Regulatory responses to over-the-counter codeine analgesic misuse in Australia, New Zealand and the United Kingdom.

OBJECTIVE: Analysis of the policy response by Australia's National Drugs and Poisons Schedule Committee (NDPSC) and comparison with recommendations by expert advisory committees in New Zealand and the United Kingdom. METHODS: Analysis of public policy documents of relevant regulatory authorities was conducted. Data were extracted regarding changes to over-the-counter (OTC) codeine analgesic scheduling, indications, maximum unit dose, maximum daily dose, maximum pack size, warning labels, consumer medicine information and advertising. Where available, public submissions and other issues considered by the committees and rationale for their recommendations were recorded and thematically analysed. RESULTS: Expert advisory committees in Australia, NZ and the UK defined the policy problem of OTC codeine misuse and harm as small relative to total use and responded by restricting availability. Pharmacist supervision was required at the point-of-sale and pack sizes were reduced to short-term use. CONCLUSIONS: Comparison with recommendations by expert advisory committees in NZ and the UK suggests the NDPSC's actions in response to OTC codeine misuse were appropriate given the available evidence of misuse and harm, but highlights opportunities to utilise additional regulatory levers. IMPLICATIONS: Framing policy problems as matters of public health in the context of limited evidence may support decision makers to implement cautionary incremental policy change.

Over-the-counter codeine analgesic misuse and harm: characteristics of cases in Australia and New Zealand.

AIM: To describe the characteristics of clients addicted to over-the-counter (OTC) codeine analgesics presenting to an Auckland open-access clinic, and to compare them to clients admitted to a New Zealand detoxification unit, and in the Australian community. METHOD: Cross-sectional study of clients presenting to a regional, open-access detoxification clinic covering the Greater Auckland area between 1 January and 31 March 2010. RESULTS: Fifteen clients were analysed, and compared to 77 similar clients identified in Victoria and five other Australian States, and 7 clients admitted to a New Zealand detoxification unit. Cases in each cohort were consistent with those in the published literature, and appear to be similar to each other both demographically and in terms of the high average tablets consumption (49-65 tablets per day), the serious non-steroidal anti-inflammatory drug (NSAID) adverse drug reactions identified, and the long duration of misuse. Many had a history of alcohol or other drug use and mental health disorder. CONCLUSIONS: This study has identified that controls on OTC codeine analgesics in both countries were not sufficient to limit non-medical use of these products. As a result, cases identified in these two countries escalated the number of self-administered tablets taken daily for misuse, resulting in codeine dependence and serious NSAID toxicity secondary to this dependence.

Addiction and addiction medicine: exploring opportunities for the general practitioner.

Addiction medicine deals with problems arising from the use of psychoactive substances, and encompasses the disciplines of general practice and primary care, psychiatry, psychology, internal medicine, public health, pharmacology and sociology. Addiction is a chronic, relapsing illness that is difficult to cure. There are now effective, evidence-based interventions for the prevention and treatment of substance misuse disorders. Harm minimisation and treatment are more cost-effective than policing and supply-reduction methods of responding to substance misuse.

Cancer education and training in primary health care--a national audit of training providers.

BACKGROUND: Primary care professionals play a critical role in cancer care but relatively little is known about their education and training. This article presents the results of a national audit of education and training providers in relation to primary care and cancer. METHOD: A semistructured telephone questionnaire. RESULTS: The response rate was very high (96%) with 210 organisations participating. Forty-two percent provided cancer education and training. Evidence of good adult education practice was demonstrated, and 95% of organisations ran accredited programs. Although pharmaceutical industry support was not favoured, the majority (78%) described this as their main source of funding. DISCUSSION: There is optimism and strong commitment among primary care cancer education and training providers. Their content seems appropriate and their approach is consistent with good adult learning principles and multidisciplinary care, but this could be enhanced with increased funding and improved collaboration and communication between organisations.

The research potential of practice nurses: what contribution to primary health care research?

Primary health care (PHC) is at the core of effective, sustainable population healthcare. Although PHC research has been described as the missing link in the development of high-quality, evidence-based health care for populations, research outputs have been disappointingly low in Australia and overseas. This paper reviews the current status of PHC research in Australia, particularly relating to funding and research capacity building needed to conduct high quality and relevant research with significant transfer potential for practice and policy. It explores the likely contribution of research-trained practice nurses (R-T PNs) as study coordinators, rather than as independent nurse researchers, although this is certainly possible, and proposes adapting a successful secondary care research model for use in the PHC research setting.

