Treatment for substance use disorders: the Belgian Treatment Demand Indicator registration protocol

Abstract

BackgroundRegistration of patients with substance use disorders is of key importance to get insights and to study trends in patients characteristics and substance use patterns. The Treatment Demand Indicator (TDI) is gathering this information at European level since 2000. In Belgium, this registration started at national level in 2011 and an increasing number of facilities of different types are participating in this data collection since then.Methods/DesignThis surveillance register collects information on every treatment episode started by patients for their substance use disorder. Information is collected on socio-demographic characteristics of the patient, treatment history and substance use patterns. Patients are identified uniquely using their national identification number in order identify multiple episodes followed by a same person. A large range of treatment facilities have the possibility to participate in this registration to allow a wide coverage of the population.DiscussionThe objective of the paper is to facilitate the use of data by authorities or researchers by correctly describing all aspects of the indicator. The case definition, the variables collected and the way data should be reported are of key importance to use and interpret the data correctly. An overview of the data registered in 2014 gives also an idea of the content of the database. The article also pictures the strengths and limitations of the register and foresees some future improvements.

Use of health care services by people with substance use disorders in Belgium: a register-based cohort study

“…The current study has several strengths and limitations, some of which have already been mentioned in previous articles [1,6,31]. Outreach services and harm reduction initiatives are not covered by TDI, nor are GPs who are considered to play a major role in detecting and managing SUD directly [28]. This means that people with SUD who are only treated by GPs are not included in the database.…”

“…Data for the current study was generated through the linkage and matching of two existing Belgian national health and population registers: (1) the Belgian Treatment Demand Indicator database (TDI) with information on socio-demographic variables and substances for which treatment was sought at the start of the treatment episode for people in treatment for SUD, covering almost all specialized drug treatment centers and by around one third of the general or psychiatric hospitals [28], and (2) the InterMutualistic Agency database (IMA, [29,30]) with data on reimbursed health care services, gathered through the seven Belgian health insurance agencies. The data that was used from this database consists of contacts with the general practitioner, the psychiatrist, ED and admissions to the hospital, and spanned a period between 1 January 2008 and 31 December 2017.…”

General practice patients starting treatment for substance use problems: observations from two data sources across levels of care

“…The Belgian TDI study protocol has been recently extensively described [2]. Participation in the TDI surveillance is only mandatory for some type of treatment centres for substance use problems.…”

“…The Treatment Demand Indicator (TDI) has been implemented on behalf of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) to collect data in a standardized way in the European Union, Turkey and Norway [1]. Belgium started collecting TDI data from 2011 on, including also data from patients with problems of alcohol only or primarily [2]. The Belgian TDI covers specialist treatment for substance use problems, excluding treatment in general practice because of feasibility issues.…”

Commentary on Chalmers et al . (2016): A thoughtful integration of routine data sources and primary research findings

“…The complexity of relationships between specialist treatment and other services within a treatment ‘system’ is recognized in the conceptual model of Babor and colleagues . However, even where well‐developed treatment utilization monitoring protocols are in place, such as in Belgium, they do not necessarily include the full range of AOD specialist and non‐specialist services .…”