Commentary on Gustafson <i>et al</i>. (2013): Can we know that addiction treatment has been improved without evidence of better patient outcomes?

Humphreys, Keith

doi:10.1111/add.12144

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…Any additional indicators would then benefit from the ongoing efforts by European countries to ensure the timeliness, quality and completeness of data. Candidate indicators should compare key aspects of intervention delivery across countries, should be relatively easy to collect, where possible be evidence-based and, if not, based on expert consensus, and represent quality and coverage of services [110]. It was decided to start in a pragmatic way by producing a ‘framework’, i.e.…”

Section: Resultsmentioning

confidence: 99%

“…client retention and return rates, reductions in drug use, crime, improvements in health, etc. ), but given their complexity, this may be more appropriate to assess in detailed service evaluation studies at national or local level [171] (although note [110]). Further work may be needed to link up more strongly with recently adopted EU quality standards [68].…”

Section: Resultsmentioning

confidence: 99%

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Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study

et al. 2017

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Background and aimsDespite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality.Methods and resultsThe framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included ‘coverage’, ‘waiting list time’, ‘dosage’ and ‘availability in prisons’. For the specific NSP indicators, the priority indicators included ‘coverage’, ‘number of needles/syringes distributed/collected’, ‘provision of other drug use paraphernalia’ and ‘availability in prisons’. Among the generic or cross-cutting indicators the priority indicators were ‘infectious diseases counselling and care’, ‘take away naloxone’, ‘information on safe use/sex’ and ‘condoms’. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries.ConclusionsThe establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study

et al. 2017

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“…While the benefit of physician training and education on patient- and public-health outcomes has yet to be determined (Humphreys, 2013), to our knowledge, coverage estimates have not been established in any Canadian setting. Therefore, we undertook a local need assessment, using a demand-side approach, to estimate the number of skilled addiction care providers required in a Canadian province.…”

Section: Introductionmentioning

confidence: 99%

A Needs Assessment of the Number of Comprehensive Addiction Care Physicians Required in a Canadian Setting

McEachern

Ahamad

Nolan

et al. 2016

Journal of Addiction Medicine

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Objective Medical professionals adequately trained to prevent and treat substance use disorders are in short supply in most areas of the world. While physician training in addiction medicine can improve patient and public health outcomes, the coverage estimates have not been established. We estimated the extent of the need for medical professionals skilled in addiction medicine in a Canadian setting. Methods We used Monte Carlo simulations to generate medians and 95% credibility intervals for the burden of alcohol and drug use harms, including morbidity and mortality, in British Columbia, by geographic health region. We obtained prevalence estimates for the models from the Medical Services Plan (MSP) billing, the Discharge Abstract Database (DAD) data, and the government surveillance data. We calculated a provider availability index (PAI), a ratio of the size of the labour force per 1,000 affected individuals, for each geographic health region, using the number of American Board of Addiction Medicine certified physicians in each area. Results Depending on the data source used for population estimates, the availability of specialized addiction care providers varied across geographic health regions. For drug-related harms, we found the highest PAI of 23.72 certified physicians per 1,000 affected individuals, when using the MSP and DAD data. Drawing on the surveillance data, the drug-related PAI dropped to 0.46. The alcohol-related PAI ranged between 0.10 and 86.96 providers, depending on data source used for population estimates. Conclusions Our conservative estimates highlight the need to invest in health-care provider training and to develop innovative approaches for more rural health regions.

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Drug Treatment Graduation Ceremonies: It's Time to Put This Long-Cherished Tradition to Rest

Williams

2014

Alcoholism Treatment Quarterly

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Commentary on Gustafson et al. (2013): Can we know that addiction treatment has been improved without evidence of better patient outcomes?

Cited by 3 publications

References 10 publications

Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study

Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study

A Needs Assessment of the Number of Comprehensive Addiction Care Physicians Required in a Canadian Setting

Drug Treatment Graduation Ceremonies: It's Time to Put This Long-Cherished Tradition to Rest

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