Post on 27-Mar-2015
Contact: michael.schaub@isgf.uzh.ch
www.isgf.ch
EQUS
EQUS Conference - Brussels, June 16, 2011Michael Schaub, Ambros Uchtenhagen
Minimum Quality Standards in the field of Drug Demand ReductionParallel Session A: Harm Reduction
• Background information• Harm reduction standards with high consensus• Harm reduction standards with moderate
consensus for discussion• Harm reduction standards with low consensus
dropped from the list
Overview
2
BACKGROUND INFORMATIONCountry comparisonsAvailability of services
3
4
Western & Southern Europe
Austria, Belgium, Cyprus, France, Germany, Greece, Italy, Netherlands, Portugal, Spain, Switzerland
Central & Eastern Europe
Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, Slovenia
Northern EuropeDenmark, Finland, Ireland, Sweden, United Kingdom
Subdivision for country comparisons
Number completed per region
5
Harm Reduction
Western & Southern Europe 58
Central & Eastern Europe 44
Northern Europe 21
Total 123
Availability of Services
6
Needle and syringe exchange All countries Supervised injection rooms * DE, ES, LU, NL, PL, NO, CH Outreach/street work All countries
Pill testing *BE, CZ, ES, FR, IT, NL, AT, PT, SI, UK, CH
BBV testing & counseling All countries Vaccination All countries Referrals All countries Safer use counseling All countries Safer sex counseling All countries Sheltered housing * All countries but: BG, EE, RONote. For the purpose of clarity, on the following slides only n of those services available in every country is displayed; n of the services marked with * is lower; Regional comparisons: for supervised injection rooms and pill testing no significance tests were cal-culated; the significance tests for sheltered housing included only countries, which offer this service
HARM REDUCTIONStandards with high consensus (more than 80% agreement)
7
Structural Standards of Interventions 1. Accessibility: location
8
Evidence:
Documents per country: Source:Lit review 11Expert opinion 10Expert consensus 8Research project 11Practice experience 17
Structural Standards of Interventions 1. Accessibility: location
9
n = 147
(service can easily be reached by public transport)
- In my opinion, this standard should be a minimal standard in my country…
Structural Standards of Interventions 2. Staff qualification: minimum qualification
10
Evidence:
Documents per country: Source:Lit review 12Expert opinion 17Expert consensus 12Research project 10Practice experience 22
Structural Standards of Interventions 2. Staff qualification: minimum qualification
(e.g. at least half of staff has a diploma in nursing, social work, or psychology)
11
n = 133
- In my opinion, this standard should be a minimal standard in my country…
Outcome Standards at the System Level3. Goal: reduced risk behaviour
Evidence:
Documents per country: Source:Lit review 25Expert opinion 25Expert consensus 25Research project 15Practice experience 26
12
Outcome Standards at the System Level3. Goal: reduced risk behaviour
n = 133
(reducing unsafe injections, unsafe drug use and unprotected sex)
- In my opinion, this standard should be a minimal standard in my country…
13
Outcome Standards at the System Level4. Goal: referrals
Evidence:
Documents per country: Source:Lit review 17Expert opinion 19Expert consensus 16Research project 11Practice experience 20
14
Outcome Standards at the System Level4. Goal: referrals
n = 130
(treatment services must be prepared to refer clients/patients to other health/social/treatment services if needed and agreed)
- In my opinion, this standard should be a minimal standard in my country…
15
Outcome Standards at the System Level5. Internal evaluation
Evidence:
Documents per country: Source:Lit review 9Expert opinion 15Expert consensus 12Research project 8Practice experience 11
16
Outcome Standards at the System Level5. Internal evaluation
n = 130
(services must regularly perform an internal evaluation of their activities and outcomes)
- In my opinion, this standard should be a minimal standard in my country…
17
Outcome Standards at the System Level6. External evaluation
Evidence:
Documents per country: Source:Lit review 11Expert opinion 17Expert consensus 13Research project 9Practice experience 11
18
Outcome Standards at the System Level6. External evaluation
n = 129
(services must regularly allow an evaluation of their activities and outcomes by an independent external evaluator)
- In my opinion, this standard should be a minimal standard in my country…
19
