Rapid implementation of standards to improve access, choice and quality in drug treatment services in Scotland

Background

IN 2022 there were 19.8 drug deaths per 100,000 pele in Scotland oneof the highest in Europe. Contributory factors included long waits to access treatment, inconsistent quality of care and a lack of involvement in service improvement from peole with experience of problematic drug use. IN 2021 rthe Scottish Government declared a public health emergency and published tem standards for medication assisted treatment to improve access, choice and care. Pulic Health Scotland (P:HS) undertook a supporetive clinicnal approach to assist 29 local health and social care partnerships (HSCP) to implement them

Methods

The underlying change framework was Rogers Diffusion of Innovation and a supportive clinical approach was used with regular adjustments in response to a rapidly changing political, policy and resource environement. Improvement strategies included field visits (120) to community and custodial settings, additional funding (£11million), ministerial letters of direction and development of information systems to provide evidence of implementation. A MAT implementation support team (MIST) worked with providers of treatment and social care, local government, prisons and police, thrid sector organisations and community recovery groups and set up national networks to share models of care. An annual benchmarking report published by PHS used a red amber green (RAG) reporting system based on the experiential, numerical and process evidence submitted by the 29 HSCP.

Results

Systems were set up for the collection, dissemination and use of clinical process, numerical and experiential data for improvement. This included a data manual, automated excel spreadsheets and a REDCAP module for numerical data. To collect experiential data a questionnaire was agreed and 749 mainly peer interviewers were trained. MIST suported 50+ quality improvement projects. Evidence indicates that in 2023 66% of the standards for access and choice were fully implemented across Scotland vs 17% in 2022. Aggregate national data from 1 January 2023 to 31 March 2023 showed: 75% of people who requested a prescription for opioid substitution therapy recevied it within 4 days; a 7% increase from 2022 in people chosing long acting injectable buprenorphine; of 1,234 referrals for serious risk 72% resulted in an assertive outreach response and 75% had a risk assessment within 3 days; harm reduction interventions were available on site for 79% of people recieving treatment; and 75% of people continued on MAT for at least 6 months. 

Conclusions

The approach combining standards, benchmarking and improvement with practical field support, funding and performance management by government has been successful in the rapid implementaiton of standards of care. Further work is needed to understand the generalisability of the approach to other countries seeking to improve access, choice and quality in drug treatment services.