Transcript Drug & Alcohol Clinical Services

Drug and Alcohol Clinical Services
Historical Issues
Pre 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
800
Number of Clients
700
600
500
400
300
200
100
0
Pre D/S
Public Clients
Private Clients
Drug & Alcohol Clinical Services
Now
Public Clinic Dosing
DRS
Number of Clients
60
50
40
30
20
10
0
Pre D/S
Public Prescribers
Drug & Alcohol Clinical Services
Now
Private Prescribers
Now
•
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
Drug & Alcohol Clinical Services
Models of service delivery
Tamworth and surrounding northern area
• well integrated community based services
• public clinic brief stabilisation.
• public hospitals
• Remote prescribing (videoconferencing)
Drug & Alcohol Clinical Services
Models of service delivery
LMNC
• public clinic stabilisation
• majority of clients private prescribers /
community pharmacies
Drug & Alcohol Clinical Services
Models of service delivery
Newcastle / Cessnock
• public clinic – stabilisation transfer to
community
• Significant support to community based
program
Drug & Alcohol Clinical Services
Benefits of Outreach
• 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.
Drug & Alcohol Clinical Services
Benefits of Outreach (Cont)
• Keeps community happy.
• Reduces number of adverse events in
community
• Coordinates holiday pharmacy closure
• Facilitates TT of clients
Drug & Alcohol Clinical Services
2008
• 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
Drug & Alcohol Clinical Services
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
Drug & Alcohol Clinical Services
Restructure of Clinics (Cont)
• Transfer back to clinic setting for restabilisation
• Swap problematic clients with GPs for
stable clients
• Multiservice delivery of care
Drug & Alcohol Clinical Services
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
Drug & Alcohol Clinical Services
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.
Drug & Alcohol Clinical Services
Rationale (Cont)
• 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)
Drug & Alcohol Clinical Services
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
Drug & Alcohol Clinical Services
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.
Drug & Alcohol Clinical Services
How can these barriers be
addressed? (Cont)
• 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
Drug & Alcohol Clinical Services
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
Drug & Alcohol Clinical Services
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
Drug & Alcohol Clinical Services
Outreach
• 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
Drug & Alcohol Clinical Services
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
Drug & Alcohol Clinical Services
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
Drug & Alcohol Clinical Services
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
Drug & Alcohol Clinical Services
Client requirements
• Safety net to return to clinic short-term for
financial respite & more intensive case
management
• Improving & encouraging autonomy
• Discharge planning & after care support
Drug & Alcohol Clinical Services