Drug misusers and their general practitioners : a survey of the views of drug misusers : training of general practitioners in the management of drug misuse
Objectives 1. To determine drug misusers' views about their primary health care and their relationship with general practitioners. 2. To undertake a controlled evaluation of small group education of general practitioners in the management of drug misusers. Method 1. Drug misusers attending five treatment services in north east London - a general practice with a special interest in managing drug misuse; a private drug clinic; a community drug team; a drug dependence unit and a street agency - were interviewed using a semi-structured interview and the Social Functioning Questionnaire. 2. All general practitioners who practised within the former North East Thames Regional Health Authority were approached to take part in small group teaching about drug misuse. This was conducted over two consecutive afternoons in a general practice, with four follow-up seminars. The trained doctors were compared with two groups of untrained general practitioners. Outcome measures included: Drug Training Questionnaire responses at the outset and 9 months after training; evaluation of the training appraised on a ten point Likert scale; Home Office Addicts Index and North Thames Regional Drug Misuse Database figures for notification of newly presenting subjects, for each of the three groups of general practitioners, 8 months prior to training and 8 and 16 months after training. Results Ninety percent of the drug misusers were registered with a non-specialist general practitioner and 88% of these doctors were aware of their patients' drug use. Half of the non-specialist general practitioners aware of their patient's drug use were reported as prescribing substitute medication. Sixty percent of misusers attending the non-specialist doctors perceived their general practitioners to hold negative or neutral views about them. Doctors in the specialist general practice were more likely to prescribe, compared to the other four centres, and 97% of their patients believed these doctors had a positive view of drug misusers. The specialist general practice was more active in providing counselling and/or education about drug misuse. 2. Forty doctors attended the teaching programme. Twenty-eight doctors comprised comparison group one (interested but unable to attend the teaching) and 30 formed comparison group two(not interested in training but completed questionnaires). The about to be trained group were seeing and treating more drug misusers compared to the comparison groups. The overall ratings for the teaching programme were high (7.9 for usefulness and 8.0 for interest - maximum score 10). Doctors in the trained group were found to be notifying significantly more drug misusers to the Home Office and prescribing methadone more frequent1y 16 months after the teaching, than doctors in the comparison groups. Over 9 months, the Drug Training Questionnaires demonstrated no significant changes. The cost of the course per doctor was £127. Conclusions 1. The majority of drug misusers attending treatment centres are registered with general practitioners and regarded them as an important health resource in managing both their drug use and wider medical issues, despite the reluctance of non-specialist general practitioners to be involved in prescribing and a high prevalence of unfavourable attitudes towards drug misusers. 2. The participating doctors assessed the teaching programme positively and it was relatively cheap to run. The self-report questionnaires as a single determinant of outcome revealed no significant change in attitudes, knowledge or behaviour but when assessed by more objective means, demonstrated a rise in notification rates and methadone prescribing by the trained doctors.