Process Standards of Interventions7. Assessment procedures: risk behaviour
Evidence:
Documents per country: Source:Lit review 15Expert opinion 12Expert consensus 8Research project 9Practice experience 15
20
Process Standards of Interventions7. Assessment procedures: risk behaviour
n = 125
(client’s/patient’s risk behaviour is assessed)
- In my opinion, this standard should be a minimal standard in my country…
21
Process Standards of Interventions8. Informed consent
Evidence:
Documents per country: Source:Lit review 12Expert opinion 13Expert consensus14Research project 6Practice experience 11
22
Process Standards of Interventions8. Informed consent
n = 124
(clients/patients must receive information on available service options and agree with a proposed regime or plan before starting an intervention)
- In my opinion, this standard should be a minimal standard in my country…
23
Process Standards of Interventions9. Confidentiality of client data
Evidence:
Documents per country: Source:Lit review 18Expert opinion 17Expert consensus 17Research project 10Practice experience 19
24
Process Standards of Interventions9. Confidentiality of client data
n = 124
(client/patient records are confidential and exclusively accessible to staff involved in a client’s/patient’s intervention or regime)
- In my opinion, this standard should be a minimal standard in my country…
25
Process Standards of Interventions10. Routine cooperation with other agencies
Evidence:
Documents per country: Source:Lit review 22Expert opinion 23Expert consensus 22Research project 15Practice experience 22
26
Process Standards of Interventions10. Routine cooperation with other agencies
n = 124
(whenever a service is not equipped to deal with all needs of a given client/patient, an appropriate other service is at hand for referral)
- In my opinion, this standard should be a minimal standard in my country…
27
Process Standards of Interventions11. Continued staff training
Evidence:
Documents per country: Source:Lit review 17Expert opinion 18Expert consensus 15Research project 8Practice experience 20
28
Process Standards of Interventions11. Continued staff training
n = 123
(staff is regularly updated on relevant new knowledge in their field of action)
- In my opinion, this standard should be a minimal standard in my country…
29
HARM REDUCTIONStandards with moderate consensus (50-80% agreement)
30
Evidence:
31
Documents per country:
Structural Standards of Interventions 1. Accessibility: opening hours
Source:Lit review 12Expert opinion 12Expert consensus 9Research project 7Practice experience 13
Structural Standards of Interventions 1. Accessibility: opening hours
(adjusted to the needs of clients/patients, e.g. evenings & week-ends)
n = 140
32
- In my opinion, this standard should be a minimal standard in my country…
Structural Standards of Interventions 1. Accessibility: opening hours
(adjusted to the needs of clients/patients, e.g. evenings & week-ends)
n = 140
33
- In my country, this standard is…
Structural Standards of Interventions 1. Accessibility: opening hours
(adjusted to the needs of clients/patients, e.g. evenings & week-ends)
34
n = 61 r = 124
- …feasible, but meets problems – specification
Structural Standards of Interventions 1. Accessibility: opening hours
(adjusted to the needs of clients/patients, e.g. evenings & week-ends)
35
• Overall acceptability: tendency toward more “No answer” and less “Yes”-answers from Central & Eastern Europe
• Referrals: significantly less “Yes”-answers and more “No answer” from Central & Eastern Europe
Regional differences:
Evidence:
36
Documents per country: Source:Lit review 7Expert opinion 7Expert consensus 3Research project 4Practice experience 10
Structural Standards of Interventions 2. Accessibility: costs to be paid by clients
Structural Standards of Interventions 2. Accessibility: costs to be paid by clients
n = 138
(exclusion of costs which limit the accessibility for poor clients/patients)
- In my opinion, this standard should be a minimal standard in my country…
37
Structural Standards of Interventions 2. Accessibility: costs to be paid by clients
n = 138
(exclusion of costs which limit the accessibility for poor clients/patients)
- In my country, this standard is…
38
Structural Standards of Interventions 2. Accessibility: costs to be paid by clients
(exclusion of costs which limit the accessibility for poor clients/patients)
n = 37 r = 74
- …feasible, but meets problems – specification
39
Structural Standards of Interventions 2. Accessibility: costs to be paid by clients
