Feasibility and outcomes of a general practice and specialist alcohol and other drug collaborative care program in Sydney, Australia

Abstract

Alcohol and other drug (AoD) use is an important health and community issue and may be positively affected by collaborative care programs between specialist AoD services and general practice. This paper describes the feasibility, model of care and patient outcomes of a pilot general practice and specialist AoD (GP-AoD) collaborative care program, in Sydney, Australia, based on usual care data, the minimum data set, service utilisation information and the Australian Treatment Outcome Profile (ATOP), a patient-reported outcome measure. There were 367 referrals to the collaborative care program. GPs referred 210 patients, whereas the AoD service referred 157 patients. Most GP referrals (91.9%) were for AoD problems, whereas nearly half the AoD service referrals were for other issues. The primary drugs of concern in the GP group were either opioids or non-opioids (mostly alcohol). The AoD service-referred patients were primarily using opioids. An ATOP was completed for 152 patients. At the time of referral, those in the GP-referred non-opioid group were significantly less likely to be abstinent, used their primary drug of concern more days and were more likely to be employed (all P , 0.001). A second ATOP was completed for 93 patients. These data showed a significant improvement in the number of days the primary drug of concern was used (P ¼ 0.026) and trends towards abstinence, improved quality of life and physical and psychological well-being for patients in the program. There are few studies of GP-AoD collaborative care programs and nothing in the Australian context. This study suggests that GP-AoD collaborative care programs in Australia are feasible and improve drug use.

General-practitioner-led alcohol and other drugs withdrawal: Supporting patient choice, safety and success

“…6,23 These patients should be referred to a specialist service because of their increased risk of complications. 4 Pregnant or breastfeeding women should be reviewed and managed by specialist services, as should young people under the age of 18 years. 6,7 Withdrawal symptoms can feel the same as trauma symptoms, 'triggering' a patient, activating their nervous system and risking real harm.…”

“…GPs are the bedrock of Australian healthcare, frequently treating patients who have AOD-related issues, including those with a substance use disorder (SUD), whether it be their primary complaint or comorbidity. 4,5 For those people who experience withdrawal symptoms if they try to reduce or cease their AOD use, a GP-led, home-based withdrawal program can be an effective option for patients in the primary care setting. 6,7 Current guidelines for AOD withdrawal speak to patients having various goals of care that include, but are not limited to, abstinence, stabilisation and respite from AOD use.…”

What do general practitioners want from specialist alcohol and other drug services? A qualitative study of New South Wales metropolitan general practitioners

“…Care 'siloing' between AOD specialist services and primary care may delay access to treatment and limit relapse prevention support and aftercare [20,21]. Collaboration between AOD specialist services and primary care in the USA, Canada and Australia showed increased patient engagement in care, improved access and utilisation of treatment services, significant decrease in drug use and greater 6-month abstinence [22][23][24][25][26][27][28]. Unfortunately, short-term programs to encourage primary care to undertake care for patients with complex AOD needs tend to fail after specialist support is withdrawn [29].…”