Success of GP-led AOD program shown in report

Morgan Liotta

3/03/2023 3:35:26 PM

The RACGP’s alcohol and other drugs education program has received a ringing endorsement.

Patient talking to GP
Around 10% of Australia’s full-time equivalent GPs completed the RACGP program, shown to reduce common barriers to AOD care and treatments, while increasing confidence in providing this care.

An assessment of the RACGP’s Alcohol and Other Drugs (AOD) GP Education Program has demonstrated how the training successfully enhanced participants’ skills.
According to the program’s newly published final report, between 86–99% of GPs across the different training pathways said the training met their needs, with participants described as being ‘highly engaged’ throughout.
With funding from the Department of Health and Aged Care (DoH), the RACGP developed and delivered the training package between 2020–22 to strengthen GPs’ capacity to address AOD harm and addiction in their community.
The training, which faced additional operating challenges during pandemic restrictions, included face-to-face workshops, online webinars, and options for further professional development schemes.
The program’s final report details the successes and GP participants’ satisfaction with the program, along with their experiences and outcomes.
Almost all reported that the program met their needs, and that the content and materials were highly relevant to their clinical practice – a testament to the ‘by GPs for GPs’ approach.
Dr Paul Grinzi is a GP with a special interest in addiction medicine, as well as a medical educator on the program and co-author of the final report. He told newsGP he believes there are several reasons for the program’s success.
‘Australian GPs engaged really strongly with the program’s education offerings, from weekly community-of-practice peer support meetings, online courses and webinars, through to the very popular AOD Live [Treatment Skills pathway] peer-learning online class format,’ he said.
‘The content and design were led by GPs who understood the challenges of accessing high-quality professional development, especially with regard to AOD.
‘The program was designed to address AOD educational needs of all GPs, from fundamental “essential skills” through to bespoke “advanced skills” opportunities.’
In addition, Dr Grinzi said that the COVID pandemic ‘created a necessity’ to ensure the program could continue online, which increased its capacity to reach more GPs, particularly those who felt more isolated and vulnerable due to geography.
Structured around five main training pathways, the program offered a range of training levels and modes of delivery:

  • Essential Skills, Treatment Skills and Advanced Skills Training – offered AOD training complexity depending on the GPs’ level of need or skill
  • AOD Connect: Project ECHO – an online community-of-practice forum where GPs connect with colleagues, practice skills, discuss cases, and seek support from peers and AOD experts
  • Higher Risk Groups – provided training around common factors that may lead to increased risk of harms associated with a patient’s substance use, including people who have experienced trauma and those in contact with the criminal justice system.
Overall, 3042 GPs completed the training across the various pathways, representing 10% of full-time equivalent GPs in Australia and triple the DoH’s target number of GPs completing the program.
Across all program pathways, there were more female participants (56%) and more from metropolitan areas compared to regional/rural/remote areas. Participants comprised a mix of Australian GPs and international medical graduates (49%).
Underlining the fact that GPs see ‘a lot of patients affected by AOD’, Dr Grinzi says the program builds on the number of ways to help these patients within the community. 
‘We need not work alone when assisting our patients,’ he said.
‘The AOD Program’s “whole-of-practice” package allows for the whole clinic to upskill in caring for our patients, including reception staff, nurses, and practice managers. 
‘AOD health issues are often chronic and comorbid, with many other conditions we see on a daily basis. GPs are experts in navigating this complexity, and developing skills in AOD can only add to our ability to care for our communities.’
Program participants established learning priorities as part of their personal learning plans within the program, with the top three documented as:
  • deliver a GP-led planned withdrawal from alcohol use disorder
  • prescribe medication-assisted treatment for opioid use disorder
  • use motivational interviewing techniques.
The report reveals that the program improved awareness and understanding of GP-led, whole-person AOD care, and access to related resources. It also increased GPs’ confidence to manage patients using a variety of commonly used substances, such as alcohol, opioids, cannabis and benzodiazepines. The most significant increases in confidence were seen with the treatment of patients using stimulants, heroin and/or illicit/diverted prescribed opioids.
The program evaluation also found it increased GP knowledge, skills and self-efficacy, and reduced patient stigmatisation, demonstrating that the program reduced common barriers to GP-led AOD care and treatments.
Dr-Paul-Grinzi-article.jpg‘GPs are experts in navigating the complexity of AOD, and developing skills in this area can only add to our ability to care for our communities,’ says program medical educator Dr Paul Grinzi.

Increased confidence using the 5As framework post-training to facilitate behavioural change was cited among all participants, including across each component of the 5As – to ‘ask’, ‘assess’, ‘advise’, ‘assist’ and ‘arrange’ – with the most significant increase occurring in confidence to ‘assist’ patients.
Dr Grinzi said the 5As framework is familiar to GPs and works well within the constraints of general practice’s time and resource pressures.
‘Each step of the 5As has something for the GP to consider with their patients, regardless of the stage of change the patient is in,’ he said.
‘For me, one key aspect is integrating the “ask” part, a permission-based inquiry, with a framing of genuine curiosity going a long way in developing the therapeutic alliance that allows the remaining “As” to fall into place.’ 
Through better empowering GPs to lead AOD care and arming them with confidence to provide ongoing community and team-based care to support people impacted by AOD use, the RACGP believes the program is ‘likely to have a long-lasting impact’ on Australia.
Dr Grinzi agrees, and points to a key priority of the program to ensure ‘a practical and broad-based suite of resources’, which was created by GPs for GPs to ‘tap into at any time’. 
The RACGP’s education resource library provides access to over 200 AOD resources and whole-of-practice resources for GPs’ CPD, including online training modules still available from the program, as well as the program’s final report. The complete library is available on the RACGP website.
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