Contact: [email protected] EQUS EQUS Conference - Brussels, June 16, 2011 Michael Schaub, Ambros Uchtenhagen Minimum Quality Standards.

Contact: [email protected]

www.isgf.ch

EQUS

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

Minimum Quality Standards in the field of Drug Demand ReductionParallel Session A: Harm Reduction

• Background information• Harm reduction standards with high consensus• Harm reduction standards with moderate

consensus for discussion• Harm reduction standards with low consensus

dropped from the list

Overview

2

BACKGROUND INFORMATIONCountry comparisonsAvailability of services

3

4

Western & Southern Europe

Austria, Belgium, Cyprus, France, Germany, Greece, Italy, Netherlands, Portugal, Spain, Switzerland

Central & Eastern Europe

Bulgaria, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia, Slovenia

Northern EuropeDenmark, Finland, Ireland, Sweden, United Kingdom

Subdivision for country comparisons

Number completed per region

5

Harm Reduction

Western & Southern Europe 58

Central & Eastern Europe 44

Northern Europe 21

Total 123

Availability of Services

6

Needle and syringe exchange All countries Supervised injection rooms * DE, ES, LU, NL, PL, NO, CH Outreach/street work All countries

Pill testing *BE, CZ, ES, FR, IT, NL, AT, PT, SI, UK, CH

BBV testing & counseling All countries Vaccination All countries Referrals All countries Safer use counseling All countries Safer sex counseling All countries Sheltered housing * All countries but: BG, EE, RONote. For the purpose of clarity, on the following slides only n of those services available in every country is displayed; n of the services marked with * is lower; Regional comparisons: for supervised injection rooms and pill testing no significance tests were cal-culated; the significance tests for sheltered housing included only countries, which offer this service

HARM REDUCTIONStandards with high consensus (more than 80% agreement)

7

Structural Standards of Interventions 1. Accessibility: location

8

Evidence:

Documents per country: Source:Lit review 11Expert opinion 10Expert consensus 8Research project 11Practice experience 17

Structural Standards of Interventions 1. Accessibility: location

9

n = 147

(service can easily be reached by public transport)

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

Structural Standards of Interventions 2. Staff qualification: minimum qualification

10

Evidence:


Structural Standards of Interventions 2. Staff qualification: minimum qualification

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

11

n = 133


Outcome Standards at the System Level3. Goal: reduced risk behaviour

Evidence:


12

Outcome Standards at the System Level3. Goal: reduced risk behaviour

n = 133

(reducing unsafe injections, unsafe drug use and unprotected sex)


13

Outcome Standards at the System Level4. Goal: referrals

Evidence:


14

Outcome Standards at the System Level4. Goal: referrals

n = 130

(treatment services must be prepared to refer clients/patients to other health/social/treatment services if needed and agreed)


15

Outcome Standards at the System Level5. Internal evaluation

Evidence:


16

Outcome Standards at the System Level5. Internal evaluation

n = 130

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


17

Outcome Standards at the System Level6. External evaluation

Evidence:


18

Outcome Standards at the System Level6. External evaluation

n = 129

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


19

Process Standards of Interventions7. Assessment procedures: risk behaviour

Evidence:


20

Process Standards of Interventions7. Assessment procedures: risk behaviour

n = 125

(client’s/patient’s risk behaviour is assessed)


21

Process Standards of Interventions8. Informed consent

Evidence:

Documents per country: Source:Lit review 12Expert opinion 13Expert consensus14Research project 6Practice experience 11

22

Process Standards of Interventions8. Informed consent

n = 124

(clients/patients must receive information on available service options and agree with a proposed regime or plan before starting an intervention)


23

Process Standards of Interventions9. Confidentiality of client data

Evidence:


24

Process Standards of Interventions9. Confidentiality of client data

n = 124

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


25

Process Standards of Interventions10. Routine cooperation with other agencies

Evidence:


26

Process Standards of Interventions10. Routine cooperation with other agencies

n = 124

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


27

Process Standards of Interventions11. Continued staff training

Evidence:


28

Process Standards of Interventions11. Continued staff training

n = 123

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


29

HARM REDUCTIONStandards with moderate consensus (50-80% agreement)

30

Evidence:

31

Documents per country:

Structural Standards of Interventions 1. Accessibility: opening hours

Source:Lit review 12Expert opinion 12Expert consensus 9Research project 7Practice experience 13


(adjusted to the needs of clients/patients, e.g. evenings & week-ends)

n = 140

32




n = 140

33

- In my country, this standard is…



34

n = 61 r = 124

- …feasible, but meets problems – specification



35

• Overall acceptability: tendency toward more “No answer” and less “Yes”-answers from Central & Eastern Europe

• Referrals: significantly less “Yes”-answers and more “No answer” from Central & Eastern Europe

