Treatment monitoring and reporting systems

consumption at national and local level. The EMCDDA has made available on its homepage the final report of the project, guidelines for using the estimation tech-niques in the EU as well as a help desk which supports local prevalence estima-tion studies:

http://www.emcdda.org/activities/epidem_comparability_estimates.shtml

In Greece a Treatment Demand Reporting System based on the "First Treatment Demand Form" (Group Pompidou), co-ordinated by the Greek Focal Point, has been established.

A detailed description of the individual systems from Germany, the Netherlands, Spain and Great Britain can be found in the special issue of European Addiction Research on Treatment Monitoring and Reporting Systems (Simon 1999). In the following sections two instruments of international importance will be briefly de-scribed:

4.2.4.1. Treatment Demand Indicator Protocol (TDI)

Information on drug treatment is collected in almost all European States. The methods of data collection, however, vary considerably. The EMCDDA and the Pompidou Group, in collaboration with experts from the EU member states, have therefore launched various projects in order to develop comparable treatment reporting systems.

The Treatment Demand Indicator Protocol⁹⁶ is the latest result of these joint ef-forts. Its purpose is to provide comparable, reliable and anonymous information on the number and characteristics of people in treatment for drug abuse in Europe. The protocol defines a minimum data set (core item list) which national treatment-monitoring systems should provide on each individual admitted to treatment. The TDI items represent the smallest common denominator in terms of required information and the national systems are free to collect any additional information they deem relevant.

The latest version 2.0 of the Joint EMCDDA-Pompidou Group Treatment Demand Indicator Protocol is the reference document for implementation in the member states. The instrument can be obtained at the following address:

http://www.emcdda.org/activities/epidem_comparability_treatment.shtml .

4.2.4.2. European Addiction Severity Index (EuropASI)

The EuropASI is a documentation system based on the US document standard, the Addiction Severity Index (ASI), developed by McLellan. Its objective is a sim-plification of the documentation in the field of addiction and drugs at European level (in particular in terms of research). An English version was produced a few years ago by a working group of which translations now exist in the most impor-tant European languages.

96European Monitoring Centre for Drugs and Drug Addiction & Council of Europe (EMCDDA). EMCDDA Scien-tific Report, Treatment demand indicator, Standard protocol 2.0. Lisbon, EMCDDA, 2000.

The Addiction Severity Index is a semi-structured interview designed to provide important information about aspects of a client’s life which may contribute to his/her substance abuse syndrome. It is divided into the following fields: General information (9), Physical condition (16), Employment and income situation (26), Legal problems (23), Family background regarding alcohol and drug use as well as psychological problems, drug and alcohol use (28), Family/social relation-ships (26) and Psychological state (22)⁹⁷.

The diagnosis of the drug consumption is not made here using a medi-cal/psychiatric classification system, but using a frequency-determined question-naire on drug consumption along a time axis. For each question area, the current degree of problems and the importance of treatment are evaluated by both the client and the interviewer using a rating scale. To assess the need for treatment and the reliability of the information provided by the patient, the EuropASI uses rating scales (severity rating and reliability rating). Furthermore, this question-naire additionally allows a psychological assessment to be made of the client during the interview.

On the clinical level, using the EuropASI an overview can be gained across the entire span of problems for which a client seeks help. At the same time the infor-mation received serves as the basis for the initial treatment plan. At the research level the EuropASI enables, using the description of client populations from dif-ferent therapy programmes, the selectivity of these programmes to be compre-hended. Since there are severity ratings for each of the surveyed fields, the Eu-ropASI is also suited for progress investigations and thus for monitoring the treatment quality of the individual programmes.

The EuropASI can be downloaded in English from the homepage of the Addic-tion Research Institute, Zurich: http://www.suchtforschung.ch .

The European Addiction Training Institute is offering training seminars for the use of EuropASI (see: http://www.eati.org/easi.htm) .

A new version of the widely accepted “Documentation standards” for the treatment of addicts (see German report, 2.3.4.1) will be available in the book trade in spring 2001 in German and English (for details see Lambertus-Verlag:

http://www.lambertus.de/) .

97 The figure given in brackets corresponds to the categories for the various fields for this survey instrument including the rating scale.

4.2.4.3. Characteristics, aims and requirements of a monito-ring system

In the country reports various aims are named to which monitoring systems should contribute as well as requirements formulated as to what should be ex-pected of good treatment monitoring. After a listing of characteristics, these find-ings will be summarised below:

Characteristics of Monitoring systems:

- Intervention areas: There are usually various monitoring systems for out-patient and in-patent services as well as for substitution treatments. No moni-toring system is known of for low-threshold outreach services. In addition, the Netherlands has a monitoring system for intramural health care. Attempts to harmonise the various systems are already underway at national and interna-tional level.

- Forms of addiction: Sometimes only facilities for addicts of illegal drugs are surveyed, sometimes those for alcohol and medicine substance abuse as well.

- Participation requirements for facilities: Normally participation in the monitor-ing systems is voluntary for the establishments. Sometimes there is the possi-bility of choosing between various systems, or there are regional systems.

This situation limits the use of these systems for service planning and evalua-tion.

- Recorded unit: clients (also beyond the institution) or treatment cases (clients who seek counselling at several locations simultaneously are repeatedly re-corded)

- Random samples: Complete survey or a selection of random samples

- Information source: The need for treatment can only be assessed by the pro-fessional or, in addition, by the clients (e.g. EuropASI).

- Time intervals: Start of treatment; completion of treatment; follow-up survey;

periodic recording of basic information concerning the establishments (serv-ice)

- Evaluation level: client-related, institutional, regional, national evaluations, Objectives of treatment monitoring at different levels:

Treatment area

- Assessment of epidemiological developments with regard to various aspects of dependence for clients willing to be treated

- Improvement of the amount of information about consumption and consumers of legal and illegal drugs as the basis for regional service planning (observa-tion of the needs development)

- Observation of the development of the scope (utilisation) of the addiction care establishments

- Comparison of the concepts of different facilities and observation of their ef-fectiveness for the further development of intervention forms (e.g., the devel-opment of the drug consumption, the health situation or the linking of clients to the health system); influencing factors which promote or hinder identification - Stimulation of professional discussion through the continual observation of

the counselling and treatment practice Treatment and care facilities

- Simplification of the documentation work of the facilities

- Preparation of principles for a specific improvement of their services through a systematic observation of client-related data; improvement of quality through the practical evaluation of courses of treatment

Demands made on a treatment monitoring system to reach these objectives:

- Uniformity or compatibility of the monitoring systems in a planning region which also enables professionally all-embracing and internationally compa-rable analyses (unified documentation of the same characteristics, e.g., ad-diction diagnoses)

- Large participation of the treatment and care facilities within a treatment re-gion in a monitoring system to optimise the planning basis.

- Detailed information on the facility (service, aims, target groups) as a prereq-uisite for differentiated evaluations at regional level

- Anonymous labelling of client data to enable differentiated epidemiological evaluations at regional level (e.g. to analyse course use patterns for the facili-ties)

- Enabling and supporting differentiated evaluations at institutional level as an element of the quality assurance

- Integration of the electronic recording of the monitoring data in the facility as part of comprehensive computer-aided case management (documentation, file management, quality assurance, accounting)