Needling away at a problem

Injecting drug users post a particular challenge to public health services. They are at increased risk of viral infections such as hepatitis B and C and HIV, bacterial infections, overdose and general poor health.

Put together, these contribute to injecting drug users being an incredible ten times more likely to die prematurely than the general population.

Public Health Wales, the body which provides the public health resources formerly provided by five separate health authorities in Wales, faced an additional challenge when it came to addressing their needs, because it had poor data on the scale of injecting drug use across the country.

Only local, paper-based data collection schemes existed within needle and syringe programmes, and these did not provide experts with some key data.

For instance, they were unable to work out the number of individuals accessing the services, movement by clients across services, identification of any specific risk behaviours or aggregation of data on issues such as hepatitis C infection rates.

“As part of the development of the Blood Borne Viral Hepatitis Action Plan for Wales 2010-15, it was necessary to try to establish the number of individuals at risk,” says Public Health Wales research scientist Josie Smith.

Establishing the database

The Harm Reduction Database Wales was established in 2010 in response to this. Built by social enterprise Harm Reduction Solutions, the web-based national database has since been established in all third sector and statutory needle and syringe programmes across Wales.

Individual client records are available for review at each visit to a programme, allowing staff to identify potential need for a Hepatitis B vaccination, be alert to Hepatitis C and HIV status and the potential to be referred for testing.

“The database gave a national approach to surveillance of a particularly vulnerable group,” says Smith.

Details of the IT behind the programme are commercially sensitive, as a number of other organisations have expressed interest in developing similar systems.

But using the database allows frontline staff to work more effectively with clients to be able to deliver specific and individually tailored harm reduction information and onward referrals to other services.

It also allows for the collection of data to give details of a client’s social and other influences that can influence their health and treatment outcomes, such as homelessness. Enabling historic records to be built up means health practitioners can identify previous patterns of drug use, infections, overdose and risk behaviour.

“Early identification of wounds and early intervention for wound management has increased, as has the amount of ongoing care for injecting site infections,” says Smith.

There have also been increased referrals for specialist treatment. Following the introduction of the database, there has been a 47.5% increase in the total number of individuals accessing needle and syringe programme services.

There has also been a substantial increase in recorded onward referrals to specialist health and social care services.

“In 2011-12, a total of 641 recorded onward referrals were made to specialist health and social care services, including community drug service prescribing, hepatitis B vaccination, blood borne virus testing, housing support, sexual health clinics, social services, counselling and support services.

“This represents an average of 54 referrals per month. Prior to and at the time of initiation of the Harm Reduction Database, the average number of recorded onward referrals per month was 13,” says Smith.

“Both the practitioner and client can identify trends and progress towards harm minimisation and to set goals to improve health and well-being.”

Further developments

Further developments include data gathered by the database being used to develop a national database for the provision of the ‘Take-home Naloxone’ scheme.

Naloxone is a drug that reverses the effects of opiate overdose, thereby reducing the risk of overdose and death.

This database can be accessed by practitioners working in criminal justice, prison healthcare, secondary healthcare, and ambulance services, reducing the risk of over dose in an increased number of settings.

With anonymised information regularly collated and fed back to substance misuse service commissioners and planners and strategic leads within Welsh government in addition to project managers, evidence based planning and tailoring of substance misuse services is now possible.

“Emerging trends can be identified at local, regional and national levels,” says Smith. It is hoped the database can be used in future to help identify and promote training needs in the relevant sectors while monitoring and evaluating the efficacy of new and existing clinical interventions.

It is believed the system has had a direct impact of the number of drug related deaths in Wales. In 2011 the number of drug-related deaths in 2011 was 137; a decrease of 10% on the previous year.

Moving into new areas

Since its implementation in Wales, the system has been introduced in other harm reduction services including that run by the Southampton Drug Action Team.

“It also has had a direct influence on other countries looking at the system and running with pilots such as Ana Lifey drugs project on Dublin.

“There are a number of organisations currently trialling the system – from small government funded bodies to national charitable organisations – however, for commercial reasons, these cannot be named,” says Smith.

Back in Wales it is now planned to roll out the database to all pharmacy based needle and syringe services in 2012.

“We believe this will make Wales the only country in the world with a national unified surveillance system for injecting drug user populations and those at risk of initiation to injecting,” says Smith. “As the system is web-based, all that is required is access to the internet.”

The EHI Awards 2013 are now open for entries. For full details of this year’s categories, judging process and how to submit your entry please visit the dedicated awards website.

This year’s black tie awards dinner will be held at the prestigious Roundhouse in north London on 10 October. For information about sponsorship opportunities contact head of events Neil Hadland. Tickets will also be on sale soon.