Regional differences:

Evidence:

36


Structural Standards of Interventions 2. Accessibility: costs to be paid by clients


n = 138

(exclusion of costs which limit the accessibility for poor clients/patients)


37


n = 138



38



n = 37 r = 74


39



• No significant differences between investigated regions


40

Evidence:

41


Structural Standards of Interventions 3. Indication criteria: diagnosis


n = 137

(treatment indication is always made on the basis of a diagnosis or, if not possible, a detailed assessment of the current substance use)


42


n = 137



43




44



• No significant differences between investigated regions• Overall acceptability: tendency towards more “Yes”- and less “No”-

answers from Northern Europe


45

Evidence:

46

Documents per country: Source:Lit review 9Expert opinion 13Expert consensus 11 Research project 3Practice experience 11

Structural Standards of Interventions 4. Indication criteria: age limits


(e.g. minimal age required for admittance)

n = 135


47



n = 135


48




49





50

Evidence:

51


Structural Standards of Interventions 5. Staff composition: transdisciplinarity


n = 133

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


52


n = 133



53



n = 45 r = 74


54





55

Evidence:

56


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




n = 133


57



n = 133


58



n = 47 r = 105


59



• Vaccination: tendency towards less “Yes”- and more “No”-answers from Central & Eastern Europe, especially when compared with Northern Europe

• Sheltered housing: significantly more “No answer” and less “Yes”-answers from Central & Eastern Europe

• Significantly less “Already implemented”-answers from Central & Eastern Europe, especially when compared with Western & Southern Europe


60

Evidence:

61


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


62


n = 129

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


63


n = 129



64



n = 52 r = 85


65



• Overall acceptability: tendency towards less “Yes”- and more “No”-answers from Western & Southern Europe, especially when compared to Northern Europe

• Needle-syringe exchange, safer use counseling, safer sex counseling, sheltered housing: significantly less “Yes”- and more “No”-answers from Western & Southern Europe


Evidence:

66


Outcome Standards at the System Level 8. Cost-benefit ratio



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

n = 128


67



n = 128


68



n = 48 r = 78


69



• Overall acceptability, needle-syringe exchange, outreach/street work, vaccination, referrals, safer use & safer sex counseling, sheltered housing: significantly more “No”-answers from Western & Southern Europe

• Significantly more “Feasible, but meets problems”-answers from Northern Europe


70

Evidence:

71


Process Standards of Interventions 9. Assessment procedures: complete needs assessment and priorisation


Process Standards of Interventions 9. Assessment procedures (1)

complete needs assessment and priorisation (e.g. 1. harm reduction of intravenous drug use and, 2. reduction of used syringes in public spaces etc.)

72

n = 127




73

n = 127




74

n = 36 r = 60




75

• Acceptability: no significant differences between investigated regions

• Significantly more “Not feasible at all”-answers from Central & Eastern Europe, especially when compared to Western & Southern Europe


Evidence:

76


Process Standards of Interventions 10. Assessment procedures: client/patient status



(the client’s/patient’s health status is assessed)

n = 126


77



n = 126


78



n = 32r = 55


79



• Acceptability for vaccination: significantly more “Yes”- and less “No”-answers from Western & Southern Europe, especially when compared to Northern Europe

• Significantly more “Not feasible at all”-answers from Central & Eastern Europe


80

Evidence:

81


Process Standards of Interventions 11. Individualised treatment planning


82


(intervention regime and intervention plans, if applicable, are tailored individually to the needs of the client/patient)

n = 125


83



n = 125


84



n = 42 r = 74


85



• No significant differences between investigated countries


Evidence:

86


Process Standards of Interventions 12. Written client records



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

n = 124


87



n = 124


88



n = 32 r = 58


89



• No significant differences between countries found• Referrals: tendency towards less “Yes”- and more “No”-answers from

Central & Eastern Europe, especially when compared with Northern Europe


90

Evidence:

91


Process Standards of Interventions 13. Neighbourhood/community consultation

Source:Lit review 9Expert opinion12Expert consensus 10Research project 7Practice experience 8


(avoiding nuisance and conflict with other people around the service)

n = 123


92



n = 123


93



n = 42 r = 86


94



• Acceptability: no significant differences between investigated regions

• Significantly more “Not feasible at all”-answers from Central & Eastern Europe


95

HARM REDUCTIONStandards with low consensus (less than 50% agreement)

96


97

n = 135

(e.g. minimum age required for admittance)


Questions?

Discussion

Contact: www.isgf.ch

98

Contact: [email protected] EQUS EQUS Conference - Brussels, June 16, 2011 Michael Schaub, Ambros Uchtenhagen Minimum Quality Standards.

Documents

country slide

expert opinion

outcome standards

expert consensus

service slide

harm reduction slide

minimal standard

system level