Treatment
Indicators
Some Additional Considerations
Moving On
More than 3 decades of research show that drug misuse treatments can be effective• In reducing drug use• Improving personal health & social functioning• Reducing public health & safety risks
Time for policy makers, providers & researchers to have a more ambitious agenda:• How can treatment be improved?• How can treatment be tailored to meet the needs of
clients?
Improving patient outcomes & treatment Treatment is more than just specific procedures Treatment is a complex process. Need to understand:
• Nature & severity of client problems• The process which occur during treatment• The role of staff competence & skills• The organization & provision of service
Don’t have a cure, an “antibiotic” - treatment & treatment process are intertwined more closely
Involvement of providers in understanding & improving process of treatment is essential.
Treatment Outcomes
4 major national drug treatment outcome studies:• NTORS (National Treatment Outcome Research Study ,
UK)• DARP (Drug Abuse Reporting Program, US)• TOPS (Treatment Outcome Prospective Study, US)• DATOS (Drug Abuse Treatment Outcome Study, US)
Findings
Substantial reductions in illegal drug misuse & other outcomes after treatment
Improved outcomes for injecting risk behaviour Most drug dependent clients were multiple
substance misusers, often with multiple dependencies• Focus on single substance disorders likely outdated
& misleading Reductions in crime levels provide substantial
& immediate cost savings for society
Findings (& considerations)
Most drug dependent clients received more than 1 episode of treatment• Not a failure of treatment, a reality to understand• Drug dependence for many is a chronic, relapsing
condition– Need to understand
• cumulative effects of multiple treatments• how episodes interact or interfere with each other• characteristics of clients most likely to require multiple treatments so we
can incorporate this into treatment processes
Drinking outcomes often poor • Many clients continuing to drink heavily• May reflect focus on illegal drugs in treatment &
insufficient attention to alcohol
Findings (& considerations)
Time in treatment & treatment completion associated with better treatment outcomes• Staying in treatment & completing treatment more likely
to achieve best outcomes regardless of outcome measure• Treatment duration effects reported from studies of range
of treatment interventions (drug-free, drug maintenance, residential, outpatient)
• Need an adequate exposure to treatment to achieve positive outcomes– Beyond 90 days for most drug problems– Beyond a year for those treated with methadone– Outcomes tend to improve as retention increases from 3
months to 12 or more
Retention in Treatment
Treatment effectiveness, outcomes improve with retention in treatment• In UK, National Treatment Agency developed Public
Service Agreement target to “ increase year on year the proportion of users successfully sustaining or completing treatment programmes”
Study of 2,616 client in community-based services, north west England• 49 specialist drug treatment services & 100 general
practitioners (physicians)
Study findings
Factors NOT associated with retention or completion:• Ethnicity of client• Type of drug misuser (heroin, crack cocaine or both)• Whether client injected drugs• Whether client using methadone at time of
presentation for treatment
Study findings
Factors associated with retention or completion• Younger clients more likely to drop out within 6 months• Males 1.5 times more likely to drop out early than females• Those with no previous treatment experience 1.7 times more
likely to drop out early than those with previous treatment• Clients referred from criminal justice system 2.7 times more
likely to drop out early • Clients attending the worst performing services 7.1 times
more likely to drop out early than clients attending the best Strongest predictor of retention or completion of treatment
NOT a characteristic of client but related to agency
Improving patient outcomes & treatment Treatment is more than just specific procedures Treatment is a complex process. Need to understand:
• Nature & severity of client problems• The process which occur during treatment• The role of staff competence & skills• The organization & provision of service
Don’t have a cure, an “antibiotic” - treatment & treatment process are intertwined more closely
Involvement of providers in understanding & improving process of treatment is essential.
Outcome domains
Increasing agreement on domains - area of life function or status that is expected to be positively influenced by treatment (patient level)• Substance use• Employment / self support• Crime • Stability in housing• Social connectedness• Perception of care (or services)• Access • Retention
SAMHSA - 2004
04/10/23
Indicadores de Resultados (SAMHSA, 2003)
Funcionamiento social• Soporte• Vínculos
Accesibilidad de servicios• Cobertura
Retención en tratamiento Percepción sobre la atención Costo efectividad Uso de prácticas basadas en la evidencia
04/10/23
Indicadores de Resultados (SAMHSA, 2003)
Reducción de Morbilidad• Abstinencia• Reducción de sintomas
Laboral / Académico• Permanencia• Recuperación
Delito / P. legales• Disminución
Residencia• Incremento de estabilidad de vivienda
Outcome Measures
Specific items, measures or tests of an individual’s functional status within a domain• For example domain of Employment
– Number of days worked– Dollars earned– Days of unexcused absence– Tax return for a year
Functional domains have many facets - multiple measures, tests or items often needed for each domain
Performance or quality indicators System level Traditional methods to measure outcomes &
effectiveness: costly, time-consuming, dependent on scarce research skills
Performance or quality indicators • measures to estimate & monitor extent a program or
provider conforms to best or evidence-based practices or other standards of quality
• Often derived from administrative information systems– Financial and/or client
No single measure or indicator At this point, available measures and
indicators have benefits & limitations No single measure or indicator = quality of
treatment or sufficient for accountability Needs & goals of treatment system should
determine the set of measures & indicators that will most efficiently provide the amount & detail of information to improve quality of care at a given time.
Opening the door together
Must ‘ open the door’ for scientific understanding of treatment
Look at ourselves, our services and help others understand
Dynamic process - based in monitoring & tailored to meet changing objective & goals.
Success depends upon collaboration of service providers, policy makers & researchers
Treatment process improvement & data-driven decisions Supporting providers to make process
improvement & data-driven decisions to improve client access to and retention in care
Success factors• Provider leadership valued data & provided
resources• Staff received training on data collection & use• Sharing of change results• Success making data-driven decisions
Gracias por su atención
Cuando es cuestión del tratamiento de las adicciones, nada justifica la falta de transparencia por parte de proveedores, centros, o autoridades publicas...Pacientes, contribuyentes, y legisladores deben exigir a los que proporcionan tratamiento a personas con adicciones pruebas razonables de intentos de control y mejora tanto de estos tratamientos como de los resultados conseguidos.-A.Thomas McLellan, Mady Chalk, John Bartlett
Journal of Substance Abuse Treatment 32 (2007)
Gracias por su atención
Top Related