Plans for 2002 and 2003

Quality improvement substitution treatment in Europe

The European Commission has contracted Quest for Quality to carry out the project 'Quality improvement substitution treatment in Europe'. The project is co-sponsored by Molteni pharmaceuticals in Florence, Italy and will be carried out under the responsability of Quest for Quality in Amsterdam, The Netherlands. Starting date is September 1st, 2002 and the project should be finished in 9 months. Project co-ordinator is Ellen de Jongh-Bouwhuis (email: info@q4q.nl). It concerns the following activities.

The training package will contain a blueprint for training of professional involved in substitution treatment. It will contain (1) topics to cover, (2) suggested timetable, (3) profile of trainers, (4) instructions for trainers, (5) materials, (6) a list with internet references, (7) a bibliography with suggested literature and (8) an evaluation form. The package will be produced under the supervision of a group of experts who will meet once in Amsterdam in May 2002. Subsequently the package will be tested in a try-out training. After taking the feedback into consideration the final package will be designed, made available in English, Spanish, French and German.

The draft training package will be tested in a try-out training. This will be a three-day ‘on-site’ training with a team of a substitution treatment centre. Special attention will be given to the various modules of the package, its relevance, its usability training and the feedback received by trainees. This information will be used to finalise the training package.

The best way to learn how to run a substitution programme is to do an ‘on-site training’ in a ‘centre of excellence’. Euro-Methwork will facilitate in this ‘training on-site’. Candidate centres will be contacted and asked for co-operation. Subsequently, the centre will receive experts appointed by Euro-Methwork. These experts will speak with the patients, the staff and look into treatment protocols, evaluation strategies and assess whether the staff in this centre is equipped to serve as trainers. Once approved, the centre will receive a ‘Quality Certificate’ and thus serve as a ‘centre of excellence’ for the region, which is qualified to receive trainees. It is anticipated that at least 5 centres of expertise have to be identified to meet training needs. Euro-Methwork will facilitate those who wish to follow a training.

On the website of Euro-Methwork (www.euromethwork.org) special pages will be developed with frequently asked questions and answers on substitution treatment. In cases where these answers are not sufficient, people can send an email and this email will be redirected to someone in the network who can answer the question. This website will be developed in close co-operation with participants of the network, making use of their specific expertise.

An innovative approach will be used to facilitate quality improvement of substitution treatment, i.e. the development of a ‘virtual clinic’ on the website of Euro-Methwork (www.euromethwork.org). The visitor ‘enters’ this virtual clinic and can choose to have an intake, to see a doctor, nurse, social worker or psychologist. Questions can be asked about the clinic, the rules and regulations, various substitute drugs and their effects and the treatment plan. Information can be obtained about the layout of the clinic and safety issues as well. Furthermore, information will be provided about the latest developments to optimise the provision of substitution treatment (chip cards for patients, automated dispensers etc. etc.). The target groups are (1) drug experts and policy makers who wish to start substitution treatment and (2) people working in substitution treatment, who special pages will be developed with frequently asked questions and answers on substitution treatment. In cases where these answers are not sufficient, people can send an email and this email will be redirected to someone in the network who can are looking for new ideas or who wish to improve their services.

Still resistance can be found among decision-makers to invest in substitution treatment. Often they are not aware of the scientific data about the positive effects of substitution treatment and lack knowledge about the cost effectiveness of such treatment. Discussions are often based on outdated information and/or ideological and emotional ground. In order to stimulate a more rational debate, Euro-Methwork will produce an information package for decision makers and those involved in discussions with decision makers. The material in the package will consist of summaries of the last scientific information, a paper about the pros and cons of substitution treatment, a paper on how to make a cost-effectiveness calculation for a specific region, and addresses for reference. A draft version of this package will be discussed in an expert meeting in Amsterdam. After incorporating their suggestions and comments, the package will be finalise and made available in English, Spanish, French and German.

Evaluation and follow-up

It is important to evaluate the actions taken by Euro-Methwork. The evaluation will consist of both process as well as outcome evaluation. The process evaluation will give a precise description of the various steps taken in each proposed action, difficulties encountered and solutions found. For the outcome evaluation, a questionnaire will be used which will be sent to the end-users of the products. Also feedback regarding the virtual clinic and the methadone helpdesk received via the Internet shall be used as input for the outcome evaluation. This information will be analysed and result in a concise description of the final products and a description of the assessment by the end-users of the quality and usability of the final products.