This audit is relevant to psychiatrists working in substance misuse services.
The Treatment Outcomes Profile (TOP) was developed by the National Treatment Agency for Substance Misuse at the Department of Health and introduced in 2007. It is a single-page questionnaire completed by clinicians following an interview with patients attending substance misuse services. It attempts to measure the amount of illicit drugs used by patients as well as patients’ criminal activity and physical and mental health. It must be completed every 3 months for all patients in drug treatment services in England. The results are used to assess the effectiveness of these services.
Standards for TOP form completion are available from the National Treatment Agency for Substance Misuse:
ᐅ The TOP should be completed within 2 weeks either side of the date when a patient started structured drug treatment.
ᐅ It is good practice to conduct regular care plan reviews; these are usually completed in 12 week (3-month) cycles. It is recommended that the TOP is completed as part of this process.
ᐅ The TOP should be completed within 2 weeks either side of the date when the patient exits structured treatment.
The national standard is 100% for this and funding is dependent on submitting this information to the commissioners (the local drug action teams). In this audit a threshold for TOP compliance of 80% was considered an appropriate standard to reach. This means that a TOP was expected at each treatment stage for at least 80% of the patients who were accessing, retained in or exiting structured drug treatment.
Records for all patients in the community substance misuse services within the trust were audited, to ensure the TOP form was properly completed. Information was collected from the patients’ medical records, which contained the completed TOP forms.
The primary outcome was the proportion of patients who had a properly completed TOP form.
Three people are likely to be needed in a service with 200 patients. The audit does not require multidisciplinary involvement, but this can be considered.
The audit can be completed within 1 week if auditors can commit to it full time. In larger services or with part-time commitment, a few weeks should be allowed for completion of the audit.