Alcohol Outcome Measures by xyd32971

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									Alcohol Outcome Measures

        Scoping the outcome measures
        available for alcohol treatment
                    services
                             November 2009
  DH
  Sue Baker
  Cascade Health
  sue@cascadehealth.org.uk
  07957174661
Alcohol Outcome Measures
Scope of the review

 Focus was on outcome measures for
 treatment interventions for people with
 alcohol problems

This presentation is based on a report of
 the scoping study
Alcohol Outcome Measures
Work Undertaken

 Desk research on the literature available
 Checking out with some of the key
  academics
 Contacting the alcohol leads
 Conversations with services and
  commissioners
Alcohol Outcome Measures

Review of effectiveness of treatment – Duncan
 Raistrick, Nick Heather and Christine Godfrey, NHS/NTA Nov 2006

 Identifies 5 packages
 Discusses factors important to the
  development of a good package in addition to
  validity and reliability
Alcohol Outcome Measures
 Comprehensive Drinker Profile
 Addiction Severity Index
 MAP
 Result
 Christo Inventory for Substance Misuse
  Services
Alcohol Outcome Measures
Comprehensive Drinking Profile
 (Miller and Marlatt 1987)
 Developed in late 80’s
 A detailed tool - assessment and treatment planning
  tool with a follow up facility
 Covers 88 items and incorporates validated
  assessment tools such as MAST
 Very alcohol focused and incorporates space for
  client concerns and issues.
 Down side is size (despite a shorter version being
  available)
Alcohol Outcome Measures
 The Addiction Severity Index (McLellan et al 1980, updated
   in 1992)


  Another detailed assessment tool covering
   alcohol and drug dependence plus 5 other
   common problem areas
  Uses a 30 day period to establish base line
  Said to be widely used in treatment and
   research
  The alcohol component was included in respect
   of drug users but is considered to cover the
   issues know to be seen in people with alcohol
   problems
Alcohol Outcome Measures
Maudsley Addiction Profile (MAP) (Marsden et al 1998)

 Short
 60 items in 4 domains using a 30 day period
 Developed and tested for use with drug and
  alcohol misusers in tier 3 and 4
 Some limitations for alcohol misusers
 Widely used
RESULT (Raistrick and Tober 2003 )
Combines a range of validated measures in
  packages to suit different outcome
  measure requirements
 Incorporates QALYS, ICD-10;
  LDQ,CORE, SSQ; QF + Agency Det
 Draws on measures from the field and
  beyond – very credible
 Adaptable
ct contact with a client or from case notes. It covers social function, health, risk behaviour, psychological wellbeing, occupation, criminal activity, subs




                          Alcohol Outcome Measures
                           Christo Inventory for Substance Misuse
                             Services (Christo et al 2000)
                           • One page tool covering 10 domains
                           • Simple scoring system 0-2 leading to a
                             single overall score
                           • Validated
                           • Limitations re sensitivity for example
                           • Popular use to ease of use
Alcohol Outcome Measures
Since the Effectiveness Review?

 TOPs
 Outcome spider
 Outcome Star
 ATOM
Alcohol Outcome Measures
TOPs
 Designed as a drug treatment outcome
  measurement tool
 Said to be equally appropriate for alcohol
 4 domains covering substance misuse,
  injecting behaviour, crime and health and
  social functioning
 Widely used, short and concise
 Disliked by many alcohol services
Alcohol Outcome Measures
Alcohol Star
 Adapted from the alcohol spider
 Measures change by quantifying steps on
  the client journey across 8 domains
 Does not include measure of alcohol
  misuse
 Service find it combines well with key
  working
Alcohol Outcome Measures

