Publication - Independent report

Medication Assisted Treatment (MAT) standards: access, choice, support

Published: 31 May 2021
Directorate:
Population Health Directorate
Part of:
Health and social care
ISBN:
9781800049826

Evidence based standards to enable the consistent delivery of safe, accessible, high-quality drug treatment across Scotland. These are relevant to people and families accessing or in need of services, and health and social care staff responsible for delivery of recovery oriented systems of care.

Medication Assisted Treatment (MAT) standards: access, choice, support
Appendix 2 Numerical Measures for Standards 1-5

Appendix 2 Numerical Measures for Standards 1-5

Standard 1 All people accessing services have the option to start MAT from the same day of presentation.
What to measure? How long does it take from first presentation to starting a prescription as part of MAT?
Required data items For each individual person
  • – Date and timea of first contact with any partner in the multi-agency partnership within an episode of care.
  • – Date and timea of first prescription within an episode of care.
  • – Age, gender, setting and service.
For the given period e.g. month, quarter, year
  • − Number of people started on MAT.
  1. Mean, median or mode length of time between first contact and first prescriptionb. 2. Range or interquartile range of length of time between first contact and first prescriptionc. 3. Proportion of people started on MAT within a given time period (e.g. month, quarter, year) who started MAT within a given time period (e.g. 1 working day, 2 working days, 3 working days, 5 working days and more than 5 working days)d. 4. Disaggregated into age, gender, setting and service.
What these measures demonstrate
  • 1. Demonstrates the typical period of time taken for people to start MAT from initial contact with any partner in the multi-agency partnership.
  • 2. &3. Demonstrates the variation in the period of time taken for people to start MAT.
4. Demonstrates any differential access according to age, gender, setting and service. Note: Assessment of the trend in measures will help to determine the rate of change in time from first contact to starting MAT
Frequency This will depend on things like the throughput of the service, the stage of the service development and the method for collecting the data. In general monthly reporting of numerical measures will enable an assessment of the trend and will help to determine the rate of change.
Potential data sources
  • − Drug and Alcohol Information System (DAISy)
  • − Prescribing Information Systems (PIS or PRISMS)
  • NHS partners: local patient management systems e.g. TRAK, EMIS/VISION
  • − Third sector: local case management records
  • − Social care: local case management records e.g. SWIFT
  • − Local prescribing system: e.g. Illy, Nebula.
Notes a. Date and time will enable a more accurate calculation of the period of time taken to start MAT, but date will be sufficient.
b. The mean, median and mode gives a measure of where the center of the data falls, but often give different answers. The mean is most frequently used measure of central tendency, but there are some situations where either the median or the mode are preferred. The median is the preferred measure when there are a few extreme data point (e.g. patients that have very long lenths of wait) that would have a great effect on the mean. The mode is the most common value and is useful when data are categorical measurements (e.g patients on each OST type).
c. The range gives a measure of the spread or variability of the whole data set, while the interquartile range gives you the spread of the middle half of the data set. The interquartile range is the best measure for data sets with a few extreme data points (outliers) because it is based on values that come from the middle half of the data set, it's unlikely to be influenced by outliers.
d. These are suggested splits, others may be more appropriate for your service depending on the range of time periods involved within your service.
e. Some services may wish to do further analysis of the local pathway e.g. between (a) initial presentation to any member of the multiagency team; (b) to referral to the nursing team; (c) to consultation with the nursing team. (d) to prescription; (e) to dispensing. This may help to identify specific challenges and opportunities for improvement at different parts of the pathway.
Standard 2 All people are supported to make an informed choice on what medication to use for MAT, and the appropriate dose
What to measure? Number of people on the different opioid substitution medications.
Required data items For the given snapshot (e.g. end of month/quarter/year)
  • The number of people on the MAT caseload taking methadone,
  • The number of people on the MAT caseload taking oral buprenorphine,
  • The number of people on MAT caseload taking injectable buprenorphine,
  • The number of people on MAT caseload taking heroin assisted treatment,
  • The number of people on the MAT caseload.
  • Age, gender, setting and service.
Proposed measure and disaggregation 1. Percentage of people currently on the MAT caseload taking each type of opioid substitution therapy medication
  • Percentage of people on the MAT caseload taking methadone,
  • Percentage of people on the MAT caseload taking oral buprenorphine,
  • Percentage of people on MAT caseload taking injectable buprenorphine,
  • Percentage of people on MAT caseload taking heroin assisted treatment.
2. Disaggregated into age, gender, setting and service.
What this measure demonstrates 1. Demonstrates people are provided different medication options. 2. Demonstrates any differential access according to age, gender, setting and service.
Frequency This will depend on things like the throughput of the service, the stage of the service development and the method for collecting the data. In general monthly reporting of numerical measures will enable an assessment of the trend and will help to determine the rate of change.
Potential data sources
  • Drug and Alcohol Information System (DAISy)
  • Prescribing Information Systems (PIS or PRISMS)
  • NHS partners - local patient management systems e.g. TRAK / EMIS/ VISION
  • Local prescribing systems e.g. Illy / Nebula
  • Local manual data capture systems
Notes Some services may wish to do further analysis on the dosage offered to people. This may help to identify specific challenges and opportunities for improvement on the appropriate dose for people

