Building an EU consensus for minimum quality standards in the prevention, treatment and harm reduction of drugs Quality Standards - Policy Perspectives Boguslawa Bukowska Piotr Jablonski National Bureau for Drug Prevention, Poland June 2011, Brussels

1. Improvement of the quality of drug care system instead of quantity development (apart from substitution treatment): Code of Ethics for drug treatment therapists, Approved by Ministry of Health System of Training for specialists and instructors dealing with drug treatment & rehabilitation, Accreditation system of treatment facilities, Basic Assumptions

2. Accreditation system common for drugs and alcohol dependency, 3. Accreditation for drugs and alcohol facilities is built in the general accreditation system of health care in Poland. Basic Assumptions

In-patient centres – 170 Detoxification wards - 94 Out-patient centres Day-care wards - 76 Total: units How many care centres (alcohol/drugs) might be involved in the accreditation process?

patients in alcohol treatment facilities (2009 data) patients in drug treatment facilities How many patients might (hopefully) benefit from the quality standards?

Health care centres delivering alcohol/drug treatment and harm reduction, Public and NGO-based health care centres, Out-patient and in-patient health care centres (rehabilitation centres incl. therapeutic communities, hospital wards, detoxification centres, ambulatory and day-care units). Target group of quality standards and accreditation process

– Public health care units of the national, regional and local governments – about 30%, – Non–public care units - mostly NGOs – about 70% Structure of health services for drug users covers:

Why accreditation is important for the substance abuse system ? Improvement of treatment and care quality, Increasing safety (both patients and professionals), Supporting the increase of staff qualification, Optimization of expenditure related to treatment and care for drug/alcohol users, Improvement of care effectiveness, Increasing public trust in drug/alcohol care and treatment, Promotion of good practice.

Who defined the quality standards? Working Group set up by the Ministry of Health in 2004, Members: - National Bureau for Drug Prevention, - The State Agency for the Prevention of Alcohol-Related Problems, - National Center for Quality Assessment in Health Care (NCQA) - and the staff of treatment services.

How were the quality standards defined? Based on: – knowledge of the good practice and what works in treatment and care (evidence-based), – human rights (including patient rights), – experience of experts involved, – contemporary management science, – legislation (accreditation requirements are higher than the law). Agreed on the consensus basis between experts and practitioners.

What has been achieved so far? Quality standards developed for the out-patient and in-patient drug/alcohol dependence care, Pilot testing of quality standards in 7 treatment facilities, Further modification involving results of pilot site visits, Development of the accreditation procedure, Training of accreditation surveyors, Presentation of quality standards for approval of the Accreditation Council (Ministry of Health), Applications for accreditation survey.

Type of standards I. Process of Care 1. Patient Rights (PP) 2. Continuity of Care (CO) 3. Patient Safety (BP) 4. Patient Care (OP)

II. Organizational functions 1. Quality Improvement 2. General Management and Human Resources Management 3. Information Management 4. Environment of Care Management 5. Infection Control 6. Pharmacotherapy Type of standards

Process of accreditation Based on voluntary basis, Application form sent to NCQA, which functions as Accreditation Center (plans the survey, conducts it, provides the accreditation report), Site surveys to verify the standards compliance, Survey report presented to Accreditation Council to recommend (or not) the accreditation for the organization to the Minister of Health, Possible outcomes: not recommended = refusal of accreditation or approval of accreditation (certificate for 3 years)

Legal grounds for standards and accreditation National Programme for Counteracting Drug Addiction 2001 – 2005, 2006 – 2010 and adopted by the Council of Ministers Priority 1.5. introduction of accreditation procedure for facilities dealing with substance abuse, approved by Accreditation Council and National Centre for Quality Assessment in health care. Law on accreditation (2008)

- First version of standards was presented to Accreditation Council of the Ministry of Health in 2010, - Standards are in the process of amendments, taking into account the Accreditation Council remarks Quality standards and accreditation process - state of art in Poland

Steps planned in 2011 Pilot visits to verify the final version of quality standards, Accreditation surveyors training, Official opening of the accreditation process for care centers, Further work to verify the standards set up for out- patients centres.

Potential cons Standards are used against the interests of treatment providers by National Health Fund (to eliminate from the market or limit the financial coverage), Quality standards do not contribute to care improvement, Standards will kill the spirit of treatment (particularly raised by Therapeutic Community). The above might result in the resistance of addiction treatment centers to undergo the accreditation procedure.

Summary Elaboration of quality standards was more time consuming and demanding that it was expected, Lack of experience and insufficient access to the experience in this field in other countries slowed down the process of elaboration of quality standards. Currently we observe: - increasing level of awareness concerning the role and importance of quality standards, – increasing interest of health care units to apply for accreditation.

Thank you!