(exclusion of costs which limit the accessibility for poor clients/patients)
• No significant differences between investigated regions
Regional differences:
40
Evidence:
41
Documents per country: Source:Lit review 9Expert opinion 10Expert consensus 7Research project 9Practice experience 8
Structural Standards of Interventions 3. Indication criteria: diagnosis
Structural Standards of Interventions 3. Indication criteria: diagnosis
n = 137
(treatment indication is always made on the basis of a diagnosis or, if not possible, a detailed assessment of the current substance use)
- In my opinion, this standard should be a minimal standard in my country…
42
Structural Standards of Interventions 3. Indication criteria: diagnosis
n = 137
(treatment indication is always made on the basis of a diagnosis or, if not possible, a detailed assessment of the current substance use)
- In my country, this standard is…
43
Structural Standards of Interventions 3. Indication criteria: diagnosis
(treatment indication is always made on the basis of a diagnosis or, if not possible, a detailed assessment of the current substance use)
- …feasible, but meets problems – specification
44
Structural Standards of Interventions 3. Indication criteria: diagnosis
(treatment indication is always made on the basis of a diagnosis or, if not possible, a detailed assessment of the current substance use)
• No significant differences between investigated regions• Overall acceptability: tendency towards more “Yes”- and less “No”-
answers from Northern Europe
Regional differences:
45
Evidence:
46
Documents per country: Source:Lit review 9Expert opinion 13Expert consensus 11 Research project 3Practice experience 11
Structural Standards of Interventions 4. Indication criteria: age limits
Structural Standards of Interventions 4. Indication criteria: age limits
(e.g. minimal age required for admittance)
n = 135
- In my opinion, this standard should be a minimal standard in my country…
47
Structural Standards of Interventions 4. Indication criteria: age limits
(e.g. minimal age required for admittance)
n = 135
- In my country, this standard is…
48
Structural Standards of Interventions 4. Indication criteria: age limits
(e.g. minimal age required for admittance)
- …feasible, but meets problems – specification
49
Structural Standards of Interventions 4. Indication criteria: age limits
(e.g. minimal age required for admittance)
• No significant differences between investigated regions
Regional differences:
50
Evidence:
51
Documents per country: Source:Lit review 8Expert opinion 7Expert consensus 6Research project 6Practice experience 14
Structural Standards of Interventions 5. Staff composition: transdisciplinarity
Structural Standards of Interventions 5. Staff composition: transdisciplinarity
n = 133
(e.g. service employs a multidisciplinary team composed of at least 3 professions)
- In my opinion, this standard should be a minimal standard in my country…
52
Structural Standards of Interventions 5. Staff composition: transdisciplinarity
n = 133
(e.g. service employs a multidisciplinary team composed of at least 3 professions)
- In my country, this standard is…
53
Structural Standards of Interventions 5. Staff composition: transdisciplinarity
(e.g. service employs a multidisciplinary team composed of at least 3 professions)
n = 45 r = 74
- …feasible, but meets problems – specification
54
Structural Standards of Interventions 5. Staff composition: transdisciplinarity
(e.g. service employs a multidisciplinary team composed of at least 3 professions)
• No significant differences between investigated regions
Regional differences:
55
Evidence:
56
Documents per country:
Outcome Standards at the System Level 6. Goal: reduced substance use
Source:Lit review 12Expert opinion 8Expert consensus 8Research project 8Practice experience 13
Outcome Standards at the System Level 6. Goal: reduced substance use
(reducing unsafe injections, unsafe drug use and unprotected sex)
n = 133
- In my opinion, this standard should be a minimal standard in my country…
57
Outcome Standards at the System Level 6. Goal: reduced substance use
(reducing unsafe injections, unsafe drug use and unprotected sex)
n = 133
- In my country, this standard is…
58
Outcome Standards at the System Level 6. Goal: reduced substance use
(reducing unsafe injections, unsafe drug use and unprotected sex)
n = 47 r = 105
- …feasible, but meets problems – specification
59
