Shared Care Pharmacotherapy Management of Alcohol Dependence Project SCAP

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Shared Care Pharmacotherapy Management of Alcohol
Dependence ProjectSCAP

• Dr Martyn Lloyd-Jones
• Sharyn Amos
• Dept of Addiction Medicine
• St Vincents Hospital

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Participants

• Turning Point Adrian Dunlop, Nico Clark
• Monash Medical Centre Nico Clark, Matthew Frei
• Dandenong Hospital Nico Clark
• South Eastern Drug and Alcohol Services
• St Vincents Hospital Martyn Lloyd-Jones, Sharyn
  Amos
• Depaul House

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Background

• Alcohol abuse is a significant health and social
  problem in Australia
• Social cost of alcohol abuse in 1998-9 est at
  7.56 billion (Collins and Lapsley, 2002)
• In 1998 3000 people died as the result of
  harmful/hazardous alcohol consumption (21,000
  life years lost)
• In 1997-8 over 71,000 hospital separations were
  related to alcohol (Ridolfo and Stephenson, 2001)

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• 1997 Mental health and wellbeing survey suggested
  that 5.1 of males (Andrews, Hall et al. 1999)
  and 9.3 of young adults were alcohol dependence
  (Degenhardt, Hall et al. 2000)
• In Victoria alone it is estimated that between
  142,800 and 351,400 people drink alcohol at
  problematic/harmful levels (Ritter et al. 2003)
• National Alcohol Strategy June 2003 about 10 of
  Australians consume alcohol at risky/high-risk
  levels and the prevalence of alcohol use
  disorders was estimated at 6.1 of the population

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More importantly

• Of the 142,800 patients in Victoria with harmful
  alcohol use only 9100 were receiving treatment
  (Turning Point 2004) despite evidence that
  treatment can significantly reduce health (and
  other) costs (Holder, Cisler et al. 2000).
  Estimated that only 2.6-6.4 of
  problematic/harmful drinkers in Victoria receive
  treatment from the specialist treatment sector
  (Ritter et al. 2003)

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Why is this?

• HIC data indicate that lt1 of all eligible
  patients have been prescribed naltrexone/acamprosa
  te (HIC, 2004)
• Lack of skills/competency (Sandlow and Dos
  Santos, 1997)
• Time constraints (Holmwood, 2002)
• Reluctance on behalf of practitioners to
  prescribe despite knowledge (Mark, Kranzler et
  al. 2003)

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opportunities

• Over 80 of Australians visit a GP at least once
  per year
• The Primary Care environment is ideal for
  providing non-judgemental interventions (Slama,
  Redman et al. 1990)
• GPs are a credible source of advice (Moore,
  Makkai et al. 1989, Pols and Hawks, 1992)

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Aims of project

• Establish a network of GPs willing to see and
  treat these patients
• Identify patients presenting to hospital
• Offer anti-craving to all eligible patients
• Provide (brief) intervention whilst in-patient
• Link with GP
• Provide support to GP (shared-care, education
  sessions, mentorship, attendance at out-patient
  clinics, telephone support etc)
• Possible role for limited case-management
• Evaluation and follow-up

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in order to

• improve the treatment outcomes for the patient
• increase GPs understanding and treatment of
  alcohol dependent patients

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Period from Sept 06 Jan 07
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General Practitioners
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Referral Source to project
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Patients commenced on anti- craving medication
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Current update on project

• Patient evaluation has been occurring
• G.P. evaluation has been occurring
• Establishment of specific database
• Establishment of preadmission response

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