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Prescribing drugs of dependence in general practice

Part A - Clinical Governance Framework

Appendix E. Practice letters

Last revised: 07 Nov 2019

Purpose

To detail safe limitations for prescribing opioid medication in this practice. The policy relates to indications other than malignant pain.

Example policy

[Insert practice name]
Address Date
Dear [Patient name]
We are currently undertaking a review of prescriptions for medications collectively known as benzodiazepines and sleeping tablets. I am writing to you because our records show that you have received a number of prescriptions for one or more of these types of medications in the past 12 months.

A growing body of evidence suggests that if these medications are used for long periods, they can have harmful side effects, including anxiety symptoms, memory and sleep problems, and they can be addictive. We do not recommend long-term use.

We are writing to ask you to consider cutting down your dose of tablets and perhaps stopping them completely at some time in the future. As each person is different, we would like to discuss this with you in person within the next 3 months.

The best way to cut down your tablets is to take them only when you feel they are absolutely necessary. It is best to cut down gradually; otherwise you may have some withdrawal side effects. You should not stop your tablets suddenly. Once you start to reduce your dose you may start to notice that you feel a lot better and you may be able to think about stopping altogether.

Please make an appointment with your GP to discuss this further. If you have not attended to discuss this within the next 3 months, we may not be able to continue to prescribe this medicine for you. If you have already discussed this with your doctor, or have stopped your medications, this letter does not apply to you.

Yours sincerely,
[Dr name]


 

Example policy

[Insert practice name]

Date effective: Review date:

Dear [Referrer]

Thank you for your referral of [Patient name] back to primary care.

I am concerned that your referral does not meet the RACGP or Australian Commission on Safety and Quality in Health Care (ACSQHC) handover standards.

[Patient name] has a number of bio-psychosocial problems, which would put [him/her] in a [moderate/high] complexity group for ongoing management. It is our practice policy that before accepting a patient in this risk group back into primary care, we are fully conversant with [his/her] case to ensure we provide the highest care available to [patient first name].

To ensure proper coordination of care, we also require information about your plans regarding routine review of [patient first name], and your advice on situations that would prompt the need for your immediate review.

To facilitate this process, please provide the following information.

Diagnoses

  • Please list all diagnoses with respect to pain management, addiction, and mental health. Please confirm that these diagnoses are consistent with DSM-IV/5 criteria or ICD-10.

Current status of patient

  • Please document the patient’s social issues that you are aware may impact on management.
  • Can you please provide a current psychological assessment including risk of addictive disorders?
  • Can you please provide an assessment of pain score (if applicable)?
  • Can you please describe the patient’s current level of function?
  • Has the patient ever displayed any aberrant behaviour toward his/her treatment plan, or problematic use of his/her medication?
  • Is there any relevant medical history (eg renal impairment) that may impede overall management?

Current treatment

  • Please provide a summary of the treatment plan with medication, doses and times of administration. This includes how often you wish to review this patient’s progress. Please also detail any non-drug interventions that have been organised.
  • Have any of these medications been instituted as a trial of therapy (eg opioids)?
  • Has a treatment plan been documented for the patient (please provide copy)? Has the patient consented to this treatment plan?
  • Please document instances that would prompt immediate transfer back to your care.

Contact details

  • Can you please provide contact details of a case manager and a clinically responsible person with whom case discussion can occur?
  • Can you please provide documentation that details mechanisms for rapid transfer back to specialty care if deterioration occurs?

Thank you for this information. Please be aware that it is also practice policy not to accept high-risk patients if either the practice or practitioner is unhappy with the treatment plan.

Regards
[Dr name]



 

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