Opioid replacement therapy: A wait unmanaged

Abstract

There has been a rapid increase in members of the Australian population using opioids in recent years. The flow-on effect has been an increase in demand for treatments, particularly opioid replacement therapy (ORT), but the availability of treatments has not increased. This has frequently resulted in delays before treatment can be commenced. Outcomes could improve if health-care professionals had clearer guidelines on how to prioritize access to ORT. This review investigates the triage of consumers in ORT within Australia. Information on triage in ORT was not available, and an understanding of how consumer needs are managed when they present for ORT triage was not identified. In the absence of research to guide this practice, the body of evidence regarding ORT treatment access is weighted on government policies. Triage, as applied in general health and mental health-care service delivery, was reviewed to consider the components of triage and how these might pertain to triage in ORT. Failure to facilitate the needs of consumers accessing ORT can result in further harm to consumers and increased social and financial costs for society. Research is required to investigate how this issue is currently being managed and to lead the way for needed improvements in service delivery.

John or Jane? Exploring How Clinical Judgment is Applied in Managing Access to Opioid Replacement Therapy

“…A detailed outline and/or pathway of the ORT access management process would assist clinicians in the task and aid their confidence. This has been recommended in mental health triage (Broadbent et al 2010) and previously raised for ORT triage (Harlow, Happell & Browne 2011).…”

“…Having more information on a person can only assist in determining a person's need for treatment and the undertaking of triage assessment on a person's presentation can only assist with gathering this collateral (Harlow, Happell & Browne 2011).…”

“…In Australia's Capital Territory, the vulnerable population groups also includes people identified as For people that do not meet priority criteria, policy recommends clinicians use clinical judgment to determine who receives immediate treatment. However, little information is available to describe how this is applied (Harlow, Happell & Browne 2011). To facilitate appropriate clinical judgement in health care, it is desirable for clinicians to have the clinical skills required to consider all of the consumers' needs, knowledge of the boundaries of the service, and a working knowledge of related policy.…”

Triage in Opioid Replacement Therapy: What's the Wait?

“…Improving access to ORT has therefore been identified as a necessity in managing prescription opioid misuse (Hallinan et al, 2011). With the likelihood of increased referrals to ORT resulting from early detection of POD behaviors via ehealth and risk screening and the suggestion that people in need of ORT are unable to access this treatment, it is surprising to identify there is no national triage system in ORT to manage accessibility (Harlow, Happell, & Browne, 2011).…”

Guided by Priority: How Clinicians Manage Access to Opioid Replacement Therapy

“…Clinicians also are expected to make decisions in a high-paced, demanding work environment (Andersson, Omberg, & Svedlund, 2006;Kam & Midgley, 2006;Purc-Stephenson & Thrasher, 2010 How this is applied in managing access to ORT is unknown as no study has been undertaken on this topic (Harlow et al, 2011). Research is therefore required to explore how clinicians respond to consumer requests for ORT.…”