Community Pharmacy Service Development in Dumfries and Galloway
Explore the service development of the NHS.D&G.LAIB in Dumfries and Galloway, focusing on primary care and community pharmacy initiatives. Delve into funding timelines, staff details, and the impact on the local multidisciplinary team. Discover the approach to substance abuse treatment, qualitative and quantitative data on quality of life, and the overall patient experience under the LAIB program.
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Presentation Transcript
NHS D&G LAIB NHS D&G LAIB Service Development Service Development SDAS Primary Care Community Pharmacy
Dumfries and Galloway 55 SDAS staff in multidisciplinary team Rural area of 110 miles wide 2 main hubs: Dumfries and Stranraer 4 localities: A&E Nithsdale Stewartry Wigtownshire A&E: Annandale & Eskdale, SDAS: Specialist Drug and Alcohol Service
Funding timeline April 2021 Increased to 60 patients Nov 2021 Application: places/staff/HO licence Dec 2020 Pilot of 30 patients Priority to prison/AO/chaotic Jan 2022 Extra 200 places over 3 years/ 2 nurses/pharmacy tech Mar 2021 Increased to 50 patients Tactical priority: D&G ADP ADP: Alcohol and Drug Partnership, AO: Assertive Outreach, D&G: Dumfries and Galloway, HO: Home Office
January 2023 SDAS 182 on Buvidal and numbers increasing weekly. New Assessments first line treatment if suitable. Heroin/ Oral Opiates (Codeine/Oxycodone) Links to Prison and Primary Care- education Slight Increase in injectable Cocaine/Alcohol
Assessment spreadsheet Proving value Yearly report HB/ADP General health/ medication Domestic arrangement: housing/ children/ SW/ employment Current ORT Assessment Criminal justice system Alcohol use GP/ SDAS/ A&E engagem ent Illicit drug use ADP: Alcohol and Drug Partnership, A&E: accident and emergency, GP: general practitioner, HB: Health Board, ORT: opiate replacement therapy, SDAS: Specialist Drug and Alcohol Service, SW: social worker
Quantitative data WHOQOL-BREF 26 questions, 4 domain scores Physical health Psychological health Social and family relationships Environmental health 0-, 3-, 6-, 9- and 12-month scores Increase in all domain scores QOL: Quality of Life
Qualitative data Start What do you hope changing to LAIB will do? (e.g. employment, avoid pharmacy, more time with family) 3/6/9/12 months What difference has LAIB made to you? What has been the largest difference for you since changing to LAIB? Is LAIB treatment meeting your expectations and goals? If not, what had you hoped for from LAIB that hasn t been achieved? LAIB: long-acting injectable buprenorphine
Challenges/ Solutions/ Reflections Staff illness/ shortages Covid/ stress/ recruitment/ duty pressures Empower team/ good data rather than perfect data/ encourage data collection/ more spaces LAIB champions in SDAS team D&G rurality clinics in outlying towns Clinical lessons learned: LAIB flexibility dosage regimen Three-weekly then monthly steady state D&G: Dumfries and Galloway, LAIB: long-acting injectable buprenorphine
Primary Care Covid Impact SDAS / Primary Care Contact HB DRD Help to get stable patients GP Buvidal Application 1.6 nurse, 0.5 P Tech MAT Standard 7 Option MAT shared in PC/CP Free SDAS staff time chaotic/high risk Shared Care GP Practices 21/31 Patients in Region 150 SDAS: Specialist Drug and Alcohol Service, HB: Health Board, DRD: Drug-related Deaths , GP: general practitioner, P Tech: Pharmacy Technician, MAT: Medication Assisted Treatment, PC: Primary Care, Community Pharmacy
GP Reservations/ Issues Inexperience with Buprenorphine/Buvidal Consider it as Secondary Care in Primary Care Funding and Time Issues Benzo/Gabapentinoid Prescribing Room bookings in surgery Patient Stability GP worry 2nd injection
GP Problem Solving Education SDAS and Camurus Involving MDT in surgeries - delegation GP Champions Consultants/ NMP Staff GP Area Cluster Pilot Surgery experienced GPs roll out NMP: Non-Medical Prescribers, MDT: Multi-disciplinary Team
Shared Care Logistics Number of patients on Meth/ Oral Buprenorphine Number of clinics required for Buvidal Number of staff involved Current Methadone dose Micro induction time SC Team getting remote access to EMIS Prescription production for micro-dosing SC: Shared-care Team
Shared Care Logistics Suitability of Transfer initial contact Introduction and Explanation Review of Current ORT- Options Initial Appointment- Information Pack Micro-dosing/ frequency/ timings Weekly appts microdosing/ 3 weekly Buvidal Monthly x 2 Buvidal transfer Time investment SDAS appts/phone calls
Shared Care Uptake Uptake Dumfries/Annan size community differs Long time stabilised on methadone mature/no peer mixing Allay Fears and Myths Old Meth to Bup Transition difficult Withdrawal symptoms (48-72 hours) Rapid Withdrawal of Methadone to 30ml Pain Relief DHC/Co Cod 30/500 - Nefopam Unstability fear - weekly/fortnightly pick up
Problems/ Motivations Inaccurate Peer Info Successful Peers SDAS Suspicions New Strategies and Drugs Staggered start dates Uncertainty GP staff Driving Licences Social Work Involvement Reduced Pharmacy visits- stigma/dealers
Community Pharmacy Logistics Compile SLA (with help from Grampian) Contact D&G CPS and D&G HB agree finance Pick Test Pharmacies with Experienced Pharmacists- IP if possible SDAS and Camurus Training SDAS shadow injection technique 3 sign off Identify patients for transfer/liaise with CP Pharmacy offering flexibility of appt times SLA: Service Level Agreement, CPS: Community Pharmacy Scotland, IP: Independent Prescribers
