A quality assurance study of the development of quality of care in outpatient clinics for treatment of addiction in Greenland

Abstract

Introduction

In 2016, a new addiction treatment service, Allorfik, was introduced in Greenland. Allorfik has, throughout the implementation and after, used auditing of patient records with feedback to develop the quality of care in treatment. Audits and feedback are routinely done in each treatment center. This study wishes to investigate the development of the quality of treatment through the case notes from the journal audits.

Methodology

This study is based on case notes audits from 2019, 2020 and 2021. In the audits, the focus has been on the quality of documentation and content for ten specific areas in each patient record. Each area was scored on a Likert scale of 0–4 for both outcomes. Statistical analyses were done using Stata 17, and P-values < 0.05 were considered statistically significant. We present baseline characteristics for patients and illustrate the development of quality for both outcomes as time trends with scatter plots.

Results

The analysis was based on data from 454 patients and audits of their case notes. The mean number of weeks in treatment is 12.72, and the mean age for the people in the audited case notes is 39. Time had a positive effect on both outcomes, and so each month, documentation increased by 0.21 points (p-value = <0.001), and content increased by 0.27 points (p-value = <0.001).

Conclusion

For documentation and content, the quality level has increased significantly with time, and the quality of case notes is at an excellent level at the final audits of all treatment centers.

Keywords:

• Addiction treatment
• quality assurance
• Greenland
• audit
• alcohol

Disclosure statement

Birgit Niclasen is the director of the National Addiction Treatment Services, Allorfik, but has never handled the audits of case notes used for this study or contributed to the analysis or results of this manuscript. Birgit’s contributions to the manuscript are conceptualization, supervision, and validation. The authors, therefore, declare that they have no conflict of interest.

Ethical approval

The study has been approved by the National Board of Health in Greenland

Data availability statement

Data management and -storage were handled by the Open Patient Data Explorative Network. The dataset can be shared upon request.

Additional information

Notes on contributors

Julie Flyger

Julie Flyger has a background in public health and as a researcher she has been interested in addiction problems and treatment services in Greenland.

Anna Mejldal

Anna Mejldal is a biostatistician. Anna have worked with varies types of projects and have published in numerous peer-reviewed journals and her specialty is in epidemiology of persons with alcohol addiction.

Bent Nielsen

Bent Nielsen is professor MSO in psychiatry. For many years, he has researched the treatment of patients with alcohol problems and quality development in psychiatry. Has received the Quality Award from the Danish Society of Quality of Health for his work with quality development.

Birgit Niclasen

Birgit Niclasen is a trained doctor with a phd in public health. She is the principal investigator for the HBSC survey in Greenland and has published in many peer-reviewed journals. For many years she has worked as the director of Allorfik.

Anette Søgaard Nielsen

Professor Anette Søgaard Nielsen, MA, PhD, works at the University of Southern Denmark. Her research interest is primarily focused on treatment for alcohol use disorders. She has been heading several randomized controlled trials, surveys and qualitative studies in the field. She has published more than 150 peer-reviewed papers and a series of text-books and book chapters about primarily addiction, treatment, Motivational Interviewing, alcohol culture and narrative medicine.