1. Drug and Alcohol Clinical Services

2. Historical Issues Pre drug summit Low resourcing, Nil funding in Tamworth area and LMNC Minimal interface with public / private sector Low support levels for GP/ Pharmacy Limited or nil capacity to engage private prescribers clients in case management. Minimal infrastructure / It. Methadone only Lengthy waiting lists Drug & Alcohol Clinical Services

5. 90 pharmacies 219 GP clients case managed State average is 2/3 prescribed by private prescriber Different pharmacotherapies Uptake by GPS and pharmacies plateaued Demand for service consistent Now Drug & Alcohol Clinical Services

6. Models of service delivery Tamworth and surrounding northern area well integrated community based services public clinic brief stabilisation. public hospitals Remote prescribing (videoconferencing) Drug & Alcohol Clinical Services

7. Models of service delivery LMNC public clinic stabilisation majority of clients private prescribers / community pharmacies Drug & Alcohol Clinical Services

8. Models of service delivery Newcastle / Cessnock public clinic – stabilisation transfer to community Significant support to community based program Drug & Alcohol Clinical Services

9. Increased propensity to engage, maintain, retain private sector. Facilitate transfer in & out of clinics from private sector. Solidifies the role of public/private sector. Supports private sector. Pro-active approach to issues and client management. Benefits of Outreach Drug & Alcohol Clinical Services

10. Keeps community happy. Reduces number of adverse events in community Coordinates holiday pharmacy closure Facilitates TT of clients Benefits of Outreach (Cont) Drug & Alcohol Clinical Services

11. Review of pharmacotherapy services – March to May 2008. Recommendation - redesign & coordinate outreach across southern sector Working group Identify clients to be fast-tracked to GP / community pharmacy sector Match clients to pharmacies / GPs Recruitment of new GPs / pharmacies Drug & Alcohol Clinical Services 2008

12. Restructure of Clinics Changing client expectations on admission Induction and short term stabilisation Meet criteria for take-a-ways transfer to community pharmacy Stable transfers straight to pharmacy Linking with GPs Drug & Alcohol Clinical Services

13. Transfer back to clinic setting for re- stabilisation Swap problematic clients with GPs for stable clients Multiservice delivery of care Restructure of Clinics (Cont) Drug & Alcohol Clinical Services

14. Aim Place clients within 5km radius of LGA with GP prescriber & local pharmacy Normalise service delivery Improve links with GP, pharmacies & HNE Framework – Holistic proactive shared care & early referral Drug & Alcohol Clinical Services

15. Rationale General practice & pharmacies are an integral part of the health system GP’s will see 80% of the population in one year. Provide continuity of care Seen as a credible source of health information. May be the first to identify a drug and alcohol problem. Drug & Alcohol Clinical Services

16. Are ideally placed to intervene. Brief interventions are well suited to the general practice setting. Pharmacotherapy, detoxification and brief counselling can be provided by General Practitioners. (NSW Health General Practice Policy 2002) Drug & Alcohol Clinical Services Rationale (Cont)

17. Barriers Lack of confidence Low level of knowledge and skills Misconceptions They do not have a legitimate role Lack of support Lack of resource material Lack of time Negative attitudes Drug & Alcohol Clinical Services

18. How can these barriers be addressed? Providing training, resource material & information Ready access to expert consultation Ease of referral & access to services DACS contribution to shared care patient management for complex clients. Drug & Alcohol Clinical Services

19. Ensure internal process are in place that will recognize & support GPs, pharmacists Work force in-tune with the context in which GPs / pharmacists work & relate in a professional manner How can these barriers be addressed? (Cont) Drug & Alcohol Clinical Services

20. Risks If we don’t deliver on what we promise Run the risk of creating a negative impression of DACS from which we may have difficulty recovering GPS / pharmacists remain under confident, lacking skills. Stereo-types, misconceptions and negative attitudes of clients and services will persist Drug & Alcohol Clinical Services

21. Opportunities Work with DGP to train practice nurses Increased numbers of GP’s with decreased client numbers-mainstreaming Increased video / teleconferencing reviews to support staff / GPS in remote areas Promote newer pharmacotherapies where possible Drug & Alcohol Clinical Services

22. Unstable clients transferred back to clinic for 6-12 weeks. GPs can exchange unstable clients for stable clients. Outreach staff participate in EPC for complex clients. Staff Specialists and VMOs offer mentoring and facilitate Small Learning Groups. Ready access to advice and support as needed Drug & Alcohol Clinical Services Outreach

23. Changes to the way we work Designated team with one NUM to coordinate delivery of outreach & monitor waiting list Clients given assessment appointment within 5 working days Case worker maintains regular contact with dosing pharmacy / GP Ideally Prescriber is client’s GP Service delivery driven by GP Drug & Alcohol Clinical Services

24. Changes to the way we work Case management only of clients in need of intervention – coordinated with visit for script Appointments coordinated through GP practice staff Pharmacist input into client review Assistance with co-ordination of care during pharmacy closures if required Personalised approach builds rapport Drug & Alcohol Clinical Services

25. Client requirements Linking with GP & other services in LGA Pathways & co-ordination to services Encouraging family GP to engage in pharmacotherapy prescribing – EPC Pharmacies actively participating in financial management of treatment cost Drug & Alcohol Clinical Services

26. Safety net to return to clinic short-term for financial respite & more intensive case management Improving & encouraging autonomy Discharge planning & after care support Client requirements Drug & Alcohol Clinical Services