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Introduction UP TO DATE : U se of psychoactive substances in adults: P revention & T reatment by general practiti O ners and occupational physicians. DAT a retri E val Aim : providing an accurate view of the management of addiction in

  1. Introduction • UP TO DATE : U se of psychoactive substances in adults: P revention & T reatment by general practiti O ners and occupational physicians. DAT a retri E val • Aim : providing an accurate view of the management of addiction in Belgium, from the physicians' perspective, current collaboration between OPs and GPs and future policies. 1

  2. Workpackage: Qualitative research What are experiences, attitudes and decision making policies of GPs regarding to alcohol, illicit drugs, hypnotics and tranquilizers abuse from a physician’s perspective? 2

  3. Method • Research perspective: phenomenological • Researcher’s perspective: GPs • Sampling: typical cases for each of the substances (alcohol, illicit drugs, hypnotics and sedatives) • 20 Flemish and Walloon GPs 3

  4. Method • Analysis – two methods - Integrated model for change De Vries* - Thematic analysis to develop a survey De Vries H, Mudde A, Leijs I, et al. The European Smoking prevention Framework Approach (EFSA): an example of integral prevention. Health Education Research 2003; 18(5):611-26 4

  5. Method • Analysis – two methods - Integrated model for change De Vries - Thematic analysis to develop a survey 5

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  8. Predisposing factors Behavioural factors Personal experiences Psychological factors Former emotions 8

  9. Predisposing factors Behavioural factors Personal experiences in “I’ve lost some young patients with heroin practice addiction…I even went to their funeral… Own experiences with drug that has influenced me strongly until now… and alcohol abuse This has marked me for the rest of my life GP 6, M, 58 years I had a depression myself. I’ve learned Psychological factors a lot from that episode … I feel Personal emotions immediately, if someone has difficulties in her or his personal life… GP 3, F, 36 years 9

  10. Predisposing factors Behavioural factors “Maroccans use a lot of cannabis. Experience doctors The young men use much cocaine Own habits: alcohol…. but no heroin. Turkish young men use more heroin and Flemish youngsters misuse pills” Psychological factors GP 8, M, 40 y Bio logical factors Age and gender GP “In a fee for service system, it’s difficult to refuse… Patients ask only for a prescription….’Do I need to pay?’… Ethically it’s Social and cultural factors difficult… in a health care centre Practice organisation we can easily refuse to prescribe. Practice environment GP 9, F, 29 y 10

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  12. Information sources Message- content Knowledge on skills Support tools for practice Channel Practice: sharing medical records, team meetings Source Not enough guidelines, no patient leaflets 12

  13. Information sources “We only got a medical education and Message- content not on psychosocial skills,… to find Knowledge on skills solutions together with the Support tools for practice patient, that was not done…” GP 4, F, 49 y Channel “Problematic use of drugs, this always discussed on our weekly Practice: sharing medical records, practice meeting and than we make team meetings agreements: he (the patient) gets only prescriptions with that GP and the date is noticed in the patient’s Source record, so there is no discussion” GP 9, F, 29 y Not enough guidelines, no patient leaflets 13

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  15. Awareness factors Knowledge Definitions of abuse not important “ a young woman abused by her Cues to action partner… she got an alcoholaddiction Social dysfunction and was threaten to loose the care of her Alcohol smell little boy… this was a cue for action for Blood results me and a motivation for her” Patient or family asks for help GP 6, M, 58 y Risk perception “ Doctor-patient relationship is the Elderly people basis for everything. Certainly for School results substance abuse. It’s essential people Low socio-economic situation feel they can talk in an open Psychosocial problems confidential atmosphere. Stress in the workplace GP 2, M, 52 y 15

  16. Awareness factors Knowledge Definitions of abuse not important Cues to action Social dysfunction “More and more young people Alcohol smell misuse substances because of Blood results the stress on the job and fatigue Patient or family asks for help because of the children GP 3, F,36 y Risk perception Elderly people “I get annoyed at those elderly, taking School results sleeping pills, you can’t let them Low socio-economic situation stop…I think I will spend more time Psychosocial problems in adolescents misusing alcohol or Stress in the workplace drugs…because this could become a serious problem GP 10, F, 43 y 16

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  18. Motivational factors Attitude “The difference between hypnotics and Addiction as a disease alcohol and illicit drugs is, that I can Responsability maintain this problem and that makes Social influences you want to stop this faster because it’s To stop is not the norm part of your responsability… in contrary Percieved social pressure of alcohol and illicit drugs it’s their own patient and environment problem and you are the coach…” GP 4, F, 49 y Self-efficacy “As a young GP I found patients had to More exeperience stop and this is my responsibility as GP Frustration Now I realise that it is not my Anxiety to discuss problem responsibility … and I’m just here to No skills to handle these problems coach them and this is a more Comfortable position and I like it GP 3, F, 36 y 18

  19. Motivational factors Attitude Addiction as a disease Responsability “ I don’t find it so easy. It’s a kind of intimity, like talking about sex… it Social influences has something normative… how dare To stop is not the norm you to ask this? …. I project this on Percieved social pressure of my patient….maybe the patient patient and environment thinks ‘it’s a normal medical question” GP 2, M, 52 y Self-efficacy “ … I had to recognise these signals earlier. I’m also fatalistic: motivating More experience alcohol addicts … I never succeed and if Frustration patients did, it was certainly not because Anxiety to discuss problem of my merits but because of the patient’s No skills to handle these problems own resilience GP 6, M, 58 y 19

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  21. Intention state Precontemplation First contact difficult “The first step is to make it debatable. Good doctor-patient Let’s feel the patient that everything is relationship possible to discuss in a non-judging Looking at patient’s agenda way ‘I am here’, I’ m here to coach you, I’m your health advocate’. You Contemplation have chosen me and I have to take up Longer consultations this role. I bring it as a dilemma; I let Wrong decisions –patient leaves you free, it’s your choice and it has to practice be on your agenda GP 2, M, 52 y Preparation Referral Collaboration 21

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  23. Abilities Implementation plans Guidelines with patient material “ Continous professional Better prevention campaigns developement must cover the whole landscape of general practice. The society is in evolution. It’s a task for the GP to Performance skills develop expertise in addiction” Communication GP 10, F, 43 y Training “To be part of a team, building up Action plans experience, learning your own First line psychologists limitations, it’s a process Group practices: agreements 23

  24. Barriers Difficulties to refer to a psychologist “ We can’t send anybody to a psychologist that’s unpayable… if you go five times that’s 250 € and they don’t have tha money. If you go to a centre for psychological care you have to wait at least 3 months for an intake..” GP 4, F, 49 y Time consuming Lack of knowledge 24

  25. To discuss and to summarise Doctor as a person is not missing in the model but is overall in the model - Predisposing factors:Personal stories of change during the years - Psychological: own emotions, frustrations - Attitude: Open and confidential - Difference hypnotics and other substances - Responsibility of GP in hypnotics prescriptions - Coach with other substance abuse 25

  26. To discuss and to summarise • Patient as a person in his own context - Social context – work stress - Patient’s agenda - What’s acceptable for the patient? For the environment? • Doctor-patient relationship:cue to action 26

  27. To discuss and to summarise Education: not only knowledge on guidelines and models of motivational interviewing But make (future) GPs aware from their own influence as a human being in the doctor-patient relationship and especially in the case of treating these addicted patients 27

  28. Thanks from all these patients, for everyone of you,who takes care of them 28

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