General practitioners and cancer control.

Cancer is the leading cause of death among Australians, causing 28% of all deaths. The average general practitioner will only encounter about four new patients each year with a potentially fatal cancer. A GP's cancer-related workload mostly involves prevention, and dealing with patients with suspicious symptoms or concerns about possible cancer, or who may be at increased risk due to family history or lifestyle factors. GPs cover the full spectrum of cancer care from prevention to palliation, including providing psychosocial support to patients and their families and carers. GPs have a key role in early diagnosis and referral, follow-up and detection of recurrence, and survivorship. There is a developing role for GPs in cancer policy and research.

A randomised control trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds.

OBJECTIVE: This study investigated the effectiveness of the Chronic Disease Self-management Program (CDSMP) when delivered to for people from Vietnamese, Chinese, Italian and Greek backgrounds living in Victoria, Australia. METHOD: The CDSMP was administered to 320 people with chronic illnesse(es) in selected low income areas in the State of Victoria, Australia. At 6 months, they were compared with randomised wait-list control subjects (n=154) using analyses of covariance. RESULTS: Participants in the intervention group had significantly better outcomes on energy, exercise, symptom management, self-efficacy, general health, pain, fatigue and health distress. There were no significant effects for health services utilisation. Interactions across language groups were observed with the Vietnamese and Chinese speaking participants gaining greater benefit. CONCLUSION: Self-management programs can be successfully implemented with culturally and linguistically diverse populations in Australia. Further research is needed to evaluate long-term outcomes; explore effects on service utilisation; and to determine whether the benefits obtained from participating in a self-management program can be maintained. PRACTICE IMPLICATIONS: Self-management programs should be considered for people from culturally and linguistically diverse backgrounds. Care also needs to be taken in designing recruitment strategies to minimize withdrawal rates and to ensure harder to reach people are given encouragement to participate.

Information mastery and the 21st century doctor: change management for general practitioners.

The Internet and computers have brought immense change in how society deals with information. Uptake of these technologies has been disjointed and has occurred in a non-uniform way among general practitioners, compared with other professionals. Information mastery is a key 21st century skill that GPs should acquire. Applying "change management" concepts may help improve uptake of information mastery skills in general practice.

Primary health care research--essential but disadvantaged.

Primary health care is the foundation of effective, sustainable population health and is associated with higher patient satisfaction and reduced aggregate health spending. Although improving patient care requires a sound evidence base, rigorously designed studies remain under-represented in primary care research. The pace of research activity in general practice and the rate and quality of publications do not match the pace of structural change or the level of funding provided. Recruitment difficulties are a major impediment, fuelled by general practitioners' time constraints, lack of remuneration, non-recognition, and workforce shortages. Radical reform is required to redress imbalances in funding allocation, including: funding of GP Research Network infrastructure costs; formalising relationships between primary care researchers and academic departments of general practice and rural health; and mandating that research funding bodies consider only proposals that include in the budget nominal payments for GP participation and salaries for dedicated research nurses.

Exploring the role of self-management programmes in caring for people from culturally and linguistically diverse backgrounds in Melbourne, Australia.

BACKGROUND: Chronic disease self-management programmes are now an important adjunct to the treatment and care of Australians with chronic illnesses. Most programmes are delivered in English and cater for 'Anglo' views of health and illness. The Peer-Led Self-Management of Chronic Illness Project was funded by the National Health and Medical Research Council (NHMRC) to test the hypothesis that the Stanford University Chronic Disease Self-Management Program would improve health outcomes for people from the Vietnamese, Greek, Chinese and Italian communities in Melbourne's north-eastern suburbs. OBJECTIVE: To examine the extent to which the programme required modification so that the concepts associated with self-management programmes have relevance to the health behaviours of people with chronic illness from the above communities. METHODS: Four focus groups facilitated in English, using interpreters. RESULTS: There was wide understanding of the concepts employed in self-management programmes. Literacy problems emerged as the major obstacle to participating in unmodified programmes. CONCLUSION: The conceptual aspects of the programme require less modification than originally predicted, but the programme requires sensitive modification so that it is accessible to people with low literacy levels.