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:
Source:Lit review 49Expert opinion 58Expert consensus 74Research project 22Practice experience 54
Documents per country:
6
(treatment indication is always made on the basis of a diagnosis)
n = 145
7
Structural Standards of Services 2. Indication criteria: diagnosis
- In my country, this standard is…
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
- In my country, this standard is…
Outcome Standards at the System Level 4. Goal: health stabilisation/improvement
Evidence:
Source:Lit review 62Expert opinion 77Expert consensus 93Research project 31Practice experience 58
Documents per country:
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
- In my country, this standard is…
Outcome Standards at the System Level 5. Goal: social stabilization/integration
Evidence:
Source:Lit review 53Expert opinion 66Expert consensus 89Research project 28Practice experience 53
Documents per country:
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
- In my country, this standard is…
Outcome Standards at the System Level 6. Goal: reduced substance use
Evidence:
Source:Lit review 62Expert opinion 78Expert consensus 93Research project 37Practice experience 65
Documents per country:
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
- In my country, this standard is…
Outcome Standards at the System Level 7. Utilisation monitoring
Evidence:
Source:Lit review 18Expert opinion 33Expert consensus 37Research project 15Practice experience 29
Documents per country:
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
- In my country, this standard is…
Outcome Standards at the System Level 8. Internal evaluation
Evidence:
Source:Lit review 18Expert opinion 33Expert consensus 37Research project 15Practice experience 29
Documents per country:
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
- In my country, this standard is…
Process Standards at the Service Level 9. Assessment procedures (1): substance use history etc.
Evidence:
Source:Lit review 78Expert opinion 89Expert consensus 105Research project 40Practice experience 78
Documents per country:
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
- In my country, this standard is…
Process Standards at the Service Level 10. Assessment procedures (2): somatic status etc.
Evidence:
Documents per country:
22
Source:Lit review 65Expert opinion 78Expert consensus 89Research project 39Practice experience 63
23
n= 84
23
somatic status and social status have to be assessed
Process Standards at the Service Level 10. Assessment procedures (2)
- In my country, this standard is…
Process Standards at the Service Level 11. Individualised treatment planning
Evidence:
Source:Lit review 83Expert opinion 98Expert consensus 116Research project 46Practice experience 86
Documents per country:
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)
- In my country, this standard is…
Process Standards at the Service Level 12. Informed consent
Evidence:
Source:Lit review 68Expert opinion 80Expert consensus 93Research project 36Practice experience 71
Documents per country:
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)
- In my country, this standard is…
Process Standards at the Service Level 13. Written client records
Evidence:
Documents per country:
28
Source:Lit review 65Expert opinion 75Expert consensus 92Research project 32Practice experience 68
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)
- In my country, this standard is…
Process Standards at the Service Level 14. Confidentiality of client data
Evidence:
Documents per country:
30
Source:Lit review 60Expert opinion 75Expert consensus 83Research project 34Practice experience 64
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)
- In my country, this standard is…
Process Standards at the Service Level 15. Routine cooperation with other agencies
Evidence:
Source:Lit review 62Expert opinion 85Expert consensus 102Research project 30Practice experience 74
Documents per country:
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)
- In my country, this standard is…
Process Standards at the Service Level 16. Continued staff training
Evidence:
Documents per country:
34
Source:Lit review 55Expert opinion 74Expert consensus 86Research project 31Practice experience 64
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)
- In my country, this standard is…
Process Standards of Interventions17. Assessment procedures (1): substance use history etc.
Evidence:
Documents per country:
36
Source:Lit review 78Expert opinion 89Expert consensus 105Research project 40Practice experience 78
37
Process Standards of Interventions17. Assessment procedures (1)
n = 55
37
substance use history, diagnosis and treatment history have to be assessed
- In my country, this standard is…
Process Standards of Interventions18. Assessment procedures (2): somatic status etc.