  ATOM/AATOM-C
  New    tool developed in Australia
   Overall approach has commonalities with RESULT
    building a range of existing measures
   Alcohol focused
   5 domains inc client demographics
   Short and validated
   Possible over reliance on client’s view of situation
   Difficult to assess applicability to UK
Alcohol Outcome Measures
Similarities
 Change is measure by comparing a period
  of time (usually 1 month) with a previous
  point in time
 Increasing convergence in the domains
  covered – substance misuse, relationships,
  economic issues, crime, physical and
  psychological health
Alcohol Outcome Measures
Differences
 Combinations of areas within domains
 Choices re rating scales
 Focus on alcohol
 Client centred/purpose
 Length of time to complete
 Method of completion
Alcohol Outcome Measures
Issues

a)What are we wanting to measure
  and why
 Effectiveness of treatment?
 Investment aims?
 Clients concerns?
Alcohol Outcome Measures

b) Agency ownership
 Tie in with what they aim to do
 Have value for clients
 Fit in with assessment and data collection
  systems
 Needs to be simple as possible and short
Alcohol Outcome Measures
c) Client needs to be comfortable
 Follow up and confidentiality
 Question relevant to them

One key issue is: are we interested in
 people with alcohol problems or the
 clients of services ?
d) different services

Is there/could there be a one size fits all
  (across the tiers)?
e) Be reliable and valid

 Universal
 Proven validity and reliability
 Sensitive to change
 Easy readable and neutral language

(Raistrick, Heather and Godfrey 2006)
Alcohol Outcome Measures
What are services doing and saying?

 Using measures as required by
  commissioners
 TOPs not popular with alcohol services
 Most rely on indicators of output not
  outcomes plus qualitative info
 Long term follow up difficult
 BI – might need to stick with repeated use
  of assessment tool
Alcohol Outcome Measures
What are services doing and saying?

 Using measures as required by
  commissioners
 TOPs not popular with alcohol services
 Most rely on indicators of output, not
  outcomes plus qualitative info
 Long term follow up difficult
 BI – might need to stick with repeated use
  of assessment tool
Alcohol Outcome Measures
What are commissioners doing?
 Reconsidering TOPs for alcohol services
 Some evidence of working with services
  to devise tools and dash boards
 Balancing tensions within PCT and with
  what services can deliver
Outcome   Short   Rel for   Uni/Relia   Independent   Tiers    Stakeholder interest
Measure           alcohol   b/valid                            covered

CDP       No      Yes       Yes         No            3, 4     Clinical


ASI       No      ?         Yes         Yes           3, 4,    Clinical

                                                               Clinical Commissioner
MAP       Yes     No        Yes         No            2,3, 4   but client interest tool is
                                                               available as an add on
                                                               Clinical, User &
RESULT    Yes     Yes       Yes         No            2,3, 4   Commissioner


CISS      Yes     ?         Yes         No            2,3, 4   Clinical

                                                               Clinical
TOPs      Yes     No        ?           No            2,3, 4   Commissioner

Alcohol                                                        Clinical Commissioner
Spider    Yes     Yes       Not tested No             3, 4

Alcohol                                                        Clinical
Star      Yes     Yes       Not tested No             3, 4     Commissioner

                                                      2,3 & 4 Clinical, Commissioner
ATOM      Yes     Yes       Yes         No
Conclusions

 No single tool exists that ticks all boxes

 Agreement about the kinds of domains that
  are relevant (alcohol misuse, other
  substances, physical and mental health, use of
  time, relationships and something around
  economic status/housing)
Alcohol Outcome Measures
 Need to increase universality for alcohol
  misusers

 Package approach is required to cover the
  needs of all stakeholders and is likely to
  be achievable

 It might be that outcomes measure for
  BIs are not in many settings achievable
  other than repeating the assessment tool
Alcohol Outcome Measures
 Its a complex business and we need to
  not loose sight of main goal
 Outcome measurement is no worst here
  than in other parts of the health care
  system
 One approach might be to consider a
  Quality Account Approach - Patient Safety,
  Effectiveness & Client Satisfaction
Alcohol Outcome Measures


 Cornerstone points:-

 •Client   Focus
 •User friendly
 •Indicates public benefit from the
 investment
Alcohol Outcome Measures

Sue Baker
Cascade Health
sue@cascade.org.uk
07957 174661

								
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