Collaborative prescribing within the opioid substitution treatment program in South Australia.

Abstract

In Australia, the demand for prescribers to service opioid substitution treatment (OST) patients exceeds the interest of general practitioners in fulfilling this prescribing role. One response to meet unmet prescribing demands which has been introduced internationally is the use of pharmacist prescribing for a range of chronic medical conditions, including for OST. In this thesis, I explore a policy proposal for pharmacists to prescribe OST collaboratively (co-prescribing) with doctors. To examine this policy and its implications, I collected data from three sources: face-to-face interviews with 14 OST patients, three focus group interviews with 18 South Australian pharmacists and a study tour of pharmacist prescribing in Alberta, Canada and California, USA. A total of 28 key informants were met with during the study tour. This included people based in a range of research/academic units (5), policy/governance bodies (3), clinical sites where pharmacist prescribing was practised (12) and sites which provided an understanding of the health care system (8). My key findings are as follows. First, OST patients had varied experiences with the existing model of care. They reported varying levels of treatment access, varied degrees of pharmacist supervision and a lack of continuity of care from clinic doctors. They also displayed a range of attitudes toward the need for privacy. Although most patients valued privacy to some degree, not all did: indeed, the same layout was experienced and perceived differently by different patients. Second, the current model of OST care draws on a prescription approach to pharmacy practice, whereas co-prescribing is more aligned with patient-centred care. Under the current model of care, pharmacists are limited in their ability to actively respond to OST patient needs because their activities are primarily focused on the prescription directions. In contrast, pharmacist co-prescribing can deliver aspects of patient-centred care that cannot be provided as effectively through conventional care. It offers flexibility for the pharmacist to respond to the patient’s needs. This includes enhanced patient participation in treatment decisions, access to treatment and respect/privacy. Co-prescribing also offers continuity of treatment care due to the therapeutic relationship which already exists between a pharmacist and a patient from supervised dosing. Third, the experience of Albertan and Californian pharmacist prescribers suggests that it should be possible for Australian pharmacists to pursue similar responsibilities. These roles are possible in both hospital and community pharmacy settings, provided key facilitators are addressed. My research acknowledges that there are various challenges for pharmacist prescribing. However, the perspectives of the patients and pharmacists in my study, in conjunction with insights from Alberta and California, can be used to formulate a strategy for collaborative prescribing for OST patients in South Australia.