agencies (level of co-operation)
• Representativeness and coverage
– full surveys versus samples
– identifying systematic biases
The Bergen Clinics Foundation, Erik Iversen, 2006
Enhancing coverage of the TDI
Ways to enhance participation and coverage
• obligatory vs. voluntary participation
• measures for enhancing participation
Recommendations for improving data coverage?
Table(s) on coverage to be added to the TDI
tables?
The Bergen Clinics Foundation, Erik Iversen, 2006