Shared care through divisions of general practice: moving forward

Harris, Mark; Davies, Gawaine Powell

doi:10.5694/j.1326-5377.1999.tb123529.x

Cited by 9 publications

(3 citation statements)

References 15 publications

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“…GPs are now increasingly familiar with shared care in other fields. In Australia, divisions of general practice have provided ideal structures for the organization of shared-care programmes [23]. To be successful, drug and alcohol programmes will need to contain a number key features: Ÿ joint management and monitoring by drug and alcohol services and divisions; Ÿ national evidenced-based clinical management guidelines for drug and alcohol dependence in primary care; Ÿ effective systems for assessment, referral, consultation/liaison between GPs and drug and alcohol services; and Ÿ education, training and clinical audit for GPs in the management of drug and alcohol dependence.…”

Section: Discussionmentioning

confidence: 99%

GP attitudes to managing drug‐ and alcohol‐dependent patients: a reluctant role

Abouyanni

Stevens

Harris

et al. 2000

Drug and Alcohol Review

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The aim of this study was to determine the experience, confidence and views of GPs in South West Sydney towards managing drug and alcohol dependence and their interest in participating in shared care methadone prescribing. Five hundred and forty‐eight GPs were mailed a self complete questionnaire. Non‐responders were followed‐up by telephone. Seventy‐six per cent of GPs responded; 52% considered methadone maintenance to be effective. GPs were more confident managing smoking than alcohol and benzodiazepine dependence and least confident in illicit drug dependence. Fifty per cent reported having no patients on methadone and 40% between one and five patients. GPs in Fairfield and Liverpool reported having most patients; 25% were interested in prescribing methadone for patients in their own practice and 17% for patients referred to them. GPs who had more patients on methadone in their practice (especially those in Fairfield and Liverpool) considered methadone effective and were more likely to be interested in having patients referred to them. The most frequent reasons for not being interested were concerns about patients being demanding or aggressive or the impact on their practice. The most frequently requested support for shared care prescribing was for 24‐hour back‐up from specialist services, especially requested by those with less experience with patients on methadone. A shared‐care approach to facilitating greater GP involvement in prescribing appears feasible, especially among GPs with some previous experience with patients on methadone.

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Section: Discussionmentioning

confidence: 99%

GP attitudes to managing drug‐ and alcohol‐dependent patients: a reluctant role

Abouyanni

Stevens

Harris

et al. 2000

Drug and Alcohol Review

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“…Such arrangements can include employment of an AOD specialist by a GP practice for one or more sessions and a formalized, regular link between the GP and the AOD specialist, with the GP retaining primary responsibility for management [64]. A review [65] of Australian GP Divisions indicated that in 1998, several had instigated shared care programmes in the AOD area between GPs and both hospital and community health services. These programmes focused on early intervention, methadone prescribing and both out-patient and home-based detoxification [66].…”

Section: Work-place Structures and Policiesmentioning

confidence: 99%

The general practitioner's role in AOD issues: overcoming individual, professional and systemic barriers

Roche

Hotham

Richmond

2002

Drug and Alcohol Review

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General practitioners (GPs) and increasingly other medical practitioners are well placed to address alcohol and other drug (AOD) problems. Their involvement in this area of care, however, is assessed to be less than optimal. There is, however, a growing body of evidence for the potential efficacy of medical practitioner intervention at the primary care, emergency department and in-patient level. There is also considerably expanded scope to operate from an evidence-based perspective. However, key questions arise regarding what constitutes best practice in the translation of the growing AOD knowledge base into clinical practice behaviours. This paper explores possible contributory factors to the low level of engagement with AOD issues by GPs and examines a wide range of individual, structural and systemic issues that may be amenable to change. Strategies for the dissemination of research findings, changing professional practice behaviour and introducing sustainable structural reforms are also addressed.

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“…11 A review in 1999 of shared care in Australia showed that there were examples for conditions such as diabetes, asthma and mental health, but none for stroke. 11 To our knowledge, this is still the case. Cerebrovascular disease incidence is particularly amenable to reduction by risk factor management.…”

Section: Discussionmentioning

confidence: 99%