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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR37

Exploring the potential for supervised methadone consumption and shared care contracts with drug misusers

By Jill Jesson, Keith Wilson, Anne Barton* and Rob Pocock

Introduction The drug misuse and dependence guidelines on clinical management1 (1999) marked an important policy development because it recognised that the pharmacist could be a partner in a shared care programme along with general medical practitioners (GPs) and community-based drug workers.
At the time of its publication, we were working with the Birmingham drug action team (DAT) and local pharmaceutical committee to generate information which would be used to develop community pharmacy services to drug misusers. There was little published data, although by 1999, 20 anonymised United Kingdom health authorities had been reported to be providing a pharmacy supervised methadone scheme (SMS).2 In 1999, the PSNC provided data listing 19 named authorities with this service.3

Method To identify interest and involvement in shared care, two surveys were undertaken in the Birmingham health authority area - one of 240 contracted community pharmacies and one of 323 registered medical practices. Questionnaire design drew on literature and on an advisory group consisting of two community pharmacists and one GP.
The two (different) self-completion postal questionnaires were piloted three times on colleagues and practitioners. To follow up results, eight pharmacists, six GPs and one community drug worker attended a half-day workshop.

Focal points

  • New Department of Health guidelines for shared care offer opportunities to community pharmacy
  • Very little was known about the size of the drug misusing population, or community pharmacy contribution in Birmingham
  • Surveys produced an estimate, close to 1,000 prescribed and dispensed methadone
  • There is a marked interest from both community pharmacy and medical practice in shared care arrangements
  • The major barriers to progress are different professional cultures, insufficient community drug workers, and dedicated funding

Results Response rates were 69 per cent (167/240) for the pharmacy survey and 52 per cent (168/323) for the medical practice survey.
In a typical month 81 per cent of responding pharmacists dispensed methadone for approximately 782 clients. Clients per pharmacy ranged from one to 24. Fourteen pharmacists had supervised a client taking methadone inside the pharmacy while 24 pharmacists had been asked to do so; 69 per cent of pharmacists were interested in supervised methadone consumption and 67 per cent in shared care arrangements with prescribers.
In the GP survey, 63 per cent of responding GPs had prescribed methadone in the previous six months to approximately 931 patients. Just under one in five GPs had asked a community pharmacist to supervise a client receiving methadone, and 20 per cent (40) already had an informal arrangement; 14 per cent (28) were very interested in developing a shared-care package with pharmacists.
The follow-up workshop identified differences in the professional and cultural attitudes of pharmacists and GPs to treatment of this client group, with pharmacists placing emphasis upon cure. Remuneration was a key issue for both professional groups.

Discussion The survey provided data on the size of the methadone problem in Birmingham and data which was not previously available on the extent of supervised methadone consumption and informal shared care agreements. Even in the absence of remuneration, pharmacists were providing these key services.
A majority of pharmacists were interested in developing both supervised methadone and formal shared care arrangements. Although a significant number of GPs were interested in shared care, the major barrier to greater GP involvement was lack of support from the community drug teams (CDTs) because of a shortage of trained workers. Key barriers for pharmacists and GPs were the differing professional cultures and attitudes towards treatment of the client group, the need for appropriate joint training, and adequate remuneration.
The study demonstrated immediate potential for community pharmacy to contribute to the care of drug misusers and, as a consequence, development of pharmacy services is being written into the DAT annual plan in Birmingham.

Aston pharmacy school, Aston university, Birmingham B4 7ET; *MEL Research, Aston Science Park Birmingham

References

1. Misuse and dependence - clinical guidelines on clinical management, London: Department of Health; 1999.
2. Cairns C, Hender J. Community pharmacy supervised methadone administration in the UK, London: Pharmacy Academic Practice, St George's Hospital London;1999.
3. Supervised methadone administration documents. Model bid for funding. Aylesbury: Pharmaceutical Services Negotiating Committee; 1999.