Outcome Standards at the System Level 6. Goal: reduced substance use
(reducing unsafe injections, unsafe drug use and unprotected sex)
• Vaccination: tendency towards less “Yes”- and more “No”-answers from Central & Eastern Europe, especially when compared with Northern Europe
• Sheltered housing: significantly more “No answer” and less “Yes”-answers from Central & Eastern Europe
• Significantly less “Already implemented”-answers from Central & Eastern Europe, especially when compared with Western & Southern Europe
Regional differences:
60
Evidence:
61
Documents per country:
Outcome Standards at the System Level 7. Cost-effectiveness ratio
Source:Lit review 5Expert opinion 4Expert consensus 3Research project 3Practice experience 2
62
Outcome Standards at the System Level 7. Cost-effectiveness ratio
n = 129
(positive outcomes like e.g. number of abstinent clients/patients in relation to service costs)
- In my opinion, this standard should be a minimal standard in my country…
63
Outcome Standards at the System Level 7. Cost-effectiveness ratio
n = 129
(positive outcomes like e.g. number of abstinent clients/patients in relation to service costs)
- In my country, this standard is…
64
Outcome Standards at the System Level 7. Cost-effectiveness ratio
(positive outcomes like e.g. number of abstinent clients/patients in relation to service costs)
n = 52 r = 85
- …feasible, but meets problems – specification
65
Outcome Standards at the System Level 7. Cost-effectiveness ratio
(positive outcomes like e.g. number of abstinent clients/patients in relation to service costs)
• Overall acceptability: tendency towards less “Yes”- and more “No”-answers from Western & Southern Europe, especially when compared to Northern Europe
• Needle-syringe exchange, safer use counseling, safer sex counseling, sheltered housing: significantly less “Yes”- and more “No”-answers from Western & Southern Europe
Regional differences:
Evidence:
66
Documents per country:
Outcome Standards at the System Level 8. Cost-benefit ratio
Source:Lit review 3Expert opinion 3Expert consensus 3Research project 3Practice experience 2
Outcome Standards at the System Level 8. Cost-benefit ratio
(tangible benefits like e.g. years of increased life expectancy in relation to service costs)
n = 128
- In my opinion, this standard should be a minimal standard in my country…
67
Outcome Standards at the System Level 8. Cost-benefit ratio
(tangible benefits like e.g. years of increased life expectancy in relation to service costs)
n = 128
- In my country, this standard is…
68
Outcome Standards at the System Level 8. Cost-benefit ratio
(tangible benefits like e.g. years of increased life expectancy in relation to service costs)
n = 48 r = 78
- …feasible, but meets problems – specification
69
Outcome Standards at the System Level 8. Cost-benefit ratio
(tangible benefits like e.g. years of increased life expectancy in relation to service costs)
• Overall acceptability, needle-syringe exchange, outreach/street work, vaccination, referrals, safer use & safer sex counseling, sheltered housing: significantly more “No”-answers from Western & Southern Europe
• Significantly more “Feasible, but meets problems”-answers from Northern Europe
Regional differences:
70
Evidence:
71
Documents per country:
Process Standards of Interventions 9. Assessment procedures: complete needs assessment and priorisation
Source:Lit review 9Expert opinion 11Expert consensus 9Research project 8Practice experience 13
Process Standards of Interventions 9. Assessment procedures (1)
complete needs assessment and priorisation (e.g. 1. harm reduction of intravenous drug use and, 2. reduction of used syringes in public spaces etc.)
72
n = 127
- In my opinion, this standard should be a minimal standard in my country…
Process Standards of Interventions 9. Assessment procedures (1)
complete needs assessment and priorisation (e.g. 1. harm reduction of intravenous drug use and, 2. reduction of used syringes in public spaces etc.)
73
n = 127
- In my country, this standard is…
Process Standards of Interventions 9. Assessment procedures (1)
complete needs assessment and priorisation (e.g. 1. harm reduction of intravenous drug use and, 2. reduction of used syringes in public spaces etc.)
74
n = 36 r = 60
- …feasible, but meets problems – specification
Process Standards of Interventions 9. Assessment procedures (1)
complete needs assessment and priorisation (e.g. 1. harm reduction of intravenous drug use and, 2. reduction of used syringes in public spaces etc.)
