EQUS Conference - Brussels, June 16, 2011 Ambros Uchtenhagen, Michael Schaub Minimum Quality...

EQUS Conference - Brussels, June 16, 2011Ambros Uchtenhagen, Michael Schaub

Minimum Quality Standards in the field of Drug Demand ReductionParallel Session A: Treatment and Rehabilitation

• Treatment/rehabilitation standards with high consensus

• Treatment/rehabilitation standards with moderate consensus for discussion

Overview

2

TREATMENT / REHABILITATION

Standards with high consensus

(more than 80% agreement)

3

Structural Standards of Services 1. Physical environment: space

Evidence:

Source:Lit review 19Expert opinion 32Expert consensus 39Research project 6Practice experience 32

Documents per country:

4

(e.g. service has separate rooms for individual counselling)

- In my country, this standard is…

n = 149

5

Structural Standards of Services 1. Physical environment: space

Structural Standards of Services 2. Indication criteria: diagnosis

Evidence:



6

(treatment indication is always made on the basis of a diagnosis)

n = 145

7

Structural Standards of Services 2. Indication criteria: diagnosis


Structural Standards of Services 3. Staff composition: education

Evidence:

Documents per country: Source:Lit review 44Expert opinion 62Expert consensus76Research project 25Practice experience 60

8

(e.g. at least half of staff has a diploma in medicine, nursing, social work, or psychology)

n = 142

9

Structural Standards of Services 3. Staff composition: education


Outcome Standards at the System Level 4. Goal: health stabilisation/improvement

Evidence:



10

(treatment must be aimed at improvement or stabilisation of health)

n = 142

11

Outcome Standards at the System Level 4. Goal: health stabilisation/improvement


Outcome Standards at the System Level 5. Goal: social stabilization/integration

Evidence:



12

13

Outcome Standards at the System Level 5. Goal: social stabilization/integration

(treatment must be aimed at improvement of social stabilisation or integration)

n = 142


Outcome Standards at the System Level 6. Goal: reduced substance use

Evidence:



14

15

Outcome Standards at the System Level 6. Goal: reduced substance use

(treatment must be aimed at a reduction of substance use e.g. helping the client/patient to reduce the use or to abstain from psychotropic substances)

n = 142

15


Outcome Standards at the System Level 7. Utilisation monitoring

Evidence:



16

17

Outcome Standards at the System Level 7. Utilisation monitoring

(services must report periodically the occupancy of treatment slots or beds)

n = 142

17


Outcome Standards at the System Level 8. Internal evaluation

Evidence:



18

19

Outcome Standards at the System Level 8. Internal evaluation

(services must regularly perform an internal evaluation of their activities and outcomes)

n = 142

19


Process Standards at the Service Level 9. Assessment procedures (1): substance use history etc.

Evidence:



20

21

Process Standards at the Service Level 9. Assessment procedures (1)

n = 84

21

substance use history, diagnosis and treatment history have to be assessed


Process Standards at the Service Level 10. Assessment procedures (2): somatic status etc.

Evidence:


22


23

n= 84

23

somatic status and social status have to be assessed

Process Standards at the Service Level 10. Assessment procedures (2)


Process Standards at the Service Level 11. Individualised treatment planning

Evidence:



24

25

Process Standards at the Service Level 11. Individualised treatment planning

n = 84

25

(treatment plans are tailored individually to the needs of the patient)


Process Standards at the Service Level 12. Informed consent

Evidence:



26

27

Process Standards at the Service Level 12. Informed consent

n = 84

27

(patients must receive information on available treatment options and agree with a proposed regime or plan before starting treatment)


Process Standards at the Service Level 13. Written client records

Evidence:


28


29

Process Standards at the Service Level 13. Written client records

n = 84

29

(assessment results, intervention plan, interventions, expected changes and unexpected events are documented complete and up to date for each patient in a patient record)


Process Standards at the Service Level 14. Confidentiality of client data

Evidence:


30


31

Process Standards at the Service Level 14. Confidentiality of client data

n = 84

31

(patient records are confidential and exclusively accessible to staff involved in a patient’s treatment or regime)


Process Standards at the Service Level 15. Routine cooperation with other agencies

Evidence:



32

33

Process Standards at the Service Level 15. Routine cooperation with other agencies

n = 84

33

(whenever a service is not equipped to deal with all needs of a given patient, an appropriate other service is at hand for referral)


Process Standards at the Service Level 16. Continued staff training

Evidence:


34


35

Process Standards at the Service Level 16. Continued staff training

n = 84

35

(staff is regularly updated on relevant new knowledge in their field of action)


Process Standards of Interventions17. Assessment procedures (1): substance use history etc.