Evidence:
Source:Lit review 65Expert opinion 78Expert consensus 89Research project 39Practice experience 63
Documents per country:
38
39
n = 55
39
somatic status and social status have to be assessed
Process Standards of Interventions18. Assessment procedures (2)
- In my country, this standard is…
Process Standards of Interventions19. Assessment procedures (3)
Evidence:
Source:Lit review 63Expert opinion 74Expert consensus 85Research project 36Practice experience 64
Documents per country:
40
41
Process Standards of Interventions19. Assessment procedures (3)
n = 55
41
psychiatric status has to be assessed
- In my country, this standard is…
Process Standards of Interventions20. Individualised treatment planning
Evidence:
Documents per country:
42
Source:Lit review 83Expert opinion 98Expert consensus 116Research project 46Practice experience 86
43
Process Standards of Interventions20. Individualised treatment planning
n = 55
43
(treatment plans are tailored individually to the needs of the patient)
- In my country, this standard is…
Process Standards of Interventions21. Informed consent
Evidence:
Documents per country:
44
Source:Lit review 68Expert opinion 80Expert consensus 93Research project 36Practice experience 71
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)
- In my country, this standard is…
Process Standards of Interventions22. Written client records
Evidence:
Source:Lit review 65Expert opinion 75Expert consensus 92Research project 32Practice experience 68
Documents per country:
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)
- In my country, this standard is…
Process Standards of Interventions23. Confidentiality of client data
Evidence:
Source:Lit review 60Expert opinion 75Expert consensus 83Research project 34Practice experience 64
Documents per country:
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)
- In my country, this standard is…
Process Standards of Interventions24. Routine cooperation with other agencies
Evidence:
Documents per country:
50
Source:Lit review 62Expert opinion 85Expert consensus 102Research project 30Practice experience 74
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)
- In my country, this standard is…
Process Standards of Interventions25. Continued staff training
Evidence:
Source:Lit review 55Expert opinion 74Expert consensus 86Research project 31Practice experience 64
Documents per country:
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)
- In my country, this standard is…
TREATMENT / REHABILITATION
Standards with moderate consensus
(50-80% agreement)
54
Evidence:
55
Documents per country:
Structural Standards of Services 1. Accessibility: location
Source:Lit review 22Expert opinion 28Expert consensus 31Research project 14Practice experience 26
56
Structural Standards of Services 1. Accessibility: location
(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
Structural Standards of Services 1. Accessibility: location
(service can easily be reached by public transport)
n = 153
- In my country, this standard is…
58
Structural Standards of Services 1. Accessibility: location
(service can easily be reached by public transport)
n = 25 r = 50
- …feasible, but meets problems – specification
59
Structural Standards of Services 1. Accessibility: location
(service can easily be reached by public transport)
• No significant differences between investigated regions (Northern Europe, Western & Southern Europe, Central & Eastern Europe)
Regional differences:
Evidence:
60
Source:Lit review 28Expert opinion 39Expert consensus 45Research project 12Practice experience 40
Documents per country:
Structural Standards of Services 2. Physical environment: safety
61
Structural Standards of Services 2. Physical environment: safety
(service is equipped for reanimation and other emergencies like e.g. management of overdose)
n = 150
61
- In my opinion, this standard should be a minimal standard in my country…
62
Structural Standards of Services 2. Physical environment: safety
(service is equipped for reanimation and other emergencies like e.g. management of overdose)
n = 150
62
- In my country, this standard is…
63
Structural Standards of Services 2. Physical environment: safety
(service is equipped for reanimation and other emergencies like e.g. management of overdose)
63
n = 17 r = 31
- …feasible, but meets problems – specification
64
Structural Standards of Services 2. Physical environment: safety
(service is equipped for reanimation and other emergencies like e.g. management of overdose)
64
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
Evidence:
65
Source:Lit review 38Expert opinion 52Expert consensus 63Research project 19Practice experience 51
Documents per country:
Structural Standards of Services 3. Staff composition: transdisciplinarity
66
Structural Standards of Services 3. Staff composition: transdisciplinarity
n = 143
(e.g. service employs a multidisciplinary team composed of at least 3 professions)
66
- In my opinion, this standard should be a minimal standard in my country…
67
Structural Standards of Services 3. Staff composition: transdisciplinarity
n = 143
(e.g. service employs a multidisciplinary team composed of at least 3 professions)
67
- In my country, this standard is…
68
Structural Standards of Services 3. Staff composition: transdisciplinarity
(e.g. service employs a multidisciplinary team composed of at least 3 professions)
68
n = 25 r = 47
- …feasible, but meets problems – specification
69
Structural Standards of Services 3. Staff composition: transdisciplinarity
(e.g. service employs a multidisciplinary team composed of at least 3 professions)
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!)
