Erik Iversen, Norway Workshop at the annual TDI expert meeting EMCDDA, Lisbon 25 September 2006 Data Coverage Assessment The Bergen Clinics Foundation, Erik Iversen, 2006 Partially based on a paper by Erik Iversen 1, Arvid Skutle 1, Linda Montanari 2, Roger Holmberg 3, Mette T. Eriksen 4, Kristiina Kuussaari 5, Bert Gren 6, Mikael Dahlberg 6, and Vera Segraeus 7. 1 ) The Bergen Clinics Foundation (Norway); 2 ) European Monitoring Centre for Drugs and Drug Addiction; 3 ) National Board of Health and Welfare (Sweden); 4 ) The Danish National Board of Health; 5 ) STAKES (Finland); 6 ) IKM- Documentation (Sweden); 7 ) The National Board of Institutional Care (Sweden)

Process and format –Comparability of national data sets selection of population(s) selection of variables modes of data gathering types of data: individual, case or aggregate –Validity and reliability of the data –Coverage issues European standards: –EMCDDA: Treatment Demand Indicator (TDI) Standard protocol 2.0 Examples for utilization of data –Cannabis as a primary substance –Cocaine use as an emerging trend in Europe –Patient populations: reflecting poverty issues Are national treatment data comparable? If so, can they be used meaningfully? The Bergen Clinics Foundation, Erik Iversen, 2006

Definitions of key terms: A case is a person who starts treatment for their drug use at a treatment centre during the calendar year 1 January to 31 December. EMCDDA: Treatment Demand Indicator (TDI) Standard protocol 2.0 Which ‘cases’ should be included? What is ‘treatment’? When does treatment ‘start’? Which types of treatment centres should be included? What does ‘drug use’ mean? What ‘drugs’ should be included? TDI / E.I. 2006

Norway: Addiction treatment sector About 200 institutions/units: Publicly and privately owned Scientific, idealistic, religious bases “Treatment” spanning –from mere “bed and breakfast” –to specialist work by psychologists/psychiatrists Capacity from 4 to above 200 patients/clients Detox, in-patient, out-patient, day care treatment, social-pedagogic long term collectives, care The Bergen Clinics Foundation The Bergen Clinics Foundation, Erik Iversen, 2006

N = 11,287 / 4,389 / 1,195 / 4,087 / 356,827 TDI / EI, 2006 * Other Europe: Range male percent 67 (Hungary) to 87 (Italy, Cyprus), mean 82,9

Country Pop 2003 N. of clients % male % injection Norway4,611, (estimation) Sweden8,94,38969,041.0 Finland5,21, Denmark5,44, Czech Republic10,28, Germany82,544, Greece11,04, Italy57,3162,230 (0.28% of pop.) Cyprus0, Lithuania3,55,01182,091.9 Luxembourg0,4389 (0.097% of pop.) Hungary10,114, Malta0, ? Netherlands16,29, Austria8,16, Slovenia2,01, Slovakia5,42, UK59,399, Bulgaria7,82, Romania21,21, TDI/EI 2006

N = 3715 / 1359 / 350 / 902 / 8890 / 4674 / 1780 / / 683 / TDI / EI, 2006

N = 7572 / 3030 / 845 / 3185 / / 9491 / 8107 / / 3586 / TDI / EI, 2006

the participation percentage of the different types of treatment centres that are intended in the systems if there are types of services that are excluded from the systems the participation percent of the clients within each of the treatment centres intended to participate if there are client groups (populations) that are excluded from the systems (gender/age/substance) Main coverage issues The Bergen Clinics Foundation, Erik Iversen, 2006

The current knowledge (within TDI) of the relevant coverage types Target population(s) of the monitoring system – types of treatments/clients to be included (according to TDI) – identifying the centres/services in the field (nationally/regionally) – data management (national registers) compared with Coverage information required for meaningful data comparison – using existing information – collecting basic other information – updating over time Exploring coverage of the TDI - 1 The Bergen Clinics Foundation, Erik Iversen, 2006

If there is identified a need for improved coverage monitoring, further issues must be addressed: Obtaining examples of good and poor national/regional coverage monitoring systems and coverage situations Information on the centres covered (and not covered) by the data collection: –what type of treatment do they provide? –what is the target population: is there a defined target population? –to what extent the actual population in treatment match the target population? Exploring coverage of the TDI – 2a The Bergen Clinics Foundation, Erik Iversen, 2006

Estimating coverage –estimation based on the number/types of facilities –estimation based on the number/types of clients –how to deal with missing information? –double counting: estimation of the level of double counting within an agency (temporal) and between agencies (level of co-operation) Representativeness and coverage –full surveys versus samples –identifying systematic biases Exploring coverage of the TDI – 2b The Bergen Clinics Foundation, Erik Iversen, 2006

Ways to enhance participation and coverage obligatory vs. voluntary participation measures for enhancing participation Recommendations for improving data coverage? Table(s) on coverage to be added to the TDI tables? Enhancing coverage of the TDI The Bergen Clinics Foundation, Erik Iversen, 2006