Treatment system-based data collection:

an integrated approach to monitoring

Expert meeting: Implementation of the treatment strategy

EMCDDA Lisbon , 24-26 June 2013

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This meeting as part of a process

Treatment working Group (2007)

Cross-unit project on treatment 2010-2012:Consultant project treatment system mapsExpert meeting on facility surveysTreatment 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)

Year of OST introduction in Member States

Sources: EMCDDA SB 2011 HSR 1

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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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Specialist

Outpatient

Low threshold

Primary and general health care

Specialist inpatient

Criminal justice

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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 prevalenceProject 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

Range of treatment-related services made available, capacity, turnover

If treatments offered are evidence based and delivered in good quality

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 staying in long-term treatment from other clients (to better shape the offer for care)

Core characteristics of population remaining in treatment