| Project Objectives / Summary:
The aim of the project was to identify and implement an effective role for the GP and general practice in the early detection and treatment of patients with dual diagnosis. Dual diagnosis for the context of this project is defined as concurrent substance abuse or dependence and significant psychiatric disorder.
Project Collaboration:
The project was a collaboration between five Divisions: Central Bayside, Dandenong, Mornington Peninsula, Monash and Sherbrooke - Pakenham. The Dual Diagnosis Resource Centre was also heavily involved.
Project Outcomes:
The project focused on scoping locally to understand the issues for GPs working with Dual Diagnosis. Early research had found that, because of the complexity of dual diagnosis issues, a simple assessmen tool would be clinically inappropriate.
A model articulating the roles for GPs was developed and tested and a series of education strategies developed. A referral guide for Drug and Alcohol patients was also developed. There was consumer involvement throughout the duration of the project.
New effective pharmacotherapies and use of the EPC Items are two initiatives that should make care of Dual Diagnosis patients easier.
Recommendations:
From experience of working with GPs in Dual Diagnosis, the project has developed a number of recommendations for Divisions and the Commonwealth to consider. They are:
- That models of mentoring supervision for GPs involved in the care of patients with Dual Diagnosis be explored via State Based Organisations in collaboration with the Colleges of Psychiatry and General Practice.
- That Divisions of General Practice explore organisational mechanisms for engaging their GP members in substance abuse, mental health and Dual Diagnosis issues. Divisions may devise programs that are specific to the needs of GP members, the local community and level of engagement with relevant service providers.
- That Divisions provide feedback to GPs and improve relationships with local service providers, by developing quality improvement/ service improvement initiatives that systematically review the provision of services by GPs to Dual Diagnosis patients, families and carers.
- That Divisions of General Practice be the central educative/implementation resource for GPs in subsequent enhancements of the MBS payment system, especially for the proposed mental health item numbers.
- That Divisions participate with other relevant service organisations in the development of innovative service delivery models; For example shared care arrangements.
- That ADGP and State Based Organisations convene a conference of interested parties to explore innovative service delivery models in the context of health priorities regarding substance abuse and mental health.
- That discussions be held with local Primary Care Partnerships (and their equivalents in other States) to test principles of access to services, information sharing and service collaboration to clarify and enhance the role of GPs in service provision to Dual Diagnosis clients.
- That initiatives to provide further training and education for GPs in the management of chronic diseases, include Dual diagnosis as an example of the primary care management of chronic illness in the community.
- That all Divisions of General Practice explore multi-disciplinary CME/ professional development as part of their ongoing CME programs for all chronic conditions, using Dual Diagnosis as an example.
Lessons / Assessment:
This project was a good example of inter-Divisional collaboration.
The key lessons as outlined in the Outcomes and Recommendations show that:
- Provision of educational / training opportunities is not adequate for GPs
- Divisions have a significant roles as facilitators
- There are opportunities for consumers to influence the provision of services in this area
- Use of the EPC Items could be widened
- Dual Diagnosis provides opportunities for development of shared care models
- Opportunities for GPs to identify Dual Diagnosis as a chronic disease should not be overlooked.
This project demonstrated the need for better linkages between General Practice, the Mental Health system and other services.
|
