Engaging the reluctant GP in care of the opiate misuser: Pilot study of change-orientated reflective listening (CORL)

Abstract

Background. The GP is central to plans for improved general health care and increased availability and delivery of addiction treatment to drug misusers in the UK. Attention to the actual quality of overall primary care, rather than just the treatment of dependence, has, however, been limited.Objectives. The purpose of this study was to test the feasibility of delivery and potential value of a brief motivational enhancement intervention targeting the quality of primary care given to opiate misusers by GPs.Method. This study had an observational 'before and after' design with follow-up assessment after 2-3 months. The target population was all GPs in two Primary Care Groups who had neither attended training events nor were involved in the treatment of drug dependence (n = 66), who were then approached via a telephone-administered change-orientated reflective listening intervention, based on principles of motivational interviewing, with informational adjunct. Outcome measures for the study sample (n = 29) were overall therapeutic commitment and motivation to follow up and actual clinical activity and willingness to deliver specified general health care interventions for drug misusers.Results. Across the study sample, therapeutic commitment improved over time, whilst motivation did not. Change among individual practitioners in receipt of the intervention was observed in both positive and negative directions, and in four of the positive changers, this was judged attributable to the intervention. Positive changes were more than twice as frequent as negative changes. Conclusions.The direction and extent of change detected were encouraging. Further initiatives are needed to influence practitioner motivation, based on improved understanding of GPs' views on the delivery of primary care for drug misusers.

Start Talking About Risks: Development of a Motivational Interviewing-Based Safer Sex Program for People Living with HIV

“…A comprehensive intervention that can be tailored to each individual's circumstances is more likely to be effective at reducing risky behaviors among clients such as ours than are more confrontational or standardized prevention messages (Adamian, Golin, Shain, & DeVellis, 2004;Golin, Earp, Tien, Stewart, & Howie, 2006;Kalichman, 2005;Strang, McCambridge, Platts, & Groves, 2004;Carey et al, 1997). One potential approach to improving safer sex practices among people living with HIV/AIDS (PLWHA) is Motivational Interviewing (MI), a non-judgmental, client-centered but directive counseling style.…”

Comparaison des représentations et comportements des médecins généralistes du Canton de Genève et du Poitou-Charentes

“…Mais la prise en charge des patients souffrant d'addictions est très inégale selon les MG [4]. Leur implication varie avec le type de produits consommés [5], particulièrement pour les drogues illicites [4]. En effet, 4,7 % des médecins voient plus de dix patients par mois souffrant d'addiction aux opiacés alors que 35 % n'en voient pas du tout [4] et seulement 26 % des MG prennent en charge 75 % des patients [6].…”

“…La formation universitaire se limite aux objectifs du Centre national des concours d'internat (CNCI) et la formation des médecins en exercice est laissée à l'initiative des organisations de formation continue soumise à de nombreuses contraintes y compris dans les thèmes choisis pour pouvoir être indemnisés. De plus, les études ont montré que la formation théorique est insuffisante pour adopter les meilleures prises en charge en matière d'addiction [5,11,12]. Entre 1996 et 2006, un mouvement de MG français a essayé de mobiliser la profession dans le domaine des addictions mais il a surtout rassemblé des militants.…”

Commentary on Schwartz et al. (2014): Where next for face‐to‐face, person‐to‐person, computerized and online brief interventions for drug users?

“…We need survey data and qualitative studies to determine acceptability. There are some data available indicating that doctors in primary care may be encouraged to see brief interventions for drug users as part of their role, although drug type and problem severity matter [17,18].Targeting all drugs together makes sense from an implementation perspective, although it is to be expected that effects will vary across drugs and/or patterns of use, as seen here [8]. A broader implementation question concerns whether screening in primary care should cover a wider array of health compromising behaviours, mental health problems or other issues that people may benefit from discussing in brief interventions.…”

“…We need survey data and qualitative studies to determine acceptability. There are some data available indicating that doctors in primary care may be encouraged to see brief interventions for drug users as part of their role, although drug type and problem severity matter [17,18].…”