Insight into evaluation practices in drug treatment in Member States of the European Union

Transcription

1 Insight into evaluation practices in drug treatment in Member States of the European Union Valentina Bini December 2006

2 Objectives Present difference facets applied when it comes to ensure quality in treatment in Member States at national level. Point out some of the difficulties in collecting information at EU level on evaluation practices in drug treatment. Inform about the EMCDDA plans to develop an online portal about science-based practices.

3 EMCDDA shift towards the collection of information on demand reduction, evaluation and quality Exchange on Drug Demand Reduction Database (EDDRA) Monographs on evaluation of treatment, outreach work and prevention. Guidelines for the evaluation of drug prevention (1997) Drug treatment evaluation guidelines (2007)

4 EU Drug Action Plan ( ) Objective 7 Recommendation for actions in the Member States aim at increasing the coverage of access to, quality and evaluation of drug demand reduction programmes.

5 Terms and definitions Monitoring Evaluation Quality Assurance

6 National/regional public authorities Monitoring at national/regional level via a data collection network Governmental funds/funding agencies Quality standards defined i.e. in laws/regulations/national drug strategies Monitoring purposes Reports Funding Progress reports Formal requirements Improved quality of treatment Monitoring Routine data collection Evaluation (process/ outcome) Quality assurance Drug treatment services

7 Data collection - challenges Areas of the drug phenomenon where often quantitative assessments of their implementation level (availability) are not feasible in the context of the resources for data collection that are currently existing. Sources: National reports, structured questionnaires

8 National quality standards for the implementation of drug treatment in general (2005 reporting) Drug free treatment 10 Member States: DK, DE, FR, IT, LV, LU, HU, SK, UK Pharmacologically assisted treatment 16 Member States: BE, CZR, DE, FR, IE, IT, LV, LT, LU, HU, NL, AT, PT, SI, SE, UK

9 National policy initiatives and quality in treatment 14 MS have adopted a policy that aims to support the development of evaluation quality criteria, which is often at an early stage of the development. Inclusion in national drug strategies (recent examples): In Greece, the new National Drug Strategy ( ) envisages the immediate development of evaluation procedures for the therapeutic units in order to ensure the efficient diffusion of best practices In Portugal the need for improved quality of treatment is specified under the main priorities established by the Portuguese National Plan for the period. In Finland, the Drug Policy Action Programme calls for the development of a quality framework for drug service providers. The National Drug Strategy ( ) in Ireland identified national minimum key performance indicators against which performance evaluation can be carried out.

10 Legal bases for quality standards There is rarely a legal base for quality standards reported by MS. Examples: In Austria, there are quality standards for drug facilities announced by the Federal Ministry of Health and Women according to Art. 15 of the Narcotic Substances Act. In Luxembourg, NGOs involved in drug treatment fall under the obligation of the 'ASFT' law (8 /09 /98) and the subsequent grand ducal decree of 10 December 1998, both regulating the relation (duties and rights) between State and NGOs or organisation providing psycho medico-social and therapeutic care.

11 Linkage between monitoring system and assessment of quality in treatment new and important development Germany Core Data Set Addiction Luxembourg RELIS database England NTA and treatment providers and commissioners share the long-term goal to goal to establish proper outcomes monitoring systems

12 Level of evaluation activities -1 In several MS (i.e. DE, HU, FL) there are research and evaluation projects regarding drug demand reduction interventions Overall level of evaluation activities undertaken by individual treatment facilities in Member States can not be established and information is very scarce due to the complexity of its collection.

13 Level of evaluation activities -2 Greece: According to 2005 data, the majority of programmes (58%) have recently performed an evaluation of the therapeutic procedure and/or treatment outcome. Austria: In 2002, a pilot study by the Austrian focal point, estimated that around 20% of the 1005 registered outpatient centres have carried out an evaluation or research project, but the funds for such activities remain scarce.

14 Level of evaluation activities -2 - EDDRA 594 Entries in EDDRA In order for a project to be added to the EDDRA database Evaluated projects that are currently still being implemented. Clear evaluation indicators in place that relate to the objectives, initial situation and the theory base. Clear description of tools that are suitable for the measurements of evaluation indicators. a theory base that is clearly related to the objectives, the initial situation and the indicators. The project must be at least one year old.

15 Level of evaluation activities -2 - EDDRA 144 projects 85% process evaluation 79% outcome evaluation 9% 8% Prevention Treatment Harm reduction 24% 59% Criminal justice

16 Overall comments Coverage, extent of funding and expertise varies considerably among Member States. The lack of a shared terminology, conceptualisation and methodology in Europe is one of the reasons that make systematic overview on evaluation practices in the EU cumbersome.

17 OUTLOOK: Rationale for the EMCDDA focus on science-based practices Objective 7 of the EU Action Plan on Drugs states the need to improve coverage of, access to, quality and evaluation of drug demand reduction programmes and to ensure effective dissemination of evaluated best practices. The provision of information on best practices in the Member States and the facilitation of exchange of such practices is mentioned as a tasks of the EMCDDA in article 2 of the recast of the EMCDDA Regulation. The promotion of information dissemination on science-based practices was also included in the EMCDDA 3-year work programme s objectives. The Centre recognises that an important but currently under-developed area of work for the EMCDDA is to place the descriptive data in the context of identifying and sharing information on best practices.

18 Online portal for science-based practices Science-based practices Definition and description of interventions Prevention Treatment Social Reintegration Cross-cutting areas Harm Reduction Outcome & Impact Cochrane and other relevant reviews, meta-analysis on the effectiveness of interventions Tools for evaluating practices Evaluation Guidelines PERK EIB Others Standards in Implementation practice Operational norms, protocols and guidelines Examples of science based practices Model programmes - EDDRA

19 In the context of the development of the online portal we will also: Develop and exchange views on dissemination mechanisms for science-based practices. Develop criteria for the identification of model evaluation interventions out of the EDDRA database. Raise the profile of model outcome evaluations in the area of treatment and prevention

20 Thank you for your attention.