Difficulties associated with outpatient management of drug abusers by general practitioners. A cross-sectional survey of general practitioners with and without methadone patients in Switzerland

Abstract

BackgroundIn Switzerland, general practitioners (GPs) manage most of the patients receiving methadone maintenance treatment (MMT).MethodsUsing a cross-sectional postal survey of GPs who treat MMT patients and GPs who do not, we studied the difficulties encountered in the out-patient management of drug-addicted patients. We sent a questionnaire to every GP with MMT patients (556) in the French-speaking part of Switzerland (1,757,000 inhabitants). We sent another shorter questionnaire to primary care physicians without MMT patients living in the Swiss Canton of Vaud.ResultsThe response rate was 63.3%. The highest methadone dose given by GPs to MMT patients averaged 120.4 mg/day. When asked about help they would like to be given, GPs with MMT patients primarily mentioned the importance of receiving adequate fees for the care they provide. Secondly, they mentioned the importance of better training, better knowledge of psychiatric pathologies, and discussion groups on practical cases. GPs without MMT patients refuse to treat these patients mostly for emotional and relational reasons.ConclusionGPs encounter financial, relational and emotional difficulties with MMT patients. They desire better fees for services and better training.

Current practices and attitudes of family physicians toward substance use disorders in the Emirate of Abu Dhabi: a cross-sectional survey in primary care

“…Although the majority of those who responded believed that prescribing controlled drugs was part of general medical practice and drug users visiting the clinic would not affect other patients' access, 70% believed treatment should be provided centrally by specialists. This is similar to findings in other parts of the world 14,15 and could be attributed partially to a lack of confidence in the success of treating poly-drug users, a lack of guidelines or potential stigmatisation of this patient group.…”

How to overcome hurdles in opiate substitution treatment? A qualitative study with general practitioners in Belgium

“…[32] Previous studies have made some suggestions to overcome the reluctance in GPs to attend training are discussion groups on practical cases, community based nurse prescribing, and multidisciplinary collaboration. [11,26,33] From our results rose the idea of 'advisory physicians', GPs who are trained in OST management who provide advice to their colleague GPs whenever needed. This can be a timesaving solution and stimulate sharing of knowledge and experience amongst colleagues.…”

“…[9,10] A Swiss study in 2005 indicated that only 23.9% of GPs were willing to accept new patients for OST. [11] From these results, we can assume that barriers remain to exist in GPs to accept OST patients in their general practice.…”

“…First, the outflow of opiate users from addiction centres to general practices remains low in Antwerp, [16] compared to Australia and Switzerland for example, where most of the opiate users go to the GP for treatment. [11,30] Second, Belgian regulations regarding OST remain unchanged up until now, so the hurdles and barriers experienced by GPs remain relevant. This is confirmed in a recent study by Ketterer et al, where personal attitudes and motivation were the main hurdles for managing substance abusers.…”

Comparaison des représentations et comportements des médecins généralistes du Canton de Genève et du Poitou-Charentes

“…Des études ont essayé de les caractériser : l'isolement, le manque de temps ou de formations, les représentations négatives des toxicomanes ou alcooliques [4,[7][8][9]. Ils seraient davantage présents chez les MG que chez les psychiatres et les spécia-listes en addictions [7].…”