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Waiting room ambience and provision of opioid substitution therapy in general practice

Simon M Holliday, Parker J Magin, Janet S Dunbabin, Ben D Ewald, Julie-Marie Henry, Susan M Goode, Fran A Baker and Adrian J Dunlop
Med J Aust 2012; 196 (6): 391-394. || doi: 10.5694/mja11.11338

Summary

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.

  • Simon M Holliday1,2
  • Parker J Magin3
  • Janet S Dunbabin3
  • Ben D Ewald4
  • Julie-Marie Henry1
  • Susan M Goode3
  • Fran A Baker5
  • Adrian J Dunlop2

  • 1 Albert Street Medical Centre, Taree, NSW.
  • 2 Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW.
  • 3 Discipline of General Practice, University of Newcastle, Newcastle, NSW.
  • 4 Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, NSW.
  • 5 Clinical Research Design, IT and Statistical Support, Hunter Medical Research Institute, Newcastle, NSW.

Correspondence: simon@nunet.com.au

Acknowledgements: 

This study was funded by the NSW Health Drug and Alcohol Research Grants Program. We thank the patients who so willingly participated, and the staff of both the general practices and the now sadly unfunded Primary Health Care Research Evaluation and Development (PHCRED) program of the University of Newcastle.

Competing interests:

In 2010, Reckitt Benckiser, which holds the global licence for buprenorphine and buprenorphine naloxone (Subutex and Suboxone), both used in the treatment of opioid dependence, provided research funding to the Drug and Alcohol Clinical Services of Hunter New England Local Health District, which employs Adrian Dunlop full-time and Simon Holliday part-time.

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