Evidence:


36


37

Process Standards of Interventions17. Assessment procedures (1)

n = 55

37

substance use history, diagnosis and treatment history have to be assessed


Process Standards of Interventions18. Assessment procedures (2): somatic status etc.

Evidence:



38

39

n = 55

39

somatic status and social status have to be assessed




Evidence:



40

41


n = 55

41

psychiatric status has to be assessed


Process Standards of Interventions20. Individualised treatment planning

Evidence:


42


43

Process Standards of Interventions20. Individualised treatment planning

n = 55

43

(treatment plans are tailored individually to the needs of the patient)


Process Standards of Interventions21. Informed consent

Evidence:


44


45

Process Standards of Interventions21. Informed consent

n = 55

45

(patients must receive information on available treatment options and agree with a proposed regime or plan before starting treatment)


Process Standards of Interventions22. Written client records

Evidence:



46

47

Process Standards of Interventions22. Written client records

n = 55

47

(assessment results, intervention plan, interventions, expected changes and unexpected events are documented complete and up to date for each patient in a patient record)


Process Standards of Interventions23. Confidentiality of client data

Evidence:



48

49

Process Standards of Interventions23. Confidentiality of client data

n = 55

49

(patient records are confidential and exclusively accessible to staff involved in a patient’s treatment or regime)


Process Standards of Interventions24. Routine cooperation with other agencies

Evidence:


50


51

Process Standards of Interventions24. Routine cooperation with other agencies

n = 55

51

(whenever a service is not equipped to deal with all needs of a given patient, an appropriate other service is at hand to referral)


Process Standards of Interventions25. Continued staff training

Evidence:



52

53

Process Standards of Interventions25. Continued staff training

n = 55

53

(staff is regularly updated on relevant new knowledge in their field of action)



Standards with moderate consensus

(50-80% agreement)

54

Evidence:

55


Structural Standards of Services 1. Accessibility: location


56


(service can easily be reached by public transport)

n = 153

56

- In my opinion, this standard should be a minimal standard in my country…

57



n = 153


58



n = 25 r = 50

- …feasible, but meets problems – specification

59



• No significant differences between investigated regions (Northern Europe, Western & Southern Europe, Central & Eastern Europe)

Regional differences:

Evidence:

60



Structural Standards of Services 2. Physical environment: safety

61


(service is equipped for reanimation and other emergencies like e.g. management of overdose)

n = 150

61


62



n = 150

62


63



63

n = 17 r = 31


64



64


• No significant differences between investigated regions, but participants from Northern Europe tend to answer more often “Yes” for GP’s office-based services and for non-specialised teams

Evidence:

65



Structural Standards of Services 3. Staff composition: transdisciplinarity

66


n = 143

(e.g. service employs a multidisciplinary team composed of at least 3 professions)

66


67


n = 143


67


68



68

n = 25 r = 47


69



69

• Non-specialised teams: significantly more often “No answer” and less “Yes”-answers from Central & Eastern Europe

• Significantly less “Already implemented”-answers from Northern Europe (Only 21 participants from Northern Europe!)


Evidence:

70



Outcome Standards at the System Level 4. Discharge monitoring

71


(e.g. ratio of regular / irregular discharges, retention rates etc. have to be periodically monitored)

n = 142

71


72



n = 142

72


73



73

n = 22 r = 41


74



74


• No significant differences between investigated regions• GP’s office-based services: tendency towards more “Yes”-answers

from Northern Europe

Evidence:

75



Outcome Standards at the System Level 5. External evaluation

76


(services must regularly allow an evaluation of their activities and outcomes by an independent external evaluator)

n = 141

76


77



n = 141

77


78



78

n = 30 r = 63


79



79


• GP’s office-based services: significantly more “Yes”-answers from Northern Europe

Evidence:

80



Outcome Standards at the System Level 6. Cost-effectiveness ratio

81


(positive outcomes like e.g. number of abstinent patients in relation to treatment costs)

n = 140

81


82



n = 140

82


83



83

n = 31r = 69


84



84

• Prison-based services: significantly less „Yes“- and more „No“-answers from Western & Southern Europe


Evidence:

85



Outcome Standards at the System Level 7. Cost-benefit ratio


(tangible benefits like e.g. years of increased life expectancy in relation to treatment costs)

n = 139

86




n = 139

87




88

n = 23r = 49




89


• No significant differences between investigated regions

Evidence:

90



Process Standards at the Service Level 8. Assessment procedures: psychiatric status has to be assessed


n = 84

91



n = 84

92



93

n = 27 r = 49



94


• GP’s office-based services, non-specialised teams: significantly less “Yes”-answers and more often “No answer” from Central & Eastern Europe


Standards with low consensus

(less than 50% agreement)

95

NONE

EQUS Conference - Brussels, June 16, 2011 Ambros Uchtenhagen, Michael Schaub Minimum Quality...

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