To review the MTP with regard to data collection, collation and analysis

Scope for increasing data analysis. The CTL is a considerable asset in relation to information on drug treatment.

However there may be opportunities to increase the statistical analysis of the data that is located in the CTL.

5 Sharing Point Available and appropriate statistics. Additional data should be gathered and made available to enable better analysis and review of service. To include: the size of waiting lists to receive methadone; details for each service user on the programme by gender, by amount and by length of time; the number of people who wish to access and have accessed support for stabilisation and the numbers who have accessed support for detoxification; the number of people who have been refused support to access detoxification; and any common issues/themes aris-ing among service users that manifest duraris-ing the review with their GPs.

10 CASP Data on long term impact of methadone. Also identified within the review of service users was possible research into the long term impact of methadone on individuals prescribed such? The terms of reference of this review however may need to include issues that are not specifically health related. Considering the initial rational for methadone use in terms of harm reduction and reduction in crime etc, factors relating to same may also need to be considered in research process.

17 OMD CTL development. The CTL should be further developed within the context of the development of the overall Drug Treatment Reporting System, and with a view to insuring that it can provide information on the outputs and overall progress/outcomes being achieved. We would stress the importance of putting in place a unique identifier to facilitate the development of reporting systems, as envisaged under Action 52 of the National Drugs Strategy.

Additional data. The OMD would like to see the capacity to extract data on new entrants and all clients including drug use histories, waiting times for treatment and outcomes of treatment, progress through services - moving from Level 2 to Level 1 GP care, successful completion of substitute treatment.

18 Northern Area

Greater transparency of data. Quarterly publications of all data should be made easily publicly available. Data should include statistics on service user move on and any information relating to rehabilitation and service provi-sion.

Development of quality individual tracking system. To assist in reviewing progression a system across all clinical treatment services should be established that provides data on: care plan reviews, interagency plans in place, and service user progression. This should include the work that community and voluntary services undertake.

20 Traveller Specific

Drugs Initiative, Pavee Point Trav-ellers Centre

Use of an Ethnic Identifier and its introduction to the care planning process. Clinical, community and voluntary treatment and rehabilitation services should record ethnicity during the development of a care plan and review process. Knowing a service users ethnic identity will impact on the development of not only their treatment regime but also their care plan, ultimately playing a role in their level of engagement with services. Training should be provided to these services to ensure that the importance of having an ethnic identifier in care planning documentation is fully understood and that answering this question honestly will not negatively impact their treatment.

Clear system to review progression through drug treatment pathways. To facilitate the review of service user’s progression through drug treatment pathways, a clear system for recording care planning, inter-agency working and blocks to progression needs to be established. If Traveller service users highlight a particular block to their progress, this needs to be recorded and assessed.

27 Dr John

Moloney Additional data. Targets for data collection should include liver morbidity and mortality, rehabilitation outcomes in community based clinics. Online results from the virus reference lab would be very useful for clinicians.

29 HSE Addiction

Services Dublin North Central and Dublin North

Additional information. Use of the NDTRS forms for further information of treatment in primary care; identify numbers attending Level 1 and Level 2 GPs from the CTL and that numbers are separate from the drug treatment clinics; outlines numbers on methadone maintenance who also detox off methadone; and the numbers of new clients started on methadone treatment by Level 2 GPs.

National Standards for the completion of entry and exit forms / voiding from the CTL are required.

Agreed Standards in relation to treatment programme and urinalysis to feed into collation, collection and analy-sis of data.

Use of service user satisfaction surveys. To implement measures that allow service users to change their GP or pharmacy if requested.

30 Soilse - Service

Users

Everyone in treatment should be able to access their treatment data and it would be a good way of motivating them

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31 SOILSE - Staff Services to provide data to NDTRS and CTL. All services should provide data starting with the NDTRS. This should be reported punctually annually. Further data should be provided on a clinical level-numbers in treatment per DED by way of the Central Treatment List-on a quarterly basis to each Addiction Service and Drug Task Force.

This will accurately show service uptake per area and allow for appropriate responses

Data collection methods need to be established to feedback on relevant variables – for example care plans opened and audited, uptake in detox and rehabilitation, progression etc. DAIS was supposed to be this vehicle.

This should also include customer satisfaction surveys and should be comprised of both services users and service providers.

Focus on qualitative research. There should also be a shift to rebalance research and focus on qualitative research, particularly around the experiences of our service users and their structural marginalisation, more than just a feedback from narrow clinical determinants. A medical solution is incongruous to a social problem. Service outcomes should also be based on quality of life and social inclusion indicators – addressing poverty / secure housing or accommodation / family integration / training, educational and employment opportunities / health and lifestyle indicators / community integration / increased esteem or reduction of stigma etc.

