GP CARE METHADONE PROGRAMME
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1 GP CARE METHADONE PROGRAMME Stephen Lavery and Dr David Stoner March
2 Who is Pegasus Health? 287 member GPs across Canterbury Member of Partnership Health Canterbury PHO Gazetted in GPs with people on GP Care and Authority 2
3 Primary Healthcare Strategy Significant change in last five years Enrolled populations People enrol with their GP Updated quarterly Gaining understanding of population Systems level (365,000 people) General practice level (2,000 people) 3
4 366,323 people enrolled with GPs 303,307 (82.3%) European 22,784 (6.2%) Maori 12,006 (3.3%) Other 8,604 (2.3%) Pacific 4
5 14.0% Maori Share of Average 2009 Enrolled Population by Age Band 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 0 to 4 5 to 9 10 to to to to to to to to to to to to to Maori All 5
6 Maori Average Annual Visit Rate, Maori All to 4 5 to 9 10 to to to to to to to to to to to to to
7 7
8 8
9 GP Care Methadone Programme A collaborate service between Pegasus Health and Christchurch Methadone Programme (CMP) Committee works with GPs to transition people who have been assessed by CMP as stable long-term from Authority to Care Close collaboration between Pegasus and CMP 9
10 GP Care Committee Provides advice and support to GPs, comprises: Pegasus Health Clinical Leader Mental Health Three Pegasus Health GPs Representatives from CDHB - CADS and CMP Pharmacist Manager Health Services & project manager A consumer representative attends part of meeting to discuss protocols, policies, etc 10
11 Objectives Provide structured support and followup of people on methadone for addiction Ensure support & clinical safety of GPs and people on methadone Support people back in the community allow an extra takeaway under special circumstances, eg. work commitments CMP zero waiting list - this has been achieved 11
12 Person s journey 12
13 Policy manual Designed to support GPs by setting out guidelines of practice Supports GPs around the prescribing of methadone Information brochure sets out people s rights & responsibilities 13
14 Patient numbers Numbers on programme (Includes deaths, transfers and voluntary withdrawals/counting off) Patient numbers by year Year 14
15 Total Demographics Gender as at year end Males Females Ethnicity as at year end NZ European Maori Pacific Other 15
16 Since 2005 Five people destablised and were transferred back to CMP Two people transferred to other areas Five people died, none directly related to methadone Fourteen successfully ceased taking methadone, none of whom have had to come back onto the programme to date 16
17 Success criteria All people know the rules of the programme and that they must abide by them This protects GPs and people alike GPs are willing to participate, with GP numbers increasing from 32 in 2002 to 55 currently communicate regularly on issues of importance 17
18 Results of survey GPs: 29 responses from of 42 sent o100% felt well supported owould like more autonomy to prescribe People: 30 responses from 123 sent o100% happy/very happy with their GP omany requested 3 takeaways/week as a given, felt their long-term stability should entitle them to be trusted & rewarded 18
19 Case scenario The problem Person suspected of being on other drugs by partner who contacted GP GP requested random urine screen, noncompliance by person DNA two appointments 19
20 Steps taken Committee recommended: o GP cancel takeaways, person must consume on premises until clean urine o Bring person in to discuss what is happening, do repeat, also consult pharmacist Support offered to GP Facilitated CMP assessment 20
21 Situation development & outcome Pharmacist had noticed deterioration GP kept close communication with partner Person fast-tracked back to CMP for support After stabilised was transferred back to GP Care 21
22 Lessons Good communication is key - even people stable long-term can destablise quickly Important all work together to support and help person get back on track Committee supported GP in reinforcing best clinical practice GPs in isolation can be vulnerable to people s pressure committee support helps 22
23 Summary Programme is designed to support general practice teams to provide a safe service Relationship of trust between person-gp and GP-Committee People able to obtain support if danger of becoming unstable/have personal issues, but still remain on GP Care Support of the committee engenders confidence of GPs, who are protected from pressure to break the rules 23
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