75
• Acceptability: no significant differences between investigated regions
• Significantly more “Not feasible at all”-answers from Central & Eastern Europe, especially when compared to Western & Southern Europe
Regional differences:
Evidence:
76
Documents per country:
Process Standards of Interventions 10. Assessment procedures: client/patient status
Source:Lit review 16Expert opinion 17Expert consensus 14Research project 10Practice experience 16
Process Standards of Interventions 10. Assessment procedures: client/patient status
(the client’s/patient’s health status is assessed)
n = 126
- In my opinion, this standard should be a minimal standard in my country…
77
Process Standards of Interventions 10. Assessment procedures: client/patient status
(the client’s/patient’s health status is assessed)
n = 126
- In my country, this standard is…
78
Process Standards of Interventions 10. Assessment procedures: client/patient status
(the client’s/patient’s health status is assessed)
n = 32r = 55
- …feasible, but meets problems – specification
79
Process Standards of Interventions 10. Assessment procedures: client/patient status
(the client’s/patient’s health status is assessed)
• Acceptability for vaccination: significantly more “Yes”- and less “No”-answers from Western & Southern Europe, especially when compared to Northern Europe
• Significantly more “Not feasible at all”-answers from Central & Eastern Europe
Regional differences:
80
Evidence:
81
Documents per country:
Process Standards of Interventions 11. Individualised treatment planning
Source:Lit review 13Expert opinion 15Expert consensus 10Research project 9Practice experience 16
82
Process Standards of Interventions 11. Individualised treatment planning
(intervention regime and intervention plans, if applicable, are tailored individually to the needs of the client/patient)
n = 125
- In my opinion, this standard should be a minimal standard in my country…
83
Process Standards of Interventions 11. Individualised treatment planning
(intervention regime and intervention plans, if applicable, are tailored individually to the needs of the client/patient)
n = 125
- In my country, this standard is…
84
Process Standards of Interventions 11. Individualised treatment planning
(intervention regime and intervention plans, if applicable, are tailored individually to the needs of the client/patient)
n = 42 r = 74
- …feasible, but meets problems – specification
85
Process Standards of Interventions 11. Individualised treatment planning
(intervention regime and intervention plans, if applicable, are tailored individually to the needs of the client/patient)
• No significant differences between investigated countries
Regional differences:
Evidence:
86
Documents per country:
Process Standards of Interventions 12. Written client records
Source:Lit review 12Expert opinion 11Expert consensus 7Research project 7Practice experience 13
Process Standards of Interventions 12. Written client records
(assessment results, intervention plan, interventions, expected changes and unexpected events are documented complete and up to date for each client/patient in a client/patient record)
n = 124
- In my opinion, this standard should be a minimal standard in my country…
87
Process Standards of Interventions 12. Written client records
(assessment results, intervention plan, interventions, expected changes and unexpected events are documented complete and up to date for each client/patient in a client/patient record)
n = 124
- In my country, this standard is…
88
Process Standards of Interventions 12. Written client records
(assessment results, intervention plan, interventions, expected changes and unexpected events are documented complete and up to date for each client/patient in a client/patient record)
n = 32 r = 58
- …feasible, but meets problems – specification
89
Process Standards of Interventions 12. Written client records
(assessment results, intervention plan, interventions, expected changes and unexpected events are documented complete and up to date for each client/patient in a client/patient record)
• No significant differences between countries found• Referrals: tendency towards less “Yes”- and more “No”-answers from
Central & Eastern Europe, especially when compared with Northern Europe
Regional differences:
90
Evidence:
91
Documents per country:
Process Standards of Interventions 13. Neighbourhood/community consultation
Source:Lit review 9Expert opinion12Expert consensus 10Research project 7Practice experience 8
Process Standards of Interventions 13. Neighbourhood/community consultation
(avoiding nuisance and conflict with other people around the service)
n = 123
- In my opinion, this standard should be a minimal standard in my country…
92
Process Standards of Interventions 13. Neighbourhood/community consultation
(avoiding nuisance and conflict with other people around the service)
n = 123
- In my country, this standard is…
93
Process Standards of Interventions 13. Neighbourhood/community consultation
(avoiding nuisance and conflict with other people around the service)
n = 42 r = 86
- …feasible, but meets problems – specification
94
Process Standards of Interventions 13. Neighbourhood/community consultation
(avoiding nuisance and conflict with other people around the service)
• Acceptability: no significant differences between investigated regions
• Significantly more “Not feasible at all”-answers from Central & Eastern Europe
Regional differences:
95
HARM REDUCTIONStandards with low consensus (less than 50% agreement)
96
Structural Standards of Interventions 1. Indication criteria: age limits
97
n = 135
(e.g. minimum age required for admittance)
- In my opinion, this standard should be a minimal standard in my country…
Questions?
Discussion
Contact: www.isgf.ch
98