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

2. Development of UK Drug Treatment Information 1968-1997Addicts 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 DMRU

3. Information Needs 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 DMRU Agency Donmall 2001

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

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

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

7. Client Contacts Additional 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 DMRU

8. Client Reviews Additional 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 DMRU

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

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

11. Waiting times: between referral and assessment 2001/2 0% 10% 20% 30% 40% 50% 60% <1 week1 week to 1 month 1-3 months 3-6 months > 6 months New Clients Ongoing Clients DMRU 2002 DMRU

12. Time Lag: between first use of heroin and first ever treatment demand 2001/2 0% 5% 10% 15% 20% 25% 30% 35% Same year1-2 years3-5 years6-9 years>10 years New Clients Clients DMRU 2002 DMRU

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

14. Review: Treatment status at year end 2001/2 45% 21% 34% DMRU 2002 DMRU

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

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

17. Issues raised by first review Low initial return rate (70%) High rate of validation required –attributors dont match between contact & review –agency client number unreliable –invalid dates (referral after assessment etc.) Effort required to maximise response (83%) DMRU 2002 DMRU

18. Models of Care for Substance 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 DMRU

19. Example Care Pathway DMRU 2002 DMRU