Minimum Quality Standards in the field
of Drug Demand Reduction
Parallel Session A: Treatment and Rehabilitation
EQUS Conference - Brussels, June 16, 2011
Ambros Uchtenhagen, Michael Schaub
Overview
• Treatment/rehabilitation standards
with high consensus
• Treatment/rehabilitation standards
with moderate consensus for
discussion
2
TREATMENT /
REHABILITATION
Standards with high consensus
(more than 80% agreement)
3
Structural Standards of Services
1. Physical environment: space
Documents per country:
Source:
Lit review 19
Expert opinion 32
Expert consensus 39
Research project 6
Practice experience 32
Evidence:
4
Structural Standards of Services
1. Physical environment: space
(e.g. service has separate rooms for individual counselling)
- In my country, this standard is…
n = 149
5
Structural Standards of Services
2. Indication criteria: diagnosis
Documents per country:
Source:
Lit review 49
Expert opinion 58
Expert consensus 74
Research project 22
Practice experience 54
Evidence:
6
Structural Standards of Services
2. Indication criteria: diagnosis
(treatment indication is always made on the basis of a diagnosis)
- In my country, this standard is…
n = 145
7
Structural Standards of Services
3. Staff composition: education
Documents per country:
Source:
Lit review 44
Expert opinion 62
Expert consensus76
Research project 25
Practice experience 60
Evidence:
8
Structural Standards of Services
3. Staff composition: education
(e.g. at least half of staff has a diploma in medicine, nursing, social work, or
psychology)
- In my country, this standard is…
n = 142
9
Outcome Standards at the System Level
4. Goal: health stabilisation/improvement
Documents per country:
Source:
Lit review 62
Expert opinion 77
Expert consensus 93
Research project 31
Practice experience 58
Evidence:
10
Outcome Standards at the System Level
4. Goal: health stabilisation/improvement
(treatment must be aimed at improvement or stabilisation of health)
- In my country, this standard is…
n = 142
11
Outcome Standards at the System Level
5. Goal: social stabilization/integration
Documents per country:
Source:
Lit review 53
Expert opinion 66
Expert consensus 89
Research project 28
Practice experience 53
Evidence:
12
Outcome Standards at the System Level
5. Goal: social stabilization/integration
(treatment must be aimed at improvement of social stabilisation or integration)
- In my country, this standard is…
n = 142
13
Outcome Standards at the System Level
6. Goal: reduced substance use
Documents per country:
Source:
Lit review 62
Expert opinion 78
Expert consensus 93
Research project 37
Practice experience 65
Evidence:
14
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)
- In my country, this standard is…
n = 142
15
Outcome Standards at the System Level
7. Utilisation monitoring
Documents per country:
Source:
Lit review 18
Expert opinion 33
Expert consensus 37
Research project 15
Practice experience 29
Evidence:
16
Outcome Standards at the System Level
7. Utilisation monitoring
(services must report periodically the occupancy of treatment slots or beds)
- In my country, this standard is…
n = 142
17
Outcome Standards at the System Level
8. Internal evaluation
Documents per country:
Source:
Lit review 18
Expert opinion 33
Expert consensus 37
Research project 15
Practice experience 29
Evidence:
18
Outcome Standards at the System Level
8. Internal evaluation
(services must regularly perform an internal evaluation of their activities and
outcomes)
- In my country, this standard is…
n = 142
19
Process Standards at the Service Level
9. Assessment procedures (1): substance use history etc.
Documents per country:
Source:
Lit review 78
Expert opinion 89
Expert consensus 105
Research project 40
Practice experience 78
Evidence:
20
Process Standards at the Service Level
9. Assessment procedures (1)
substance use history, diagnosis and treatment history have to be assessed
- In my country, this standard is…
n = 84
21
Process Standards at the Service Level
10. Assessment procedures (2): somatic status etc.
Documents per country:
Source:
Lit review 65
Expert opinion 78
Expert consensus 89
Research project 39
Practice experience 63
Evidence:
22
Process Standards at the Service Level
10. Assessment procedures (2)
somatic status and social status have to be assessed
- In my country, this standard is…
n= 84
23
Process Standards at the Service Level
11. Individualised treatment planning
Documents per country:
Source:
Lit review 83
Expert opinion 98
Expert consensus 116
Research project 46
Practice experience 86
Evidence:
24
Process Standards at the Service Level
11. Individualised treatment planning
(treatment plans are tailored individually to the needs of the patient)
- In my country, this standard is…
n = 84
25
Process Standards at the Service Level
12. Informed consent
Documents per country:
Source:
Lit review 68
Expert opinion 80
Expert consensus 93
Research project 36
Practice experience 71
Evidence:
26
Process Standards at the Service Level
12. Informed consent
(patients must receive information on available treatment options and agree
with a proposed regime or plan before starting treatment)
- In my country, this standard is…
n = 84
27
Process Standards at the Service Level
13. Written client records
Documents per country:
Source:
Lit review 65
Expert opinion 75
Expert consensus 92
Research project 32
Practice experience 68
Evidence:
28
Process Standards at the Service Level
13. Written client records
(assessment results, intervention plan, interventions, expected changes and
unexpected events are documented complete and up to date for each patient in a
patient record)
- In my country, this standard is…
n = 84
29
Process Standards at the Service Level
14. Confidentiality of client data
Documents per country:
Source:
Lit review 60
Expert opinion 75
Expert consensus 83
Research project 34
Practice experience 64
Evidence:
30
Process Standards at the Service Level
14. Confidentiality of client data
(patient records are confidential and exclusively accessible to staff involved in a
patient’s treatment or regime)
- In my country, this standard is…
n = 84
31
Process Standards at the Service Level
15. Routine cooperation with other agencies
Documents per country:
Source:
Lit review 62
Expert opinion 85
Expert consensus 102
Research project 30
Practice experience 74
Evidence:
32
Process Standards at the Service Level
15. Routine cooperation with other agencies
(whenever a service is not equipped to deal with all needs of a given patient,
an appropriate other service is at hand for referral)
- In my country, this standard is…
n = 84
33
Process Standards at the Service Level
16. Continued staff training
Documents per country:
Source:
Lit review 55
Expert opinion 74
Expert consensus 86
Research project 31
Practice experience 64
Evidence:
34
Process Standards at the Service Level
16. Continued staff training
(staff is regularly updated on relevant new knowledge in their field of action)
- In my country, this standard is…
n = 84
35
Process Standards of Interventions
17. Assessment procedures (1): substance use history etc.
Documents per country:
Source:
Lit review 78
Expert opinion 89
Expert consensus 105
Research project 40
Practice experience 78
Evidence:
36
Process Standards of Interventions
17. Assessment procedures (1)
substance use history, diagnosis and treatment history have to be assessed
- In my country, this standard is…
n = 55
37
Process Standards of Interventions
18. Assessment procedures (2): somatic status etc.
Documents per country:
Source:
Lit review 65
Expert opinion 78
Expert consensus 89
Research project 39
Practice experience 63
Evidence:
38
Process Standards of Interventions
18. Assessment procedures (2)
somatic status and social status have to be assessed
- In my country, this standard is…
n = 55
39
Process Standards of Interventions
19. Assessment procedures (3)
Documents per country:
Source:
Lit review 63
Expert opinion 74
Expert consensus 85
Research project 36
Practice experience 64
Evidence:
40
Process Standards of Interventions
19. Assessment procedures (3)
psychiatric status has to be assessed
- In my country, this standard is…
n = 55
41
Process Standards of Interventions
20. Individualised treatment planning
Documents per country:
Source:
Lit review 83
Expert opinion 98
Expert consensus 116
Research project 46
Practice experience 86
Evidence:
42
Process Standards of Interventions
20. Individualised treatment planning
(treatment plans are tailored individually to the needs of the patient)
- In my country, this standard is…
n = 55
43
Process Standards of Interventions
21. Informed consent
Documents per country:
Source:
Lit review 68
Expert opinion 80
Expert consensus 93
Research project 36
Practice experience 71
Evidence:
44
Process Standards of Interventions
21. Informed consent
(patients must receive information on available treatment options and agree
