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OFFCUT 2002 PDF file 237Kb
Audit Commission paints a stark picture of drug treatment in England and Wales
In 2002 an Audit Commission investigation of drug services and GP involvement in 11 drug action team areas in England and Wales found weak commissioning practices and the absence of management information and effective performance monitoring.
STUDY 2008 HTM file
Reducing alcohol harm: health services in England for alcohol misuse
Official audit of work by the Department of Health and NHS to address the health effects of alcohol misuse. Describes a system whose infrastructure is clearly inadequate compared to the size of the task, but one recently taking steps in the right direction.
Using advanced methods, this US study asked what makes for an effective treatment agency. Being constrained by funders in terms of services and ability to individualise treatments was the clearest negative factor, quality accreditation the clearest positive.
Instead of telling addiction treatment providers what to do to qualify for funding, the US state of Delaware set recruitment and engagement targets and largely left the methods up to the services. Result: more and more engaging treatment without stifling innovation.
Placing staff in the clients' shoes was the key tactic in this national US treatment improvement programme which more than halved waiting times and increased retention without limiting patient numbers.
STUDY 2009 HTM file
Developing and validating process measures of health care quality
Finding that a retention benchmark like that used for years in Britain was only loosely related to patient improvement led a US health service to start a comprehensive search for better indicators. Intensity of contact in the first month best predicted which services most benefited their patients.
STUDY 2010 HTM file
Planned and unplanned discharge from alcohol services in Scotland, 2004–2008
In the mid-2000s over 50% of terminated alcohol treatment episodes in Scotland ended with the client or patient dropping out. Considerable variation between regions suggests there is room for improvement and with it improvement in the cost effectiveness of services.
In the US homeland of competition and private health care, it was cooperation and coordination which led to the introduction of new medications and innovations to promote continuing care – plus the exercise of regulatory and financial muscle and the salutary experience of senior staff who placed themselves in the patient's shoes.
In 2007–08 the US state of Maine introduced a new scheme directly linking funding for outpatient treatment services to performance in terms of waiting times and retention, but financial and service delivery impacts were negligible. Were the incentives too weak, or were services already doing as well as they could?
This small English study poses fundamental questions about alcohol treatment services: whether private services suffer from an ‘empathy gap’ and NHS services from poor systems; whether opening up treatment choice to patients with a record of bad decision-making is a good thing; and whether there can be universal criteria for what counts as quality provision.
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