Barriers & benefits: transfer of opioid- dependent people on methadone maintenance treatment from secondary to primary health care NAPCRG Tucson 2006 Felicity Goodyear-Smith, Annette Gohns, Rachel Butler, Janie Sheridan, Amanda Wheeler* Department of General Practice & Primary Health Care School of Population Health Faculty of Medical & Health Science University of Auckland, Auckland, New Zealand *Auckland Methadone Service, Community Alcohol & Drug Service, Waitemata District Health Board, Auckland

Background Evidence that providing care for opioid- dependent people on methadone maintenance treatment (MMT) in primary health care settings, supported by specialist services, has beneficial outcomes.

Study Dimensions Methodology Aim To explore barriers to, & incentives for, transfer of opioid-dependent people from secondary to primary health care for MMT Survey using self-completion questionnaires Both quantitative & qualitative questions Setting Auckland New Zealand

Study Dimensions AMS specialist staff identified by AMS manager AMS clients deemed stable for transfer Identified by case managers using AMS indicators Auckland FPs authorised by AMS to prescribe MMT to patients Identified from AMS database MMT patients with authorised FPs Identified from AMS database Methodology Aim Participants & Participant Selection

Study Dimensions Methodology Aim Participants & Participant Selection Data Analysis Quantitative data: SPSS (V 12) Qualitative data: thematic analysis

Results - response rate AMS specialist staff with a caseload 85% response rate (17/20) AMS clients AMS est stable clients Denominator unknown 23 returned questionnaires Authorised Auckland FPs 74% response rate (77/104) MMT patients AMS est. 274 FP patients Denominator unknown 74 returned questionnaires

Barriers to transfer Attitudes of specialist staff 70% - Clients who transfer will receive inferior service 70% - Some ‘stable’ clients not ready to transfer 65% - Concerns about GPs’ attitudes towards MMT clients

Barriers to transfer Attitudes of specialist staff Attitudes of specialist clients 32% - Case manager not encouraging to transfer 52% ‘- Not very keen’ or ‘not keen at all’ to transfer 48% - Unlikely / very unlikely to transfer in next 6 months Only 9% (n=2) very likely

Barriers to transfer Attitudes of specialist staff Attitudes of specialist clients Cost to patient 71% FP – Patients cannot afford to go 69% FP – Patients have unpaid fees

Benefits to transfer Opinions of FP patients 82% - Able to get appointments at FP at times that suit me 76% - Less stigma attending FP than being AMS client 73% - FP care better – deal with all health needs

Strengths of study 4 simultaneous perspectives on 2 o to 1 o care transfer process Triangulation of quantitative & qualitative data Rich qualitative dataset High response rates from AMS staff & FPs

Limitations of study Small sample sizes Generalisations difficult  Lack of denominator figures for clients & patients (possible selection bias)  Focus on 1 region in NZ

Key findings Most MMT FP pts very satisfied with FP standard of care Barriers exist despite govt policy & training: Attitude that FP provides lower quality of care Funding issues Clients & pts unaware can return to 2 o care / receive specialist assistance if condition deteriorates Some trained willing FPs not receiving referrals

Recommendations 1.Treatment plan: incorporate progression 2 o to 1 o care at onset 2.Specialist services staff train/upskill in transfer process: reassure most pts happy about quality of care from trained authorised FPs 3.Specialist service emphasis on integrated transition period: help clients find local authorised FPs, accompany them on 1 st visit

Recommendations 4.Financial assistance: explore options for MMT clients who transfer including funding for FPs 5.Implement local transfer guidelines: for clients, specialists & FP staff to support safe, appropriate & best practice transfer

Thank you