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DM RU

DM RU. DMRU - Drug Misuse Research Unit Evidence for Population Health Unit School of Epidemiology & Health Sciences University of Manchester. National Drug Treatment Monitoring System The Annual Client Review. Michael Donmall Senior Research Fellow & Unit Director.

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DM RU

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  1. DMRU DMRU - Drug Misuse Research UnitEvidence for Population Health UnitSchool of Epidemiology & Health SciencesUniversity of Manchester National Drug Treatment Monitoring System The Annual Client Review Michael Donmall Senior Research Fellow & Unit Director www.medicine.man.ac.uk/epidem/dmru  DMRU 2002

  2. DMRU Development of UK Drug Treatment Information • 1968-1997 Addicts Index, doctors, opiate/cocaine addicts • 1985 Drug Misuse Database (DMD) • 1990 DH adopted system nationally • Harmonization • Definitional • 1999 Strategic Review • 2001 National Drug Treatment Monitoring System (NDTMS) • 2002 Minimum Data Set for ‘Models of Care’  DMRU 2002

  3. DMRU Information Needs Agency Agency Agency Agency Agency Agency Agency Agency Referral, Client Details, Initial Assessment Clinical Management, Full Assessment [prescriptions, interventions] Outcomes Drug Action Teams Health Authorities Dept of Health NTA EMCDDA AGENCY REGIONAL NATIONAL TDI  Donmall 2001

  4. DMRU Drug Misuse Database (DMD) Incident User Episodes - scale of problem  DMRU 2002

  5. DMRU The New System First face-to-face contact after 1 April 2001 Client Contact Form Review Form Triggered on 31 March 2002 “out of contact” “still in contact” Next time client presents On 31 March 2003 and each year after that New Contact Form Review Form  DMRU 2002

  6. Client Contact Client Contact Client Review Client Review DMRU The Reporting Process Community-based drug services, outpatient clinics General Practitioners Residential and inpatient units Everybody from April 2001 Everybody from April 2001 Admission Everybody at discharge Everybody from April 2002 Discharge  DMRU 2002

  7. DMRU Client ContactsAdditional Data • Key dates for waiting times - referral, 1st Face to Face contact, assessment • Interventions referred for • 1st treatment demand data • Drug leading to presentation • Lag between drug use & treatment demand • …… other refinements  DMRU 2002

  8. DMRU Client ReviewsAdditional Data • Treatment interventions received (inc. drugs prescribed, supervised consumption, pickup details, shared care arrangements,vaccinations) • Key dates, assessmt, last contact, discharge • Completion of treatment • Length of contact • Reasons for loss of contact • …… other refinements • …………………………...  DMRU 2002

  9. DMRU Enormously Greater Relevance • for Key Performance Indicators and Targets set at Government level • for Understanding & Performance Management at Local level region/ DAT  DMRU 2002

  10. DMRU Contact: Individuals in Treatment 2001/2 53% 30% 17%  DMRU 2002

  11. DMRU Waiting times: between referral and assessment 2001/2 60% New Clients 50% Ongoing Clients 40% 30% 20% 10% 0% <1 week 1 week to 1-3 3-6 > 6 1 month months months months  DMRU 2002

  12. DMRU Time Lag: between first use of heroin and first ever treatment demand 2001/2 35% New Clients 30% Clients 25% 20% 15% 10% 5% 0% Same year 1-2 years 3-5 years 6-9 years >10 years  DMRU 2002

  13. DMRU Contact & Review: Levels of reporting 2001/02 < 83% return rate  DMRU 2002

  14. DMRU Review: Treatment status at year end2001/2 45% 34% 21%  DMRU 2002

  15. DMRU Review: reasons for loss of contact 41% 12% 10% 9% 6% 3% 1%  DMRU 2002

  16. DMRU Review: treatment interventions received during 2001/2 70% 60% 30% 16% 8% 5%  DMRU 2002

  17. DMRU Issues raised by first review • Low initial return rate (70%) • High rate of validation required • attributors don’t match between contact & review • agency client number unreliable • invalid dates (referral after assessment etc.) • Effort required to maximise response (83%)  DMRU 2002

  18. DMRU Models of CareforSubstance Misuse Treatment 1. Non-substance misuse specialist services 2. Open access substance misuse services (SMS) 3. Structured community-based SMS 4. Residential SMS 5. Highly specialised non-SMS  DMRU 2002

  19. DMRU Example Care Pathway  DMRU 2002

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