There is 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.
The aim of this study was to explore the barriers to, and incentives for, the transfer of opioid-dependent people from secondary to primary health care for their MMT within the greater Auckland region.
Methodology
The project was conducted by the Goodfellow Unit, The University of Auckland and the Auckland Methadone Service (AMS), Waitemata District Health Board. The four groups of participants were: AMS clients deemed stable for transfer by their case managers; AMS specialist staff; MMT patients with authorised general practitioners (GPs) in the Auckland region and Auckland GPs authorised by the AMS to prescribe MMT to patients. Self-completion questionnaires were distributed to each group, and included both quantitative and qualitative questions.
Key Results
1. Despite governmental policy to transfer stabilised MMT patients from secondary to primary health care, and the training of a primary health care workforce (GPs, practice nurses (PNs) and community pharmacists) there are significant barriers to patient transfer.
2. Funding issues contribute to discouragement of growth of GP prescribing and client willingness to attend. Capped funding limits new untreated clients entering the specialist service when a client transfers to primary health care.
3. Both AMS clients and GP patients may not be aware that patients under GP care for MMT can return to secondary care or receive specialist assistance if their condition deteriorates.
4. Some specialist service staff and AMS clients consider transfer to an authorised GP may result in lower quality of care. However most MMT GP patient respondents were very satisfied with the standard of care provided by their authorised GP.