Standard 3 All people at high risk of drug-related harm are proactively identified and offered support to commence or continue MAT

Measure 3.1
What to measure? How long does it take from recognition of risk to first contact and assessment?
Required data items For each individual person
  • Date and timea of first identified as at risk
  • Date and timea of first contact and initial assessment
  • Age, gender, source of risk event (e.g. SAS, Emergency Department), and service providing initial assessment
For the given period (e.g. month, quarter or year)
  • Number of people first identified as at risk,
  • Number of people followed up and an initial assessment performed.
Proposed measures and disaggregation 1. Mean, median or mode length of time between first identified as at risk and initial assessmentb. 2. Range or interquartile range of length of time between first identified as at risk and initial assessmentc. 3. Proportion of people seen within a given time period (e.g. month, quarter, year) who received an intervention within a given time period (e.g. 24, 48, 72 and more than 72 hours)d. 4. Disaggregated into age, gender, source of risk event and service.
What these measures demonstrate 1. Demonstrates the typical period of time taken for a person between being first identified as at risk and receiving an Initial assessment. 2. & 3. Demonstrates the variation in the period of time taken for follow up. 3. Demonstrates any differential access according to age, gender, source of risk event and service.
Frequency This will depend on things like the throughput of the service, the stage of the service development and the method for collecting the data. In general monthly reporting of numerical measures will enable an assessment of the trend and will help to determine the rate of change.
Potential data sources
  • Public Health Scotland Accident & Emergency Datamart for drug overdose/intoxication Emergency Department attendances
  • Scottish Ambulance Service: Date and time of emergency naloxone administration
  • NHS partners: local patient management systems e.g. TRAK/EMIS/VISION
  • Third sector: local case management records
  • Social care: local case management records e.g. SWIFT
Notes a. Date and time will enable a more accurate calculation of the period of time taken to start MAT, but date will be sufficient.
b. The mean, median and mode gives a measure of where the center of the data falls, but often give different answers. The mean is most frequently used measure of central tendency, but there are some situations where either the median or the mode are preferred. The median is the preferred measure when there are a few extreme data point (e.g. patients that have very long lenths of wait) that would have a great effect on the mean. The mode is the most common value and is useful when data are categorical measurements (e.g patients on each OST type).
c. The range gives a measure of the spread or variability of the whole data set, while the interquartile range gives you the spread of the middle half of the data set. The interquartile range is the best measure for data sets with a few extreme data points (outliers) because it is based on values that come from the middle half of the data set, it's unlikely to be influenced by outliers.
d. These are suggested splits, others may be more appropriate for your service depending on the range of time periods involved within your service.
e. Some services may wish to do further analysis of the local pathway e.g. between (a) initial presentation to any member of the multiagency team; (b) to referral to the nursing team; (c) to consultation with the nursing team. (d) to prescription; (e) to dispensing. This may help to identify specific challenges and opportunities for improvement at different parts of the pathway.
Measure 3.2
What to measure? Who is being identified as at risk?
Required data items For each individual person
  • Age
  • Gender
  • Source of risk event
For the given period (e.g. month, quarter or year)
  • Number of people identified as at risk
Proposed measures and disaggregation 1. Proportion of people by gender, age, source of at risk event and service providing initial assessment.
What these measures demonstrate 1. Characteristics of individuals being identified as at risk. How do these compare with expected patterns amongst people at risk of harm? 2. The source of risk events in order to inform further development work and demonstrate any differential access according to age, gender, source and service.
Frequency This will depend on things like the throughput of the service, the stage of the service development and the method for collecting the data. In general monthly reporting of numerical measures will enable an assessment of the trend and will help to determine the rate of change.
Potential data sources
  • Drug & Alcohol Information System (DAISy)
  • Public Health Scotland Accident & Emergency Datamart for drug overdose/intoxication Emergency Department attendances
  • Scottish Ambulance Service: Date and time of emergency naloxone administration
  • NHS partners: local patient management systems e.g. TRAK/EMIS/VISION
  • Third sector: local case management records
Measure 3.3
What to measure? Outcome of referral
Required data items For each individual person identify outcome of initial intervention
  • Community intervention
  • No intervention
  • Follow up in service
For the given period (e.g. month, quarter or year)
  • Number of people referred to outreach service
Proposed measures and disaggregation 1. Proportion of people by outcome. 2. Disaggregated into age, gender, referral source and service.
