Literature Collection

OBJECTIVE: To assess whether patients receiving opioid substitution therapy (OST) in general practice cause other patients sufficient distress to change practices--a perceived barrier that prevents general practitioners from prescribing OST. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional questionnaire-based survey of consecutive adult patients in the waiting rooms of a network of research general practices in New South Wales during August-December 2009. MAIN OUTCOME MEASURES: Prevalence of disturbing waiting room experiences where drug intoxication was considered a factor, discomfort about sharing the waiting room with patients being treated for drug addiction, and likelihood of changing practices if the practice provided specialised care for patients with opiate addiction. RESULTS: From 15 practices (eight OST-prescribing), 1138 of 1449 invited patients completed questionnaires (response rate, 78.5%). A disturbing experience in any waiting room at any time was reported by 18.0% of respondents (203/1130), with only 3.1% (35/1128) reporting that drug intoxication was a contributing factor. However, 39.3% of respondents (424/1080) would feel uncomfortable sharing the waiting room with someone being treated for drug addiction. Respondents were largely unaware of the OST-prescribing status of the practice (12.1% of patients attending OST-prescribing practices [70/579] correctly reported this). Only 15.9% of respondents (165/1037) reported being likely to change practices if theirs provided specialised care for opiate-addicted patients. In contrast, 28.7% (302/1053) were likely to change practices if consistently kept waiting more than 30 minutes, and 26.6% (275/1033) would likely do so if consultation fees increased by $10. CONCLUSIONS: Despite the frequency of stigmatising attitudes towards patients requiring treatment for drug addiction, GPs' concerns that prescribing OST in their practices would have a negative impact on other patients' waiting room experiences or on retention of patients seem to be unfounded.

Low-income women experience disproportionately high rates of adverse maternal mental health outcomes, such as pregnancy-related depression, and have less access to behavioral health support. Adverse maternal mental health affects children through compromising bonding, impeding early childhood development, and increasing risks of child maltreatment. Integrated behavioral health approaches can improve access to behavioral health services by locating services in community-based settings routinely accessed by low-income families. Warm Connections is an innovative integrated behavioral health program delivered in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and rooted in an infant and early childhood mental health (IECMH) framework. This exploratory study describes Warm Connections and provides evaluation results from its pilot implementation. Findings suggest Warm Connections may reduce distress and increase parenting efficacy among low-income mothers and support further research of this program's feasibility.

OBJECTIVE(S): To assess the impact of a regional General Practitioner Psychiatry Phone Line (GPPPL), embedded in a public Community Mental Health service (CMHS) on the wider health service's workflow and systemic outcomes. DESIGN: Non-controlled population-based interventional study. SETTING: Public CMHS in the Great Southern region of Western Australia (WA). PARTICIPANTS: Aggregated monthly data on (i) referrals to the CMHS (July 2017-March 2022), and (ii) Emergency Department presentations (July 2017-May 2022) were obtained from the West Australian Country Health Service. INTERVENTION: Introduction of a regional GPPPL, for local publicly employed psychiatrists to provide specialist mental health care advice to General Practitioners working in the same region. MAIN OUTCOME MEASURES: Service input: Number of calls to the GPPPL, call duration and frequency. Service output: Rate of referrals to the CMHS, and rate of Emergency Department presentations related to mental health issues, and alcohol and other drugs. RESULTS: The number of weekly calls to the GPPPL decreased (slope -0.13, 95% CI -0.17, -0.08; p < 0.0001) over the course of the one-year pilot. The referral rate to CMHS was approximately 70.5 referrals per 1000 person-years in July 2017, and quite steady pre-GPPPL (p = 0.9283), then reduced significantly post-GPPPL, by 1.7 (95% CI 0.14, 3.26; p = 0.0372) referrals per 1000 person-years each month. CONCLUSIONS: This study has demonstrated the GPPPL's effectiveness in reducing the referral rates to CMHS and its self-sustainability. The psychiatrists involved were able to continue full-time public service roles while running the phoneline, with a decreasing time demand over the one-year pilot.