Utforske mulighetene for oppgradering og uttesting av vurderingsverktøyet CONTINUUM for brukere med rus- og avhengighetsproblematikk

The complexity of substance use disorder (SUD) requires comprehensive assessment; without it, there is a risk of treating the wrong problems or failing to provide services that meet patients’ needs. This nation-wide clinical proposed research study involves all four health regions and service providers across sectors involving specialised health care in hospitals and substance use services in the municipalities. The main aim of the project is to enhance diagnostic procedures, provide better recommendations based on patients multiple needs, and ultimately produce better treatment outcomes. Such improvements in diagnostic procedures are vital to meet the future demands. Pressure on existing levels of care in Norway and efficient resource use, great variations in the assessment procedures, together with an increase in service demands have created a motivation for improvements that can enhance the use of services available and improve patients’ outcome and our services. A standardised assessment tool like the ASAM CONTINUUMTM Software (ASAM CS) implemented across different professions and service provider and sectors is thought to improve diagnostic procedures and stimulate increased cooperation between the different providers through a common understanding of the patients. The enhancement of diagnostic measures and improved treatment recommendations by the use of such a tool might allow a more tailored treatment, contribute to reduced drop-out, and preserve resources in the existing healthcare system and through that reduce future costs. To our knowledge, no other studies has addressed the assessment and placement procedures to reduce drop-out and improve treatment outcome and utilization of services in Norway, except the prior test executed in the mid-region of Norway. This project wants to enlarge that study on a national level with more diverse clinical settings, service providers and patients to make future decisions on implementing it nationwide. Patients with SUD represent one of the most vulnerable groups with the highest severities and drop-out rates and for those reasons they are a highly prioritised group to study. Main goal: Main aim of this project is to improve patient care and treatment outcome by implementing a technology tool for intake and placement for patients with a substance use disorder and/or co-occurring psychiatric or somatic disorders in multiple clinical settings. The pre-project had 5 main goals: 1) Establish a national and international cooperation for developing ASAM software further 2) Establish a national project group with the invited health regions and municipality 3) Apply funding 4) Execute a pilot at St. Olav’s Hospital and Ahus 5) Complete the web edition, distribution contracts, e-learning course. All project goals were reached, except nr 5 which is delayed due to discoveries in the pre-project which needed extended time to be resolved. Evaluation/future implications: This pre-project allowed us to gather clinics with national representation and together form a national protocol for testing the software in different settings and sectors which we use to apply funding for a national research project. The gathering was a great success and agreements were made between all participating health regions, one private provider, and one municipality. The international interest is also evident, and we will pursue cooperation with Iceland and UCLA and clinics in Los Angeles and apply funding together after the national test in Norway has been executed. Applications have been submitted, and earliest project start if funded, is January 2018.

Undersøkelser av samhandlingsreformen viser at en stor andel av kommunene ikke har styrket sitt tilbud til rus og psykiatripasientene(Riksrevisjonen, 2016). Opptrappingsplanen for rusfeltet viser til at det er behov for å styrke basiskunnskaper blant tjenesteytere for rus- og avhengighetsproblematikk og tilleggsproblematikk hos mennesker med rusproblemer. Rusbehandling Midt-Norge startet en langsiktig satsning på å kvalitetssikre og harmonisere vurdering og plassering av pasienter på optimalt omsorgsnivå innen tverrfaglig spesialisert rusbehandling. Denne satsningen er videreført av St. Olavs Hospital og som et viktig ledd i satsningen i klinikkens FOU-seksjon ble plasseringsverktøyet ASAM validert for norske forhold basert på data fra 10 vurderingsenheter i regionen. Valideringen er beskrevet i tre internasjonalt publiserte artikler og gav et meget godt grunnlag for implementering og uttesting i norsk klinisk praksis. For at dagens norske versjon skal være i overensstemmelse med det nyeste innen diagnostikk må den oppgraderes jevnlig, og dette krever en oppgradering fra dagens ASAM til webutgaven CONTINUUM(TM)-the ASAM decision engine. Implementering og uttesting av ASAM verktøyet i oppgradert utgave kan gi helsetjenestene de opplysninger de trenger for å legge til rette og møte brukernes behov slik at de optimale tjenestene blir tilbudt. Hensikten med prosjektet er å øke kompetansen til kommunale helse -og omsorgstjenester og spesialisthelsetjenesten på vurdering av brukere med ruslidelser og plassere disse til rett nivå for omsorg på laveste effektive og forsvarlige nivå. Dette prosjektet skal samle ressurser nasjonalt på feltet fra både kommunale helse -og omsorgstjenester og spesialisthelsetjenesten og sette de i stand til å delta på den nasjonale uttestingen gjennom kurs og oppgradert utgave av verktøyet slik at de to helsetjenestetilbyderne sammen kan dekke noe av det store behovet for forskning innenfor psykisk helse og rusmiddelavhengighet.