Children of parents on methadone. One of the main themes in drug work is children and the social reproduction of conditions and behaviour. For children of parents on methadone, there needs to be a robust response, family reinforcement and support to minimise risk of systemic addiction. In a wider context children are living in a sys-tem where methadone is heavily stigmatised and where children can become contextualised by this – arrested development, isolated and enculturated. The scope and scale of this needs researched. There is an absence of data relating to children living in addiction in Ireland.

Quantitative outcomes are too narrow and medical based – less using, reduced offending, less infection etc. This focuses on symptoms rather than underlying issues or causes. It means success re: less using, reduced offending and less infection is taken as the ultimate goal. Sources of data limit the discourse. It fails to show how drug users fail to interface with normal life or achieve their reorientation and reintegration which is their goal. Indeed this is a major weakness of the UK Four Tier Alcohol Model which fails to set itself in a social context.

All data should be unified in a manageable format. We would suggest this review should elaborate on what we need to collect. The aim of data collation and analysis is to determine the effectiveness of outcomes being achieved by services. In turn it should influence the framing of policies and contribute to setting service gaols.

41 FSN Data on families. Develop a record of the number of patients on the MMT list whose family members are access-ing a family support service. This will encourage referrals to family support services and strengthen the support system for those on treatment.

43 Ballyfermot

Advance

Data must represent the individual on methadone and include length of time in treatment, detox attempts etc.

Transparent and regular publishing of data required,

46 Drug Treatment

Centre Board Access to CTL out of 9-5 working hours. In line with treatment expansion, consideration needs to be given to ac-cess requirements outside working hours. We recommend consideration to enhancement of online acac-cess to the CTL out of hours and to electronic treatment cards.

Scope of CTL be expanded to include Suboxone and any other future treatments that may become available.

CTL database enhancements have been carried out over the years, we recommend that this be further reviewed in line with additional data requirements in respect of data collation and enhanced reporting requirements. Cur-rent reports should be enhanced to include routine reports on patient pathways, progression and entry/exit data.

We also recommend the introduction of client PPS number as unique identifier.

48 Kilbarrack Coast

Community Programme

Lack of data hindering review. Time on treatment and progression indicators would be powerful evaluation tools but appear not to be available at present. There is a lack of relevant data; whilst it is possible to ascertain at any given time how many people are being prescribed methadone, it is not possible to find out how long each person has been receiving it. It is not possible to find out how many people who have been prescribed methadone since 1971 are not living drug-free lives, or how many current methadone clients are involved in ongoing illicit opiate misuse.

50 Consultants

in Substance Misuse

New technologies. Explore new technologies in relation to electronic completion and transfer of data to and from the CTL. Key performance indicators could be developed in relation to transfer of patients for example the length of time taken for transfer to occur. The DOHC need to make a determination in relation to electronic prescribing.

Regular audit of data collection and compliance of practitioners in this respect should occur. Analysis of data already collected would be interesting and important, particularly in the area of retention in treatment. Analysis already exists from the CTL and this could be enhanced but much will depend on the practitioner entering data on a regular and timely basis

51 Pharmacy

Data should be collated and recorded regarding patient treatment pathways from specialist clinics to com-munity based GPs and comcom-munity pharmacists. The standardised NDRIC referral pathways document which may be adopted nationally to fill this purpose. The exit and entry forms completed by treating GPs/pharmacists should be reviewed with the objective of increasing information and providing a standard report on the patients pathways in treatment.

Patient satisfaction questionnaires should be collected as a quality assurance tool.

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55 South Western

Regional Drugs Task Force

Data should be used to assist service development. Drugs Task Forces are mandated to develop specific plans to address substance use in their specified areas. Anonymous data from the MTP should be forward to either the task forces or the offices of the minister for drugs in order to assist planning and development of services.

Database on GPs that have received training and participating pharmacies should be made available to drugs task forces in a joined up approach to assist in resource allocation and co-ordination.

56 Citywide Data expansion. Data collection systems should be expanded to include the work that community and voluntary services undertake, to ensure that data is captured on care plan reviews, interagency plans, and service user progression.

60 Irish

Associa-tion of Alcohol and Addiction Counsellors

To assist with reviewing progression a system across all clinical treatment should be established that provides data, particularly on the number of people: on waiting lists to receive methadone; in receipt of methadone by gender, by amount and by length of time; who wish to and have accessed support for stabilisation and/or detox;

who have been refused support to access detoxification.

61 North Dublin

City and County Regional Drugs Task Force

Data collection would be more beneficial if collated centrally and is accessible, Ethical issues with client details and client confidentiality to be considered.

66 HSE Social

Inclu-sion Data should reflect service outputs. We will develop a model of data collection that will reflect outputs as regards existing services rather than merely numbers in treatment and those waiting for treatment.

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