Researchers
- Mr Jim Hales, Health Outcomes International
- Ms Lorraine Scorsonelli, Health Outcomes International
Summary
Pharmacotherapy involves the use of medication in the treatment of problematic drug dependence. This form of drug therapy is very useful in addictions to substances such as heroin, alcohol, and other drugs that affect the body in a predominately biological manner. This form of therapy lends itself to being supervised by the patient’s own GP; however, implementation of this form therapy in general practice has been very slow, and is still at a low level. The projects evaluated were:
- Pharmacotherapy Alcohol Treatment Project
- Bendigo and District Division of General Practice, Bendigo, Victoria
This project aims to provide a more comprehensive General Practitioner (GP) continuum of care to patients and their families by reinforcing the benefits of pharmacotherapy treatment for alcohol misuse and encouraging greater patient compliance with and retention in that model.
Shared Care Alcohol Projects, Addiction Medicine Unit, Southern Health, St Vincent’s Hospital, Melbourne, Victoria: These projects aim to support patients with alcohol dependence in the post-withdrawal period through providing education and clinical advice to their GPs, and encouraging patients and GPs to consider using anti-craving medications where appropriate.
Breaking Down the Barriers Project, Drug Education Network, Hobart, Tasmania: The aim of this project is to increase the number of GPs considering pharmacotherapy as a treatment option through raising the general level awareness and knowledge of the topic within the medical community, specifically among GPs.
Call-back Telephone Counselling Service, WA Drug and Alcohol Authority, Perth, WA: This model positions the GP as the prescriber, while the Alcohol and Drug Information Service (ADIS) provides the requisite expertise to offer assessment, support, counselling, and monitoring of patients who have been prescribed alcohol pharmacotherapies and, if necessary, to offer referral to an alcohol and drug agency.
Outcomes
While all of the projects focused on the engagement of GPs in the provision of pharmacotherapies to patients with alcohol dependence, they differed markedly in their duration, mechanisms for engagement, and their geographic coverage.
All projects funded under the initiative reported initial difficulties in attracting GPs to providing pharmacotherapy services for alcohol dependence. The reports from the various projects identify several factors that influence GP participation; for example, apathy and, in some instances, resistance among GPs towards engaging with patients struggling with drug and alcohol dependence; limited training of GPs in managing alcohol problems; a lack of knowledge among GPs of the application and effectiveness of pharmacotherapies for the treatment of alcohol dependence; and the absence of, or limited access to, specialist drug and alcohol clinicians to support GPs in providing pharmacotherapies and associated counselling services.
This combination of attitude and knowledge limitations among GPs is not easily or quickly addressed; however, the projects identify the importance of the relationship between the patient and their GP in underpinning their willingness to engage in the service. This relationship seems to rely as much on the personal attributes of the GP as on their clinical expertise in treating drug and alcohol dependence or their knowledge of pharmacotherapies.
These projects were not designed as, nor intended to be, trials to test the efficacy of pharmacotherapy for alcohol dependence; however, those projects involving patient treatment found that, at least for some patients, pharmacotherapy can assist in reducing their alcohol intake. The active support and involvement of their GP was an important factor in achieving this outcome.
References
Hales, J. & Scorsonelli, L. (2009). Evaluation of interventions promoting pharmacotherapies for alcohol misuse: evaluation report. Unpublished. Adelaide: Health Outcomes International.
