Feasibility and outcomes of a general practice and specialist alcohol and other drug collaborative care program in Sydney, Australia
H. H. K. Wilson A B D , M. Schulz A , L. Mills A C and N. Lintzeris A CA Drug & Alcohol Services, South East Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia.
B School of Public Health and Community Medicine, UNSW Sydney, High Street, Kensington, NSW 2052, Australia.
C Division Addiction Medicine, University of Sydney, NSW 2006, Australia.
D Corresponding author. Email: hester.wilson@health.nsw.gov.au
Australian Journal of Primary Health 28(2) 158-163 https://doi.org/10.1071/PY20197
Submitted: 20 August 2020 Accepted: 25 May 2021 Published: 2 February 2022
Journal Compilation © La Trobe University 2022 Open Access CC BY-NC-ND
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 = 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.
Keywords: continuity of patient care, delivery of health care: integrated, patient-centred care, primary health care, substance abuse treatment centres.
References
Australian Institute of Health and Welfare (AIHW) (2016) Australian burden of disease study: impact and causes of illness and death in Australia 2011. Canberra. Available at https://www.aihw.gov.au/reports/burden-of-disease/burden-disease-study-illness-death-2015/contents/table-of-contentsAustralian Institute of Health and Welfare (AIHW) (2017) National drug strategy household survey 2016: detailed findings. Canberra. Available at https://www.aihw.gov.au/reports/illicit-use-of-drugs/2016-ndshs-detailed/contents/table-of-contents
Ampt AJ, Amoroso C, Harris MF, McKenzie SH, Rose VK, Taggart JR (2009) Attitudes, norms and controls influencing lifestyle risk factor management in general practice. BMC Family Practice 10, 59
| Attitudes, norms and controls influencing lifestyle risk factor management in general practice.Crossref | GoogleScholarGoogle Scholar | 19706198PubMed |
Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P (2012) Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews CD006525
| Collaborative care for depression and anxiety problems.Crossref | GoogleScholarGoogle Scholar |
Berends L, Lubman DI (2013) Obstacles to alcohol and drug care: are Medicare Locals the answer? Australian Family Physician 42, 339–342.
Bodenheimer T, Wagner EH, Grumbach K (2002) Improving primary care for patients with chronic illness: the chronic care model, part 2. Journal of the American Medical Association 288, 1909–1914.
| Improving primary care for patients with chronic illness: the chronic care model, part 2.Crossref | GoogleScholarGoogle Scholar | 12377092PubMed |
Britt H, Miller GC, Henderson J, Bayram C, Harrison C, Valenti L, Pan Y, Charles J, Pollack AJ, Wong C, Gordon J (2016) ‘General practice activity in Australia 2015–16.’ (Sydney University Press)
Digiusto E, Friend R, Batey RG, Mattick RP (2013) Considerations in providing shared‐care psychological treatment for clients who have alcohol or other drug misuse problems. Clinical Psychologist 17, 100–105.
| Considerations in providing shared‐care psychological treatment for clients who have alcohol or other drug misuse problems.Crossref | GoogleScholarGoogle Scholar |
Hutchings D, Cassidy P, Dallolio E, Pearson P, Heather N, Kaner E (2006) Implementing screening and brief alcohol interventions in primary care: views from both sides of the consultation. Primary Health Care Research and Development 7, 221–229.
McAvoy BR (2008) Addiction and addiction medicine: exploring opportunities for the general practitioner. The Medical Journal of Australia 189, 115–117.
| Addiction and addiction medicine: exploring opportunities for the general practitioner.Crossref | GoogleScholarGoogle Scholar | 18637785PubMed |
McKeown A, Matheson C, Bond C (2003) A qualitative study of GPs’ attitudes to drug misusers and drug misuse services in primary care. Family Practice 20, 120–125.