What these measures demonstrate 1. Demonstrates outcomes which may require further work e.g. through audit to identify improvement actions. 2. Informs further development work and demonstrates any differential improvement actions according to age, gender, source and service.
Frequency This will depend on things like the throughput of the service, the stage of the service development and the method for collecting the data. In general monthly reporting of numerical measures will enable an assessment of the trend and will help to determine the rate of change.
Potential data sources
  • Drug and Alcohol Information System (DAISy)
  • Local referral information systems
  • Public Health Scotland Accident & Emergency Datamart for drug overdose/intoxication Emergency Department attendances
  • Scottish Ambulance Service: Date and time of emergency naloxone administration
  • NHS partners: local patient management systems e.g. TRAK/EMIS/VISION
  • Third sector: local case management records
Standard 4 All people can access evidence-based harm reduction at the point of MAT delivery.
What to measure? Number of services offering evidence-based harm reduction at point of MAT delivery.
Required data items For each MAT service: Indication of which harm reduction interventions are offered by the service;
  • BBV testing and vaccination
  • Naloxone and overdose awareness - supply and encourage to carry on the person wound care - early identification, treatment and advice of possible problems Assessment of injecting risk – including technique and safer injecting advice
  • Injecting equipment provision
Proposed measures and disaggregation
  • 1. Proportion of MAT services offering each harm reduction intervention.
  • Proportion of services offering BBV testing and vaccination
  • Proportion of services offering naloxone and overdose awareness
  • Proportion of services offering wound care
  • Proportion of services offering assessment of injecting risk
  • Proportion of services offering injecting equipment provision
What these measures demonstrate 1. Demonstrates the suite of harm reduction interventions offered by MAT services. 2. Assessment of the trend in measures will help to determine the rate of change.
Frequency This will depend on things like the throughput of the service, the stage of the service development and the method for collecting the data. In general monthly reporting of numerical measures will enable an assessment of the trend and will help to determine the rate of change.
Potential data sources
  • Review of service procedures
Standard 5 All people will receive support to remain in treatment for as long as requested.
What to measure? How long do people remain in MAT treatment?
Required data items For each individual person
  • Date of first prescription within an episode of care.
  • Date of discharge.
  • Reason for discharge (e.g. planned or unplanned) where user has been discharged.
  • Age, gender, setting and service
For the given snapshot (e.g. end of month, quarter or year)
  • Date of snapshot.
  • Number of people currently on MAT treatment.
  • Number of people discharged.
Proposed measures and disaggregation 1. Mean, median, or modea length of time people are on MAT treatment. 2. Range or interquartile rangeb of length of time people are on MAT treatment. 3. Proportion of people on MAT for less than 3 months, between 3 and 6 months, and more than 6 months.c 4. Proportion of people discharged by reason (e.g. planned and unplanned) within a specified period (e.g. month, quarter or year). 5. Disaggregated into age, gender, setting and service.
What these measures demonstrate 1. Demonstrates the typical period of time on MAT treatment. 2. Demonstrates the variation in the period of time on MAT treatment between people in the service. 3. Demonstrates the share of people in treatment for various periods of time. 4. Demonstrates the proportion of people actively engaged or otherwise with the service. 5. Demonstrates differential retention according to age, gender, setting and service. Note: Assessment of the trend in measures will help to determine the rate of change in time from first presentation to starting MAT
Frequency This will depend on things like the throughput of the service, the stage of the service development and the method for collecting the data. In general monthly reporting of numerical measures will enable an assessment of the trend and will help to determine the rate of change.
Potential data sources
  • Drug and Alcohol Information System (DAISy)
  • Prescribing Information Systems (PIS or PRISMS)
  • NHS partners: local patient management systems e.g. TRAK,EMIS/VISION
  • Local prescribing system: e.g. Illy, Nebula
Notes a. The mean, median and mode gives a measure of where the center of data falls, but often give different answers. The mean is most frequently used measure of central tendency, but there are some situations where either the median or the mode are preferred. The median is the preferred measure when there are a few extreme data point that would have a great effect on the mean. The mode is the most common value and is useful when data are categorical measurements (e.g patients on each OST type).
b. The range gives a measure of the spread of the whole data set, while the interquartile range gives you the spread of the middle half of the data set. The interquartile range is the best measure for data sets with a few extreme data points (outliers) because it is based on values that come from the middle half of the data set, it's unlikely to be influenced by outliers.
c. These are suggested splits, others may be more appropriate for your service depending on the range of time periods involved within your service.

Contact

Email: MATStandardsImplementationSupportTeam@gov.scot