Data quality and feedback from the assessment on 2000 and 2001 TDI data 1 EMCDDA, TDI meeting, 23/24 June 2003 Luis Royuela.

-Introduction -Years covered and reporting period -Coverage: Geographical and Agencies -Availability of TDI items and comparability with TDI standards. -Completeness of each tables. -Double-counting. -Internal consistency. -Other problems. -Modification of TDI tables. -Conclusion. -Recommendations Data quality and feedback from the assessment on 2000 and 2001TDI data 2

Introduction Objective of indicator To provide comparable, reliable and anonymous information on the number and characteristics of people treated for their drug use in the Member States. Epidemiological -Description of the profile of drug users within Europe. -Identification of patterns of use. -Changes in patterns of use. 3 Management -Which is the population we are interested in and why? -What are the obstacles in getting this information? Purpose of information: REITOX sub-task 3.1 REITOX sub-task 3.2 REITOX sub-task 6.1 Procedures to avoid double counting in drug treatment reporting systems Feasibility study on the implementation of the proposals given in the final reports of REITOX sub-tasks on improving the quality and comparability of treatment reporting systems TDI protocol December ACTIVITIES CARRIED OUT SO FAR.

General Objective: Analysis of TDI data available in the EU member states in order to define a basic “profiles” of clients in treatment. Introduction Implementation of data quality in the EU member states and analysis of aggregated data in order to define a “basic profile of clients in treatment”. 4 Specific Objectives: I.To make data ready for analysis, through a detailed data check II.Assess quality of TDI data III. To identify methodological problems, in the data collected, which could affect the quality of the analysis outputs. IV.To transform data for analysis. V.To define analysis outputs. VI.Final report

Years covered and reporting period 5 Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

Outpatient data available in TDI Tables Not available Available 6 Geographical coverage Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

Agency and clients coverage 7 (1) N of units covered: number of outpatient treatment centres reporting to the monitoring system (2) N of units in the country: Number of outpatient treatment centres that exist in the country. (3) % of centres covered: estimated proportion of reporting outpatient treatment centres, with regard to the overall number of the outpatient treatment centre in the country covered by the monitoring system. (4) % of cases covered: proportion of cases/episodes reported to the monitoring system with regard to all cases treated nationally.

OUTPATIENTS 8 Agency coverage Not Known 10% - 30%31% - 70%> 70% Estimated proportion of reporting treatment centres (with regard to the overall number of the respective treatment centre type in the country) covered by the monitoring system. Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

Inpatient data available in TDI Tables Not available Available Geographical coverage 9 Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

Low threshold agencies data available in TDI Tables Not available Available 10 Geographical coverage Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

G.P. data available in TDI Tables Not available Available 11 Geographical coverage Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

Treatment units in prison data available in TDI Tables Not available Available 12 Geographical coverage Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

Comparability with TDI items BelgiumIntegrating the system in one national system. Not all items covered. Denmark Not all items covered. Minor conversions needed to fit categories of the TDI items. Germany Not all items covered. Some Items with multiple answers. Greece Not all items covered. Minor conversions needed to fit categories of the TDI items. SpainNot all items covered. Minor conversions needed to fit categories of the TDI items. FranceMoving to system based on TDI. IrelandNot all items covered. ItalyIntegrating the system in one national system. Luxemburg No specific problems NetherlandsNot all items covered. AustriaImplementing data collection according to TDI Protocol PortugalPortugal is in a pilot phase FinlandNot all items covered. SwedenNo specific problems United Kingdom Not all items covered. Categories route of administration do not match TDI categories. 13

Completeness of TDI tables 14

1. Missing values: Primary drug. Definition: The main drug is defined as the drug that causes the client the most problems. - Based on problems as defined by clients - Based on the ICD 10 diagnoses. Completeness of TDI tables 15 Records which primary drug is not known. Should be excluded?

Double-counting TDI collects information on persons who start treatment for their drug use at a treatment centre during a given period of time. (one calendar year). Each person should be counted only once in the period. 16

Double-counting. 17 Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

Internal inconsistency Impossibility to know the real number of: - Males - Females - Drugs - And other variables Increases the delay of the data analysis due to: - Have to request for correction. - Have to wait for the answer. 18

Internal inconsistency 19 Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

Internal inconsistency 20 Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

Internal inconsistency 21 Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

22 Internal inconsistency Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

23  Ten countries were included in the analysis. Denmark Germany Greece Spain Ireland Italy Luxemburg Netherlands Sweden Finland Only one did not present any problem. Two presented minor problems. Seven presented serious problems. Internal inconsistency Source: REITOX National Focal Points. TDI detailed tables EMCDDA..

Other problems 24  It is a HARD WORK filling in all TDI tables. oTakes many hours. oProbability of error is high. oThe cross check of the tables, to ensure they have the same information as the source, is a very complex process.  Facilitate the work of people responsible at NFPs. oStudy the modification of the tables. oStudy methods to automate the process: 1.For filling in tables. (SPSS-SAS) 2.For data checking. (Validation tables)

Modification of the tables. 25  Fundamental aim to go ahead with a modification: oIncrease and ensure the quality of data.  How data should be collected would depend on what we are going to do with the data. oDescribe general characteristics of clients in drug treatment of EU member states? oComparative analysis?

Modification of the tables 26  First option: 1.ADD a new column and row for missing values 2.Modify the formulas to allow ceros.

Modification of the tables. 27  Second option: 1.ADD a new column and row for missing values 2.Drop table 4. Previously treated. 3.Double table 14. 1st drug x ever treated by gender. 4.Drop table 7. Age x gender. (Same data in 14.1,2,3) 5.Drop 19.1,2,3 Other drug x age. 6.Double 9. Living status (with whom) 10. Living status (where) 11. Nationality by first treatment 7.Drop 20. Ever injected 8.Double 20.1 Ever injected (drugs) by gender. 9.ADD a table for missing and a validation table.

Modification of the tables. 28  Third option: Same structure for all the tables. 1. All cross-tabulations: All Treatments MENTDI Items Drugs Opiates WOMENTDI Items Drugs Opiates First Treatments MENTDI Items Drugs Opiates WOMENTDI Items Drugs Opiates ADD a table for missing and a validation table.

Modification of the tables. 29  Fourth option: Create a databank on National Treatment Demand. 1.Report individual records. (On a voluntary basis?) 2.Report TDI tables.

Data aggregation at EU level: Databank on National Treatment Demand 1.Better control of the data and increase of quality. 2.No Influence on the level of data protection -Confidentiality (identification variables should not be reported). 3.Extraordinary increase of the power and richness of the data analysis. 30

Conclusions 31 1.Not ALL European Member States report TDI data annually. 2.Quite good geographical coverage of outpatient data in EU, but there is low coverage of agencies and clients in some Member States. 3.Internal inconsistency were found in nine of the countries with data available. 4.There is a high probability of error when TDI tables are filled in. 5.Now is the best moment to face the modification of the reporting system before the new members join it. 6.Still have a long way to go until TDI is used to establish a standard baseline for comparisons.

Recommendations 32 1.Data quality and reliability should be improved. 2.Concentrate efforts on outpatients and inpatients and improve the coverage of agencies and clients in a 1 st phase. 3.Improve the data collection of the other type of units in the next phase. 4.Simplify spreadsheet. The best way to avoid internal inconsistency and facilitate the filling in of the tables is to uniform the structure of the tables. 5.Make more use of the data, analysis and dissemination. 6.TDI should be used to establish a standard baseline for comparisons. 7.Create a databank on National Treatment Demand.