| A qualitative study of GPs’ attitudes to drug misusers and drug misuse services in primary care.Crossref | GoogleScholarGoogle Scholar | 12651783PubMed |
Mules T, Taylor J, Price R, Walker L, Singh B, Newsam P, Palaniyappan T, Snook T, Ruselan M, Ryan J, Santhirasegaran J, Shearman P, Watson P, Zino R, Signal L, Fougere G, Moriarty H, Jenkin G (2012) Addressing patient alcohol use: a view from general practice. Journal of Primary Health Care 4, 217–222.
| Addressing patient alcohol use: a view from general practice.Crossref | GoogleScholarGoogle Scholar | 22946070PubMed |
Pace CA, Uebelacker LA (2018) Addressing unhealthy substance use in primary care. The Medical Clinics of North America 102, 567–586.
| Addressing unhealthy substance use in primary care.Crossref | GoogleScholarGoogle Scholar | 29933816PubMed |
Ritter A, Berends L, Chalmers J, Hull P, Lancaster K, Gomez M (2014) New horizons: the review of alcohol and other drug treatment services in Australia – final report. National Drug and Alcohol Research Centre UNSW, Sydney. Available at https://ndarc.med.unsw.edu.au/resource/new-horizons-review-alcohol-and-other-drug-treatment-services-australia [Verified 23 August 2021]
Ryan A, Holmes J, Hunt V, Dunlop A, Mammen K, Holland R, Sutton Y, Sindhusake D, Rivas G, Lintzeris N (2014) Validation and implementation of the Australian Treatment Outcomes Profile in specialist drug and alcohol settings. Drug and Alcohol Review 33, 33–42.
| Validation and implementation of the Australian Treatment Outcomes Profile in specialist drug and alcohol settings.Crossref | GoogleScholarGoogle Scholar | 24206571PubMed |
Samet JH, Friedmann P, Saitz R (2001) Benefits of linking primary medical care and substance abuse services: patient, provider, and societal perspectives. Archives of Internal Medicine 161, 85–91.
| Benefits of linking primary medical care and substance abuse services: patient, provider, and societal perspectives.Crossref | GoogleScholarGoogle Scholar | 11146702PubMed |
Samet JH, Larson MJ, Horton NJ, Doyle K, Winter M, Saitz R (2003) Linking alcohol- and drug-dependent adults to primary medical care: a randomized controlled trial of a multi-disciplinary health intervention in a detoxification unit. Addiction (Abingdon, England) 98, 509–516.
| Linking alcohol- and drug-dependent adults to primary medical care: a randomized controlled trial of a multi-disciplinary health intervention in a detoxification unit.Crossref | GoogleScholarGoogle Scholar |
Setodji CM, Watkins KE, Hunter SB, McCullough C, Stein BD, Osilla KC, Ober AJ (2018) Initiation and engagement as mechanisms for change caused by collaborative care in opioid and alcohol use disorders. Drug and Alcohol Dependence 192, 67–73.
| Initiation and engagement as mechanisms for change caused by collaborative care in opioid and alcohol use disorders.Crossref | GoogleScholarGoogle Scholar | 30223190PubMed |
U.S. Department of Health and Human Services (HHS) (2016) Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. (HHS, Office of the Surgeon General: Washington, DC, USA) Available at https://store.samhsa.gov/sites/default/files/d7/priv/surgeon-generals-report.pdf [Verified 23 August 2021]
Watkins KE, Ober AJ, Lamp K, Lind M, Diamant A, Osilla KC, Heinzerling K, Hunter SB, Pincus HA (2017) Implementing the chronic care model for opioid and alcohol use disorders in primary care. Progress in Community Health Partnerships 11, 397–407.
| Implementing the chronic care model for opioid and alcohol use disorders in primary care.Crossref | GoogleScholarGoogle Scholar | 29332853PubMed |
Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y (2001) Integrating primary medical care with addiction treatment: a randomized controlled trial. Journal of the American Medical Association 286, 1715–1723.
| Integrating primary medical care with addiction treatment: a randomized controlled trial.Crossref | GoogleScholarGoogle Scholar | 11594896PubMed |
