| Project Objectives / Summary:
This project aimed to improve rural access to A&OD services by increasing the number of GPs skilled and willing to provide best practice treatment and management of patients with A&OD issues.
Project Collaboration:
- Mid Western Area Health Service A&OD Service
- Alliance of NSW Divisions
- Lyndon Withdrawal Unit, Central Coast GP project
- GPs of the NSW Central West
Project Outcomes:
A thorough GP Needs Assessment was conducted and the key areas requiring targeting noted. These included GP support, GP ownership, sustainability and a rural focus. A number of barriers were identified i.e. time, increased GP workload, attitudes to A&OD and organisational factors.
A user friendly, durable, easily updated and identifiable Resource Folder for GPs on A&OD services in the area was developed.
Drinkcheck (Audit) in General Practice
A Drinkcheck in General Practice was carried out between May and September 2001. 738 patients were screened using the AUDIT tool and given an appropriate brief intervention. The trial involved nine GPs in nine different practices across seven towns in the central west from Orange to Lake Cargelligo. Results showed that 26% were drinking hazardously and 6% harmfully.
Rural A&OD education conference for GPs
The GP A&OD conference entitled "Going the Distance" was held from the 3rd to 4th November, 2001. The conference was designed to give Division GPs access to a broad range of A&OD topics presented by key people in the field.
A Pharmacotherapy Accreditation course was held after the conference. The Division A&OD project has collaborated closely with Area Health's GPLO and Sydney University to prove this opportunity for GPs to gain Buprenorphine or Methadone accreditation.
Monthly supplements
There were 12 supplements that were distrubuted to all GPs in the area. This was the primary vehicle for getting regular information and guidelines out to the GPs. It drew attention to new developments in the field as well as bringing significant attention to the topic of A&OD.
Monthly Question and Answer
A monthly question and answer quiz accompanied each monthly supplement with a dinner prize for the winner.
GP Education
Education events have been held for GPs on "What is craving?" Alcohol dependence and new pharmacotherapies, on the 6th June in Orange (11 GPs attended) and the 12th September, 2001 in Bathurst (13 GPs attended).
The project participated in Registrar day release training on the 1st of August providing information / resources, a tour of the local withdrawal unit, and role-plays.
Practice visits
The project officer visited GPs in their practices to engage them in discussions on A&OD.
Transition planning
The Area Health GP A&OD Liaison Officer and the Division's A&OD Project Officer collaborated on developing a transition plan to enable the continuation of key elements of the Division's project to continue within Area Health. To date many areas of the transition plan have been implemented within the Area Health Service and a new memorandum of association is being developed.
The Division is also examining means to ensure the sustainability of A&OD activity, including the availability of audits for GPs, guidelines, resources, education events and incorporating an awareness of the impact of A&OD on other Division project areas.
Recommendations:
- Continue to disseminate up-to-date information on A&OD to GPs.
- Public awareness should be raised about the role of the GP and A&OD work
- Ensure that GPs access at least one education session on A&OD per year. This could perhaps be integrated into another Division CME event i.e. men's health could include a component on alcohol and moderate drinking or Mental Health and its linkages to A&OD.
- Divisions should ensure better communication between A&OD, Mental Health and general practice.
- Each Registrar term should include a full day release on A&OD.
- Divisions need to advocate for the availability of inpatient and ambulatory detoxification services. This is particularly notable in rural / remote areas.
- GPs providing A&OD services, such as substitution pharmacotherapies, should be linked to like GPs and supported appropriately by the Division.
- The Drinkcheck in General Practice package should be maintained in the Division as an audit available to GPs on an ongoing basis. GP registrars should be encouraged to use Drinkcheck as a research project. The Drinkcheck package should be advertised at regular intervals to GPs as an opportunity to increase knowledge of brief interventions, obtain accurate data on drinking patterns in the patient population, and introduce a valid screening tool that is fast and simple to administer. This could include a longitudinal study assessing the effects of brief interventions on drinking levels.
- Further investigation is required into the drinking levels of the ATSI population. The Drinkcheck trial indicated a proportionally larger percentage drinking at harmful levels, however the sample lacks validity. A larger study is warranted incorporating the effectiveness and cultural appropriateness of brief intervention on this population.
Dissemination:
- Various media releases and presentations (TV, print, radio) leading up to the festive season in December 2000.
- Bi-monthly articles in the Division's weekly Tues News & Views practice fax from September 2000 to September 2001.
- Articles in the Division quarterly newsletter.
- The CWDGP website housed information about the project. This information was updated regularly. The 12 Information Supplements were also situated on the website.
Lessons / Assessment:
The project had a positive effect on GP confidence in the area of A&OD issues and their willingness to manage A&OD patients themselves. Evaluation of the project showed a high level of GP satisfaction particularly in the areas of education and support, a primary aim of the project.
This project has formed a solid basis for further work to be done in the area of A&OD and related issues within the Division. |
