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

Harlow, Warren; Happell, Brenda; Browne, Graeme; Choudhury, Jahar; Pinchin, David

doi:10.3109/10826084.2012.736050

Cited by 7 publications

(7 citation statements)

References 23 publications

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“…However, demand for maintenance treatment remains consistently above available capacity in many areas of the country (Friedmann et al, 2003; Harlow et al, 2013; Sigmon, 2014; Wenger & Rosenbaum, 1994). An alarming number of methadone clinics have extensive waitlists, due in part to inadequate public funding and unfavorable zoning regulations (Des Jarlais et al, 1995; Fountain et al, 2000; Gryczynski et al, 2009; Peles et al, 2012, 2013; Peterson et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Interim treatment: Bridging delays to opioid treatment access

Sigmon

2015

Preventive Medicine

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Objective Despite the undisputed effectiveness of agonist maintenance for opioid dependence, individuals can remain on waitlists for months, during which they are at significant risk for morbidity and mortality. To mitigate these risks, the Food and Drug Administration in 1993 approved interim treatment, involving daily medication + emergency counseling only, when only a waitlist is otherwise available. We review the published research in the 20 years since the approval of interim opioid treatment. Methods A literature search was conducted to identify all randomized trials evaluating the efficacy of interim treatment for opioid-dependent patients awaiting comprehensive treatment. Results Interim opioid treatment has been evaluated in four controlled trials to date. In three, interim treatment was compared to waitlist or placebo control conditions and produced greater outcomes on measures of illicit opioid use, retention, criminality and likelihood of entry into comprehensive treatment. In the fourth, interim treatment was compared to standard methadone maintenance and produced comparable outcomes in illicit opioid use, retention and criminal activity. Conclusions Interim treatment significantly reduces patient and societal risks when conventional treatment is unavailable. Further research is needed to examine the generality of these findings, further enhance outcomes, and identify the patient characteristics which predict treatment response.

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Section: Introductionmentioning

confidence: 99%

Interim treatment: Bridging delays to opioid treatment access

Sigmon

2015

Preventive Medicine

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“…This could involve detailing consumer assessment standards, the clinical skills necessary to make the decision, and direction on operational management that takes into account the variant ORT clinical environments (i.e., limited staff, large geographical area). Additionally, a triage system that prioritises consumers for treatment, reflecting consumer complexity and need for ORT treatment, is recommended (Harlow et al, 2012). These approaches could reduce the inconsistency in clinical decision making.…”

Section: Discussionmentioning

confidence: 98%

“…Australia to report the number of people waiting to access ORT or the time they wait for treatment (Harlow, Happell, Browne, Choudhury, & Pinchin, 2012). National reports focus on the number of consumers in treatment (Australian Institute of Health and Welfare, 2013).…”

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confidence: 99%

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

Harlow

Happell

Browne

2014

Issues in Mental Health Nursing

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Access to opioid replacement therapy is a problem in some parts of Australia and it is not known how clinicians respond to this situation. The aim of this study is to develop a conceptual understanding of how clinicians apply clinical judgements in managing access to treatment. Grounded theory methodology was used to guide this study. Thirty-five clinicians were interviewed. The substantive theory presented to explain the process is Guided by Priority. By presenting this understanding of practice, clinicians can reflect on their actions related to the task and determine if they are beneficial or detrimental to consumers, which may influence their future practice.

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“…In mental health services, the process is similar, with consumers allocated a priority rating: A (highest) to G, reflecting their need for intervention, with clinicians provided direction on how to respond and the timeframe to complete for each allocation (Department of Health 2010). The results demonstrated that consumers were granted access to ORT in timeframes reflecting their allocated priority category (Harlow et al 2013). For instance, a variation to the process was applied in one ORT clinic, which trialled a three-tiered triage categorization system.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this large number engaged in ORT, people are still waiting to receive treatment. In Queensland and New South Wales (NSW) in Australia, waiting is acknowledged as part of the treatment process (Drugs of Dependence Unit 2012; Harlow et al 2013;Winstock et al 2008), although nationally, there is no reporting of the number of people waiting for ORT (Australian Institute of Health and Welfare 2012). The extent of the wait list is unknown.…”

Section: Introductionmentioning

confidence: 99%

How clinicians manage access to opioid replacement therapy

Harlow

Happell

Browne

2014

Int J Mental Health Nurs

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In Australia, people wait to access opioid replacement therapy (ORT). The aim of this study was to examine how clinicians (n = 35) prioritize consumers for opioid replacement therapy (ORT). The study used a methodology informed by a constructivist approach to grounded theory. Based on a scenario related to two consumers seeking admission to opioid replacement therapy (ORT), participants were asked to prioritize one for preferential admission and questioned about their decision-making. Clinicians were neither confident nor unanimous in their decision-making. Team involvement and work experience influenced their judgment. Differences between clinicians in regard to understanding risks and protective factors were identified. To support uniformity in managing treatment requests, clearer policy direction to gui clinician practice, and further exploration of how models of care and team involvement influence consumer outcomes, are recommended.

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

Cited by 7 publications

References 23 publications

Interim treatment: Bridging delays to opioid treatment access

Interim treatment: Bridging delays to opioid treatment access

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

How clinicians manage access to opioid replacement therapy

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