with a proposed regime or plan before starting treatment)
- In my country, this standard is…
n = 55
45
Process Standards of Interventions
22. Written client records
Documents per country:
Source:
Lit review 65
Expert opinion 75
Expert consensus 92
Research project 32
Practice experience 68
Evidence:
46
Process Standards of Interventions
22. Written client records
(assessment results, intervention plan, interventions, expected changes and
unexpected events are documented complete and up to date for each patient in a
patient record)
- In my country, this standard is…
n = 55
47
Process Standards of Interventions
23. Confidentiality of client data
Documents per country:
Source:
Lit review 60
Expert opinion 75
Expert consensus 83
Research project 34
Practice experience 64
Evidence:
48
Process Standards of Interventions
23. Confidentiality of client data
(patient records are confidential and exclusively accessible to staff involved in a
patient’s treatment or regime)
- In my country, this standard is…
n = 55
49
Process Standards of Interventions
24. Routine cooperation with other agencies
Documents per country:
Source:
Lit review 62
Expert opinion 85
Expert consensus 102
Research project 30
Practice experience 74
Evidence:
50
Process Standards of Interventions
24. Routine cooperation with other agencies
(whenever a service is not equipped to deal with all needs of a given patient,
an appropriate other service is at hand to referral)
- In my country, this standard is…
n = 55
51
Process Standards of Interventions
25. Continued staff training
Documents per country:
Source:
Lit review 55
Expert opinion 74
Expert consensus 86
Research project 31
Practice experience 64
Evidence:
52
Process Standards of Interventions
25. Continued staff training
(staff is regularly updated on relevant new knowledge in their field of action)
- In my country, this standard is…
n = 55
53
TREATMENT /
REHABILITATION
Standards with moderate consensus
(50-80% agreement)
54
Structural Standards of Services
1. Accessibility: location
Documents per country:
Source:
Lit review 22
Expert opinion 28
Expert consensus 31
Research project 14
Practice experience 26
Evidence:
55
Structural Standards of Services
1. Accessibility: location
(service can easily be reached by public transport)
- In my opinion, this standard should be a minimal standard in my country…
n = 153
56
Structural Standards of Services
1. Accessibility: location
(service can easily be reached by public transport)
- In my country, this standard is…
n = 153
57
Structural Standards of Services
1. Accessibility: location
(service can easily be reached by public transport)
- …feasible, but meets problems – specification
n = 25
r = 50
58
Structural Standards of Services
1. Accessibility: location
(service can easily be reached by public transport)
Regional differences:
•
No significant differences between investigated regions (Northern
Europe, Western & Southern Europe, Central & Eastern Europe)
59
Structural Standards of Services
2. Physical environment: safety
Documents per country:
Source:
Lit review 28
Expert opinion 39
Expert consensus 45
Research project 12
Practice experience 40
Evidence:
60
Structural Standards of Services
2. Physical environment: safety
(service is equipped for reanimation and other emergencies like e.g.
management of overdose)
- In my opinion, this standard should be a minimal standard in my country…
n = 150
61
Structural Standards of Services
2. Physical environment: safety
(service is equipped for reanimation and other emergencies like e.g.
management of overdose)
- In my country, this standard is…
n = 150
62
Structural Standards of Services
2. Physical environment: safety
(service is equipped for reanimation and other emergencies like e.g.
management of overdose)
- …feasible, but meets problems – specification
n = 17
r = 31
63
Structural Standards of Services
2. Physical environment: safety
(service is equipped for reanimation and other emergencies like e.g.
management of overdose)
Regional differences:
•
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
64
Structural Standards of Services
3. Staff composition: transdisciplinarity
Documents per country:
Source:
Lit review 38
Expert opinion 52
Expert consensus 63
Research project 19
Practice experience 51
Evidence:
65
Structural Standards of Services
3. Staff composition: transdisciplinarity
(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…
n = 143
66
Structural Standards of Services
3. Staff composition: transdisciplinarity
(e.g. service employs a multidisciplinary team composed of at least 3 professions)
- In my country, this standard is…
n = 143
67
Structural Standards of Services
3. Staff composition: transdisciplinarity
(e.g. service employs a multidisciplinary team composed of at least 3 professions)
- …feasible, but meets problems – specification
n = 25
r = 47
68
Structural Standards of Services
3. Staff composition: transdisciplinarity
(e.g. service employs a multidisciplinary team composed of at least 3 professions)
Regional differences:
•
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!)
