Prescribing drugs of dependence in general practice, Part A


3. General practice systems of care
3.1 The medical home model of care
☰ Table of contents


Recommendations

Reference to the Standards

General practices should undergo and attain accreditation according to the Standards

 

General practices should have clinical leaders who have designated areas of responsibility regarding safety and quality improvement systems

(Criterion* 3.1.3 Flagged indicator A)20

Practice systems of care and treatment should seek to maximise health outcomes and social functioning for all patients prescribed drugs of dependence while minimising drug and alcohol misuse, abuse, diversion and crime

 

General practices should promote the development of competency in prescribing drugs of dependence – this may have particular relevance to registrars

(Extrapolated from Criteria 4.1.2, 3.1.2 and 5.3.1)20

General practices should support relevant training, education and resources for staff to be able to identify patients with more complex needs and those at higher risk.

 

General practices should support GP-based dependency programs with suitably qualified staff, organised support and ongoing quality assurance arrangements

(Extrapolated from Criteria 3.1.2, 3.1.3, 3.2.1 and 3.2.3)20

General practices should have agreed clinical policies regarding prescribing drugs of dependence

(Extrapolated from Criterion 5.3.1. Flagged indicator D)20

General practices should consider having policies regarding the management of patients according to mental health status and use of drugs of dependence to provide the appropriate level of service internally and externally

 

General practices should have an effective handover system that ensures safe and continuing healthcare delivery for patients

(Criterion 1.5.2)20

General practices and GPs should insist on timely, high-standard referral and discharge letters for clinical handover or shared-care arrangements from secondary care

 

General practices must implement strategies to ensure the occupational health and safety of GPs and other members of the practice team

(Extrapolated from Criterion 4.1.2. Flagged indicator B)20

General practices should facilitate GP access to information management data designed to monitor potential prescription drug abuse (eg state and territory health ministries’ drug units and PSIS)

 

*Criteria from The RACGP’s Standards for general practice (4th edition)

The quality and safety of patient care is no longer confined to the individual practitioner. General practices have responsibilities to work collaboratively with practitioners to continuously improve care for their patients.

Practice systems of care and treatment should seek to maximise health outcomes and social functioning for all patients prescribed drugs of dependence while minimising drug and alcohol misuse, abuse, diversion and crime.


3.1 The medical home model of care


The healthcare system is complex and often fragmented. The complexity can be barrier to patients seeking or continuing treatment. The lack of cohesiveness, especially with information sharing, can facilitate doctor or prescription shopping. To counter this, regular contact with a GP helps patients navigate the various systems and creates a chance to explore needs in more depth, while building rapport and continuity.

The medical home model of care aims to provide patients with continuous, accessible, high-quality and patient-centred care. Australian general practice encapsulates the medical home model.26 This model is a way of organising primary care so that patients receive care coordinated by their GP, supported by information technology, delivered by a multidisciplinary team and adherent to evidence-based practice guidelines. Each patient’s medical home is individualised to meet their needs and may change over time.

A central principle of the medical home is the ‘personal doctor’, where one GP provides the patient with first contact, and then continuous and comprehensive care.27 The medical home is responsible for the patient’s healthcare across their whole life journey, including acute, chronic, preventive and end-of-life care. This approach results in better health outcomes for patients and their families.28

The medical home model has measurable benefits, including improved continuity of patient care,29 and improved quality and cost effectiveness of care for patients with a chronic disease.30 Additionally, medical homes reduce disparities in access to quality care among traditionally difficult to reach groups,31,32 leads to improved overall population health33 and lower overall healthcare spending.34

  1. The Royal Australian College of General Practitioners. Standards for general practices, 4th edition. Melbourne: RACGP; 2013.
  2. The Royal Australian College of General Practitioners. What is General Practice? Melbourne: RACGP; 2012. [Accessed September 2013].
  3. Keckley PH, Hoffmann M, Underwood HR. Medical Home 2.0: The Present, the future. Washington, DC: Deloitte Centre for Health Solutions; 2010.
  4. American Academy of Family Physicians (AAFP) AAoPA, American College of Physicians (ACP), American Osteopathic Association (AOA). Joint Principles of the Patient-Centered Medical Home. Washington, DC: Patient Centred Primary Care; 2007.
  5. Saultz JW, Albedaiwi W. Interpersonal continuity of care and patient satisfaction: a critical review. Ann Fam Med 2004;2(5):445–51.
  6. Grumbach K, Grundy P. Outcomes of implementing patient centred medical home interventions: A review of the evidence from prospective studies in the United States Washington DC: Patient-Centred Primary Care Collaborative; 2010.
  7. Geisinger Health System. Presentation at White House Roundtable on Advanced Models of Primary Care: August 10, 2009. Washington DC; 2009.
  8. Steiner BD, Denham AC, Ashkin E, Newton WP, Wroth T, Dobson LA, Jr. Community care of North Carolina: improving care through community health networks. Ann Fam Med 2008;6(4):361–67.
  9. Scholle SH. Developing and testing measures of patient centred care. New York: The Commonwealth Fund; 2006.
  10. Beal A. Closing the divide: how medical homes promote equity in Health care. New York: The Commonwealth Fund; 2007.