jennifer hillebrand, „rehabilitation of drug addicted persons: experience of lithuania and...
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Jennifer Hillebrand, „Rehabilitation of Drug Addicted Persons:
Experience of Lithuania and European Countries”, 18 October 2007
Improving drug treatment standards across Europe
Status quo and challenges
Outline of this presentation
• Standards/guidelines – Background, definitions.
• Situation in Europe: inpatient/outpatient psychosocial interventions.
• Summary, EMCDDA work in this area -outlook
The importance and political background of this topic :
EU Action Plan on Drugs 2005-2008: “improve coverage of, access to, quality and evaluation of drug demand reduction programmes and to ensure effective dissemination of evaluated best practices”.
Task of EMCDDA: “Provision of information on best practices in the Member States and the facilitation of exchange of such practices”.
The status quo of “knowledge transfer and exchange system of ‘good practice’” has to be considered in the context of “Quality Assurance Systems”
So for analysing the status quo we look at the main aspects of the “Quality Assurance Systems” in Member States as indicators
Background
Quality assurance – a definition
• Quality assurance can be defined as a system of procedures, checks, audits and corrective actions to ensure that a service and reporting activities are of the highest achievable quality (Last, 1995). Quality assurance can be implemented as a more or less formal control measure and with a higher or lower level of reporting through treatment providers and public control institutions.
What are quality standards in drug treatment?
• Aim at improvement of quality and effectiveness of drug treatment.
• Structural (formal) aspects of quality assurance.
• Process aspects of quality assurance
• General recommendations for quality of services up to mandatory guidelines in the framework of authorisation of services
Status quo in Europe
Source of the information:• Structured Questionnaire on treatment, 2005
• Structured Questionnaire to all REITOX units in Member States (based on the corresponding chapter of SQ27) July 2007Replies from 19 countries (17 MS, Croatia, Norway)
Quality guidelines Outpatient psychosocial interventionsInpatient psychosocial interventionsSubstitution/maintenance treatment
Detoxification
Some definitions
Outpatient services refer to facilities which deliver psychosocial interventions such as structuredcounselling, motivational enhancement, briefinterventions, case management, care-coordination,psychotherapy, day care, relapse prevention, and aftercare.
Inpatient services cover all psychosocialinterventions where clients spend the night in a facility´such as residential treatment units or rehabilitationcentres.
Quality guidelines available for inpatient/outpatient psychosocial interventions
Yes
No
No info
2007 data; DG Sanco Questionnaireon quality assurance
Quality guidelines available for substitution/maintenance interventions
Yes
No
No info
2007 data; DG Sanco QuestionnaireOn quality assurance
Quality guidelines issued by (n=countries)
Outpatient psychosocial interventions
Inpatient psychosocial interventions
Substitution/maintenance Detoxification
Public authorities 11 10 10 10
Professional associations 1
Public authorities + Professional Associations 3 3 7 5
Public authorities + Professional . Associations +Research institutes 1 1 1 1
Basis for guidelines inpatient/outpatient psychosocial interventions
Expert consensus
Expert consensus + evidence base
None of this
No guidelines
No information
2007 data; DG Sanco QuestionnaireOn quality assurance
MM26%
MD4%
TC1%
Psycho-socialTreatments
8%
Other Pharmacotherapy
61%
RCT on treatment for opioid dependence.Specialized Registry. Cochrane Drugs and Alcohol Group.
May 2006 (n=1137)
Mandatory for authorisation: inpatient/outpatient psychosocial interventions
Yes
No
No guidelines
No information
2007 data; DG Sanco QuestionnaireOn quality assurance
Guidelines precondition for funding: inpatient/outpatient psychosocial interventions
Always
Sporadically
No precondition
No guidelines
No information
2007 data; DG Sanco QuestionnaireOn quality assurance
Guidelines contents
96 6
3
48 8
5 4 4
8
7
0
3
6
9
12
15
18
structure staff process 1 process 2
mem
ber
sta
tes
full partly no
Structure – Basic structural aspects; size, installations, accessibilityStaff – Staff/client ratio, professional backgroundProcess 1 – Guidance for treatment, assessment, planning, referralsProcess 2 – Accompanying process for treatment, documentation, evaluation
Monitoring, Evaluation and Research
18
6
8
15
4 3
10
8
0
3
6
9
12
15
18
register monitoring evaluation funding
mem
ber
sta
tes
full partly no
Register – Documentation of treatment entries and reportingMonitoring – Documentation of informations at entry, and discharge and reportingEvaluation – Evaluation (in or external) of treatment episodes with respect to
outcomeFunding – National funding for evaluation and improvement
of treatment interventions
Quality classification of evaluated drug demand reduction projects in the EMCDDA EDDRA database
• 146 projects to be excluded (23%)• 426 level 1 (68%)• 48 level 2 (8%)=promising projects• 2 level 3 (0,3%)= top level
Summary of the current situation (1)
• Quality assurance system has developed in the majority of the Member States
• Basics for knowledge transfer and best practice transfer are only partly implemented in Member States
• Evaluation, research – this is done sporadically• Reviews, evidence reports – this is (with few exceptions) not standard
in Member States; soonest in the medical areas• a systematic procedure for producing and control new protocols
(standard getting best practice) – this is not implemented• consensus process – up to now there are at most expert panels
Summary ... (2)
• In general; the area is at an initial stage• compared to other areas of the health system• compared to standards – that are required in the area of “evidence based”
interventions• and with regard to demands in drug treatment
• Gaps are especially the reality for an exchange system as to “Good Practice” and knowledge transfer
• No clear consensus of what standards/quality guidelines constitute• Degree to which evidence is taken into account unclear
• With a few (national) exceptions this is the context of the coming “Best practice portal”
What can the EMCDDA do to foster development of standards?
• EMCDDA standards setting (EDDRA)• Best practice portal• Dissemination of information on national
treatment guidelines and standards• Policy briefing
EMCDDA best practice portal – Main objective and target groups
To provide an overview on the latest evidence on what works in demand reduction field.
It will also present tools and standards aimed at improving the quality of interventions, as well as highlighting best-practice examples from the field.
It is primarily aimed at professionals, policy-makers and researchers in the drugs field.
Best-practice portal
Evidence
of what works
(and gaps?)
Overview on latest systematic reviews on efficacy of
Interventions
Summary of conclusions on what works/or does not work
across latest systematic reviews and information on how the
reviews arrived at the conclusions (methodology)
Tools to evaluate practices
Standards and guidelines for
practices
Evaluated DDR projectsin MS
Evaluation
Guidelines
Guidelines, quality standards for practices developed in different MS
EDDRA
+ inclusion of quality levels in EDDRA
Prevention Evaluation resource kit (PERK)
Evaluation Instrument Bank
+ glossaryLaunch Jan 2008
Thank you to:
Peter Degkwitz
Consortium „Drugs Policy and
Harm Reduction” – DG SANCO
