MATPACT: An innovative approach to finding Scotland’s forgotten generation

Background

Scotland has the highest level of drug related deaths in Europe and 19% of people who have died of a drugs related death have been in police custody in the prior 6 months. On admission all custodies who confirmed using illicit drugs during the Vulnerability Assessment were not offered a referral to health. Healthcare referrals were generated by police if any immediate intervention was required, reactionary healthcare with no focus on interventional harm reduction. This referral system provided an inequity of care as a health care problem was being identified but not actioned. The team identified 52% at risk of drug related death were not being referred to health. This prompted the team to create an innovative approach to proactively identify those at risk and offer intervention.

Methods

The team used quality improvement methodology to identify the quality issue, understand the problem and develop a theory of change (driver diagram). They completed a cause and effect diagram (fishbone analysis) and the 5 why’s to identify the root cause. Current processes were mapped identifying gaps for patients at high risk of drug related harm. They used the model for improvement as their approach. They identified the aim – what are we wanting to accomplish, they identified what they needed to measure – how do we know that the change will make an improvement and used small tests of change (PDSA’s) to identify what they need to try to make change. An analysis of drug related deaths was completed. 

Results

The team created a toolkit to ensure equitable healthcare (MATPACT).  MATPACT includes current drug use, risk assessment, harm reduction offered and accepted, take home naloxone training offered and accepted, blood borne virus screening offered and accepted, sexual health testing, vaccinations and encourages referral to outreach services with option to commence or continue on Medication Assisted Treatment of Opiate Substitution Therapy 

Acceptance of take home naloxone increased by 1775% with an increase of 83% from baseline median

BBV testing increased by 1600% with an increase of 188% from baseline median 

12% increase in patients referred to custody healthcare with sustained improvement

Conclusions

MATPACT has shown quick improvements contributing to positive patient and staff experience through low effort high impact tests of change. It enables timely person centred care and intervention to be delivered.

Following test and implementation within NHS Highland the MATPACT is now being spread within Scotland. From initial test within a police custody setting it has been tested and implemented within the prison setting and has projected expansion to other settings such as primary care and Accident and Emergency.

MATPACT has changed teams approach in identifying those at risk of drug related harm and supports harm reduction interventions. 

Early data shows promising results in relation to opportunities to reduce drug related harm in this high risk patient group.