69
Outcome Standards at the System Level
4. Discharge monitoring
Documents per country:
Source:
Lit review 13
Expert opinion 31
Expert consensus 33
Research project 10
Practice experience 26
Evidence:
70
Outcome Standards at the System Level
4. Discharge monitoring
(e.g. ratio of regular / irregular discharges, retention rates etc. have to be
periodically monitored)
- In my opinion, this standard should be a minimal standard in my country…
n = 142
71
Outcome Standards at the System Level
4. Discharge monitoring
(e.g. ratio of regular / irregular discharges, retention rates etc. have to be
periodically monitored)
- In my country, this standard is…
n = 142
72
Outcome Standards at the System Level
4. Discharge monitoring
(e.g. ratio of regular / irregular discharges, retention rates etc. have to be
periodically monitored)
- …feasible, but meets problems – specification
n = 22
r = 41
73
Outcome Standards at the System Level
4. Discharge monitoring
(e.g. ratio of regular / irregular discharges, retention rates etc. have to be
periodically monitored)
Regional differences:
•
•
No significant differences between investigated regions
GP’s office-based services: tendency towards more “Yes”-answers
from Northern Europe
74
Outcome Standards at the System Level
5. External evaluation
Documents per country:
Source:
Lit review 18
Expert opinion 36
Expert consensus 39
Research project 14
Practice experience 32
Evidence:
75
Outcome Standards at the System Level
5. External evaluation
(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…
n = 141
76
Outcome Standards at the System Level
5. External evaluation
(services must regularly allow an evaluation of their activities and outcomes by an
independent external evaluator)
- In my country, this standard is…
n = 141
77
Outcome Standards at the System Level
5. External evaluation
(services must regularly allow an evaluation of their activities and outcomes by an
independent external evaluator)
- …feasible, but meets problems – specification
n = 30
r = 63
78
Outcome Standards at the System Level
5. External evaluation
(services must regularly allow an evaluation of their activities and outcomes by an
independent external evaluator)
Regional differences:
•
GP’s office-based services: significantly more “Yes”-answers from
Northern Europe
79
Outcome Standards at the System Level
6. Cost-effectiveness ratio
Documents per country:
Source:
Lit review 13
Expert opinion 12
Expert consensus 13
Research project 7
Practice experience 12
Evidence:
80
Outcome Standards at the System Level
6. Cost-effectiveness ratio
(positive outcomes like e.g. number of abstinent patients in relation to treatment
costs)
- In my opinion, this standard should be a minimal standard in my country…
n = 140
81
Outcome Standards at the System Level
6. Cost-effectiveness ratio
(positive outcomes like e.g. number of abstinent patients in relation to treatment
costs)
- In my country, this standard is…
n = 140
82
Outcome Standards at the System Level
6. Cost-effectiveness ratio
(positive outcomes like e.g. number of abstinent patients in relation to treatment
costs)
- …feasible, but meets problems – specification
n = 31
r = 69
83
Outcome Standards at the System Level
6. Cost-effectiveness ratio
(positive outcomes like e.g. number of abstinent patients in relation to treatment
costs)
Regional differences:
•
Prison-based services: significantly less „Yes“- and more „No“answers from Western & Southern Europe
84
Outcome Standards at the System Level
7. Cost-benefit ratio
Documents per country:
Source:
Lit review 2
Expert opinion 2
Expert consensus 2
Research project 2
Practice experience 2
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)
- In my opinion, this standard should be a minimal standard in my country…
n = 139
86
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)
- In my country, this standard is…
n = 139
87
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)
- …feasible, but meets problems – specification
n = 23
r = 49
88
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)
Regional differences:
•
No significant differences between investigated regions
89
Process Standards at the Service Level
8. Assessment procedures: psychiatric status has to be assessed
Documents per country:
Source:
Lit review 63
Expert opinion 74
Expert consensus 85
Research project 36
Practice experience 64
Evidence:
90
Process Standards at the Service Level
8. Assessment procedures: psychiatric status has to be assessed
- In my opinion, this standard should be a minimal standard in my country…
n = 84
91
Process Standards at the Service Level
8. Assessment procedures: psychiatric status has to be assessed
- In my country, this standard is…
n = 84
92
Process Standards at the Service Level
8. Assessment procedures: psychiatric status has to be assessed
- …feasible, but meets problems – specification
n = 27
r = 49
93
Process Standards at the Service Level
8. Assessment procedures: psychiatric status has to be assessed
Regional differences:
•
GP’s office-based services, non-specialised teams: significantly less
“Yes”-answers and more often “No answer” from Central & Eastern
Europe
94
TREATMENT /
REHABILITATION
Standards with low consensus
(less than 50% agreement)
NONE
95