Opioid Substitution Treatment in Christchurch

Transcription

1 Opioid Substitution Treatment in Christchurch Of CORS you can do it Leadership Day 20 November 2014 Dr Carmen Lowe, Clinical Head, Consultant Psychiatrist and Addiction Specialist Kaye Johnston Service Manager Speciality and Addiction Services, SMHS Marc Beecroft, Consumer Advisor

2 Systems of Care CDHB VISION Right Place Right Time Right Person Least restriction Lowest cost No waste of patient time

3 Specialist Mental Health Service Alignment Integrated community model Customer focus Accessibility Responsiveness Capacity building Effectiveness Efficiency Workforce adaptability Connectedness

4 Importance of partnership Model of Care Consumer centred and family/whanau focussed Models to build capacity and capability Efficient & effective utilisation of resources Principles of Choice and Partnership Role models to adapt

5 Work in Progress Proposal for Change Review based Steering and Action Groups

6 Structure of OST services in Christchurch Specialist 423 Consumers (24 On Suboxone) Enter Specialist service AFTER AOD assessment supported and linked into GP of choice, dose of OST stabilised including dispensing arrangements, case management, psychosocial interventions. Shared care (GP Authority) 163 consumers Transition to Shared Care GP looks after physical health and prescribing, Specialist service continues to monitor review support. Initially reviewed 3 monthly, then annually by Specialist Service. Pegasus GP Care 139 consumers Discharged from Specialist Service, assessed as stable long term, transferred to sole GP care with oversight by Pegasus GP Care Committee. *stats as at 30 June 2014

7 Demographics Specialist Service Age range years years years years 15 Gender Male 345 Female 241 Ethnicity NZ European 447 Maori 107 Pacific 11 Other 21

8 Trends in Demographics Increasing age of consumers receiving OST Increasing rates of medical co-morbidities resulting in significant impact on quality of life, morbidity and mortality Medical co-morbidities include Chronic Obstructive Lung Disease, cardiac complications, carcinomas, etc. High rates of psychiatric disorders

9 Staffing 15 FTE Case managers combination of nursing/social workers and 2 AOD counsellors 0.4 FTE Clinical Psychologist 0.45 Psychiatric Registrar 1.7 FTE Medical Officer 1.5 FTE Consultant Psychiatrist (inclusive of clinical head) Clinical Head oversees CADS/CORS/Kennedy 0.5 Clinical Manager 0.4 FTE Pukenga Atawhai Clinical Director, Service Manager and Nurse Consultant also oversee CADS/Kennedy/Eating Disorders/Mothers and Babies/Anxiety Disorders *change in Service Manager and Nurse Consultant mid 2014

10 Name of Service Not an outcome of the review, but required due to availability of alternative to methadone -was confusing for consumers and other services Now confirmed as: Christchurch Opioid Recovery Service

11 Workshop 2013 Development of Service Philosophy Our model of care facilitates client centred, recovery and well-being focused approaches to OST. We are responsive to the needs of clients, their whanau and our community, basing our practice of principles of Harm Reduction as outlines in the New Zealand Practice Guidelines for OST 2014

12 Acceptance Criteria Clients/tangata whai ora will be treated by the service if: The client/tangata whai ora has a Comprehensive/updated alcohol and drug assessment Opioids are the main drug of dependence The client/tangata whai ora has an opioid dependence as defined in DSM-IV or ICD-10 There is physical evidence of current use, e.g. track marks, needle sites, signs of intoxication or withdrawal, and a positive opioid drug screen OR The client/tangata whai ora has been abstinent in a controlled environment (e.g. prison); or had a brief attempt of abstinence, The client/tangata whai ora gives informed consent to OST Where other substance use is present, the client/tangata whai ora are willing to engage in a treatment plan to reduce the risks associated with their use and it is considered they will benefit from OST. There are no medical contraindications to OST The client/tangata whai ora has pharmacies that are agreeing to dispense which the service will help facilitate.

13 Priority admissions/access Pregnant women. People with serious co-existing medical and mental health problems. People arriving in New Zealand already established on OST programmes overseas. Clients/tangata whai ora who previously received OST within the last 6 months and who have been unable to maintain stability in the community.

14 Clinic vrs case management model Traditionally consumers booked into clinic appointment with MO and case manager, 15 minutes, focus on scripting Change to 1:1 focus with case manager, and review with medical officer as clinically indicated. If clients are not requiring regular review by MO or case manager, then consumer should be moving through to primary care as per MOH model.

15 Discharge Criteria - voluntary The Client/tangata whai ora will be discharged from the service by the clinical team following a planned withdrawal. Ideally this withdrawal is managed in consultation with their Case Manager and Medical Officer to minimise withdrawal symptoms *if clients wish to re-access OST, they have priority access for a 6 month time period after discharge, and can contact the service directly.

16 Involuntary withdrawal Involuntary cessation of OST should be a last resort, and decisions relating to termination of treatment should be initiated only after input from a number of other sources and after all attempts have been made to resolve influencing issues. The Client/tangata whai ora may be involuntarily withdrawn from the programme and discharged by the clinical team if: A client s pattern of frequent overdose or significant intoxication is so uncontrolled that opioid substitutes cannot be dispensed with sufficient safety A client threatens violence, or is violent towards staff, other clients, a prescriber or a pharmacist and in breach of CDHB zero tolerance to violence. ** A review of the circumstances associated with aggressive behaviour should always precede any decision to withdraw a client from OST).

17 A client repeatedly displays an inability to keep to the safety requirements of the OST provider which may include: -Repeated diversion of medication or loss of doses -Repeated lack of attendance at appointments -Repeated refusal to provide observed urine drug screens (or blood screens) as requested. The decision to withdraw the client/tangata whai ora from treatment is made following a formal review of treatment, consultation with the MDT and in alignment with Section Involuntary cessation of OST, New Zealand Practice Guidelines of Opioid Substitution Treatment 2014

18 Staff education programme/inservice Focus on developing philosophy, recovery model Consumer and family engagement and involvement

19 Challenges Staff shortages case managers currently covering multiple caseloads due to vacancies. Likely to continue until early 2015 when vacancies filled and new staff orientated. Lack of whanau room and meeting rooms since other services moved into workspace post earthquake.

20 The future Stream lining consumer pathway into CORS - Assessments undertaken by CORS resourcing, staff education and reconfiguration. Satellite clinics (not occurred since CHCH earthquakes and loss of venue) Peer support

21 Consumer input - Strong consumer team at the table of the Action Group all with OST experience - Treatment perception questionnaire developed good uptake from the service - Stronger consumer feedback mechanisms have been planned and implemented - Investigating peer support and further consumer input into the service