Regional differences:
Evidence:
70
Source:Lit review 13Expert opinion 31Expert consensus 33Research project 10Practice experience 26
Documents per country:
Outcome Standards at the System Level 4. Discharge monitoring
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)
n = 142
71
- In my opinion, this standard should be a minimal standard in my country…
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)
n = 142
72
- In my country, this standard is…
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)
73
n = 22 r = 41
- …feasible, but meets problems – specification
74
Outcome Standards at the System Level 4. Discharge monitoring
(e.g. ratio of regular / irregular discharges, retention rates etc. have to be periodically monitored)
74
Regional differences:
• No significant differences between investigated regions• GP’s office-based services: tendency towards more “Yes”-answers
from Northern Europe
Evidence:
75
Source:Lit review 18Expert opinion 36Expert consensus 39Research project 14Practice experience 32
Documents per country:
Outcome Standards at the System Level 5. External evaluation
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)
n = 141
76
- In my opinion, this standard should be a minimal standard in my country…
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)
n = 141
77
- In my country, this standard is…
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)
78
n = 30 r = 63
- …feasible, but meets problems – specification
79
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)
79
Regional differences:
• GP’s office-based services: significantly more “Yes”-answers from Northern Europe
Evidence:
80
Source:Lit review 13Expert opinion 12Expert consensus 13Research project 7Practice experience 12
Documents per country:
Outcome Standards at the System Level 6. Cost-effectiveness ratio
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)
n = 140
81
- In my opinion, this standard should be a minimal standard in my country…
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)
n = 140
82
- In my country, this standard is…
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)
83
n = 31r = 69
- …feasible, but meets problems – specification
84
Outcome Standards at the System Level 6. Cost-effectiveness ratio
(positive outcomes like e.g. number of abstinent patients in relation to treatment costs)
84
• Prison-based services: significantly less „Yes“- and more „No“-answers from Western & Southern Europe
Regional differences:
Evidence:
85
Source:Lit review 2Expert opinion 2Expert consensus 2Research project 2Practice experience 2
Documents per country:
Outcome Standards at the System Level 7. Cost-benefit ratio
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
- In my opinion, this standard should be a minimal standard in my country…
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
87
- In my country, this standard is…
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)
88
n = 23r = 49
- …feasible, but meets problems – specification
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)
89
Regional differences:
• No significant differences between investigated regions
Evidence:
90
Source:Lit review 63Expert opinion 74Expert consensus 85Research project 36Practice experience 64
Documents per country:
Process Standards at the Service Level 8. Assessment procedures: psychiatric status has to be assessed
Process Standards at the Service Level 8. Assessment procedures: psychiatric status has to be assessed
n = 84
91
- In my opinion, this standard should be a minimal standard in my country…
Process Standards at the Service Level 8. Assessment procedures: psychiatric status has to be assessed
n = 84
92
- In my country, this standard is…
Process Standards at the Service Level 8. Assessment procedures: psychiatric status has to be assessed
93
n = 27 r = 49
- …feasible, but meets problems – specification
Process Standards at the Service Level 8. Assessment procedures: psychiatric status has to be assessed
94
Regional differences:
• GP’s office-based services, non-specialised teams: significantly less “Yes”-answers and more often “No answer” from Central & Eastern Europe
TREATMENT / REHABILITATION
Standards with low consensus
(less than 50% agreement)
95
NONE
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