Pharmacotherapy Advocacy Mediation & Support phone service
The work that PAMS undertakes with people who want to access or remain engaged with opioid pharmacotherapy has never been under as much pressure as it has in the past year or more.
As Sione mentioned in his report; the running crises in the opioid pharmacotherapy program in Victoria mean that we could run almost 24-7 and still not catch up.
We average around 77 cases per month and this took us to 929 cases last year.
This is only part of the story though.
The outcomes we seek for our community include:
Finding prescribers and chemists
negotiating plans with providers
financial assistance sourcing
information provision
negotiating repayment plans to retain treatment access and more
"The main reason for the pressure on PAMS however is a shortage of GPs in the community willing to prescribe opioid pharmacotherapy. Because most of our work is related to some kind of issue involving accessing a prescriber, this has a major effect on our work. "
Last year 646 cases out of 929 – or 70% - were related to issues accessing a prescriber.
PRIMARY ISSUE | NUMBER OF CASES | % of TOTAL FOR FY |
GP Retired/Moved On | 109 | 11.7% |
Payment/Debt Management | 195 | 21% |
Program Terminated | 55 | 5.9% |
Transfers | 55 | 5.9% |
Trouble; Distance- GP | 56 | 6% |
Trouble; Sourcing- Both GP/Disp | 114 | 12.3% |
Trouble; Sourcing GP | 62 | 6.7% |
TOTAL NUMBER | 646 | 69.5% |
The reasons for this shortage include:
Many are actively retiring.
Impact of COVID-19 & burnout
Regulatory issues
Little interest in opioid pharmacotherapy amongst new prescribers
Impact of stigma and discrimination on service providers
As fewer and fewer prescribers are needing to support more and more people,
we see more and more impacts on consumers.
These include:
becoming extremely difficult to access high quality, timely treatment
difficult for consumers to source new prescriber if they move from one area to the next
consumers are forced to put up with any standard of care as there is nowhere else to go
treatment is costing the consumer more than it has previously
"The combination of these issues means that each case is taking longer and longer to work through. The average number of follow-up calls that are required have risen from 7.7 per case (19-20) to 9.5 per case (21-22) in the last few years. This is an increase in workload of around 20%. In some cases, we may not find a prescriber for someone in the area they live or even within travelling distance."
Cost of Program
The cost of dosing fees in community pharmacy continues to be a key issue for the consumer group to the point some are forced to access one-off financial assistance in order to remain on program.
Added to this are more and more GP clinics that are no longer bulk-billing or requesting part payment and the cost of medical care is becoming a barrier to access for many consumers.
Medication types
The majority of PAMS Service Users are on or wanting to access methadone.
Seconded by Buprenorphine / Naloxone (Suboxone).
The number of people either prescribed or wanting to start/re-start methadone is slowly diminishing.
We are not sure whether this is by choice or by a change in prescribing practice.
The Long-Acting Injectable Buprenorphine(LAIB) products are slowly increasing in usage with growing number of people interested in this treatment type -
Almost 10% of PAMS Service users are either wanting to access or are already prescribed Buvidal or Sublocade.
While it works for some people and not needing to attend daily dosing is a bonus, there are some issues.
For example;
Travel is difficult for people needing to have injections administered in other parts of Victoria or Australia
Difficulty sourcing new prescribers (‘in time for the next injection’) for patients whose prescriber retires or ceases prescribing
Can cause problems for some needing to find community-based prescriber when released from prison
More pharmacies need to take on dose administration of this product, as finding somewhere to dose in this way is a major barrier for consumers
PAMS Data Project
We have developed, with support from the Victorian Department of Health, a data project that will help us plan for unforeseen crises and circumstances more effectively.
Once implemented, PAMS, the Department of Health and the Pharmacotherapy Area-Based Networks will be able to have a better understanding of the resources across the state that we can call on.
Corrective Services
There are ongoing issues that we saw last year within the Corrective Services sector:
Lack of access to support and advocacy for consumers incarcerated
People released dependent on illicitly acquired Bupe/Naloxone (Suboxone) from within the prison system
Unplanned release – extremely difficult for prisons released directly from the courts with no prescriber and/or dosing point
Staffing and Funding for PAMS
As Sione mentioned in his report we lost and gained a number of team members across the last year or so. Daniel Ward took leave and we look forward to welcoming them back soon! We also gained Amelia Berg and Jimmy Harrington. We said 'Bon Voyage' to Leora Robertson who was with us for many years and was a mainstay of the PAMS program and HRVic as a whole. Thank you for the more than a decade worth of service Leora! We wish you lots of adventures and health in your retirement.
PAMS Outcomes for our community include:
PRIMARY OUTCOME | NUMBER OF CASES |
Changed both GP and Pharmacy | 98 |
Changed GP | 216 |
Changed Pharmacy | 71 |
GP Appointment made | 26 |
Information provision | 85 |
Negotiated payment plan or repayment contract | 4 |
Negotiated script issue | 25 |
Negotiated treatment plan | 14 |
PAMS financial assistance | 163 |
Sourced ORT - both Prescriber & Pharmacy | 32 |
Sourced ORT Service Provider (Pharmacy) | 20 |
Sourced ORT Service Provider (Prescriber) | 25 |
Transfer arranged - interstate | 39 |
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