drug and alcohol clinical services. historical issues pre drug summit low resourcing, nil funding in...

Drug and Alcohol Clinical Services

Historical IssuesPre drug summit • Low resourcing, Nil funding in Tamworth area and LMNC• Minimal interface with public / private sector• Low support levels for GP/ Pharmacy • Limited or nil capacity to engage private prescribers clients in case management.• Minimal infrastructure / It.• Methadone only• Lengthy waiting lists

Drug & Alcohol Clinical Services

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Pre D/S Now

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Public Clients Private Clients Public Clinic Dosing


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Pre D/S Now

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Public Prescribers Private Prescribers


• 90 pharmacies

• 219 GP clients case managed

• State average is 2/3 prescribed by private prescriber

• Different pharmacotherapies

• Uptake by GPS and pharmacies plateaued

• Demand for service consistent

Now


Models of service delivery Tamworth and surrounding northern area

• well integrated community based services

• public clinic brief stabilisation.

• public hospitals

• Remote prescribing (videoconferencing)


Models of service deliveryLMNC

• public clinic stabilisation

• majority of clients private prescribers / community pharmacies


Models of service deliveryNewcastle / Cessnock

• public clinic – stabilisation transfer to community

• Significant support to community based program


• Increased propensity to engage, maintain, retain private sector.

• Facilitate transfer in & out of clinics from private sector.

• Solidifies the role of public/private sector.

• Supports private sector.

• Pro-active approach to issues and client management.

Benefits of Outreach


• Keeps community happy.

• Reduces number of adverse events in community

• Coordinates holiday pharmacy closure

• Facilitates TT of clients

Benefits of Outreach (Cont)


• Review of pharmacotherapy services – March to May 2008.

• Recommendation - redesign & coordinate outreach across southern sector

• Working group

• Identify clients to be fast-tracked to GP / community pharmacy sector

• Match clients to pharmacies / GPs

• Recruitment of new GPs / pharmacies


2008

Restructure of Clinics• Changing client expectations on

admission

• Induction and short term stabilisation

• Meet criteria for take-a-ways transfer to community pharmacy

• Stable transfers straight to pharmacy

• Linking with GPs


• Transfer back to clinic setting for re-stabilisation

• Swap problematic clients with GPs for stable clients

• Multiservice delivery of care

Restructure of Clinics (Cont)


Aim• Place clients within 5km radius of LGA with GP prescriber & local pharmacy

• Normalise service delivery

• Improve links with GP, pharmacies & HNE

• Framework – Holistic proactive shared care & early referral


Rationale• General practice & pharmacies are an

integral part of the health system

• GP’s will see 80% of the population in one year.

• Provide continuity of care

• Seen as a credible source of health information.

• May be the first to identify a drug and alcohol problem.


• Are ideally placed to intervene.

• Brief interventions are well suited to the general practice setting.

• Pharmacotherapy, detoxification and brief counselling can be provided by General Practitioners.

(NSW Health General Practice Policy 2002)


Rationale (Cont)

Barriers• Lack of confidence

• Low level of knowledge and skills

• Misconceptions

• They do not have a legitimate role

• Lack of support

• Lack of resource material

• Lack of time

• Negative attitudes


How can these barriers be addressed?• Providing training, resource material &

information

• Ready access to expert consultation

• Ease of referral & access to services

• DACS contribution to shared care patient management for complex clients.


• Ensure internal process are in place that will recognize & support GPs, pharmacists

• Work force in-tune with the context in which GPs / pharmacists work & relate in a professional manner

How can these barriers be addressed? (Cont)


Risks If we don’t deliver on what we promise

• Run the risk of creating a negative impression of DACS from which we may have difficulty recovering

• GPS / pharmacists remain under confident, lacking skills. Stereo-types, misconceptions and negative attitudes of clients and services will persist


Opportunities• Work with DGP to train practice nurses

• Increased numbers of GP’s with decreased client numbers-mainstreaming

• Increased video / teleconferencing reviews to support staff / GPS in remote areas

• Promote newer pharmacotherapies where possible


• Unstable clients transferred back to clinic for 6-12 weeks.

• GPs can exchange unstable clients for stable clients.

• Outreach staff participate in EPC for complex clients.

• Staff Specialists and VMOs offer mentoring and facilitate Small Learning Groups.

• Ready access to advice and support as needed


Outreach

Changes to the way we work• Designated team with one NUM to

coordinate delivery of outreach & monitor waiting list

• Clients given assessment appointment within 5 working days

• Case worker maintains regular contact with dosing pharmacy / GP

• Ideally Prescriber is client’s GP

• Service delivery driven by GP


Changes to the way we work• Case management only of clients in need of

intervention – coordinated with visit for script

• Appointments coordinated through GP practice staff

• Pharmacist input into client review

• Assistance with co-ordination of care during pharmacy closures if required

• Personalised approach builds rapport


Client requirements• Linking with GP & other services in LGA

• Pathways & co-ordination to services

• Encouraging family GP to engage in pharmacotherapy prescribing – EPC

• Pharmacies actively participating in financial management of treatment cost


• Safety net to return to clinic short-term for financial respite & more intensive case management

• Improving & encouraging autonomy

• Discharge planning & after care support

Client requirements


drug and alcohol clinical services. historical issues pre drug summit low resourcing, nil funding in...

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