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People who experience drug dependence in the ACT experience stigma, discrimination and ongoing impacts of criminalisation. This leads to a wide range of social and health inequities and requires an integrated approach in providing appropriate health care. Many people experiencing alcohol and other drugs (AOD) dependence need multidisciplinary approaches to primary health care. Many people experiencing AOD dependence have challenges navigating the primary health care system due to a lack of tailored support services and complex needs. Outreach services can reduce barriers and increase access to health services and treatment for vulnerable populations.
Directions Health Services’ integrated AOD primary care and counselling/case management outreach and in-reach services provide wrap around, responsive health care to people at-risk of poor health outcomes. The services utilise a drop-in arrangement, optimising practitioner time and the clinics’ accessibility to clients. Clients may not have previously accessed health care for lengthy periods, despite having complex needs for many years prior to engaging with the service, due to stigma, previous negative help-seeking experiences and challenges navigating the health care system. The service also includes Pathways to Assistance and Treatment (PAT), Directions’ mobile clinic. This custom-built clinic enables Directions’ staff to offer the full range of minor procedures and services usually on offer in a standard GP clinic, enhancing clients’ access to health care. Mobile in-reach primary care services provided a minimum of 2 days per week, led by a team of Nurses and GPs with additional services and supports from AOD counsellors.
Directions continues to provide comprehensive, respectful, non-judgemental support to people who are impacted by AOD, and their families in the ACT and surrounding regions of NSW. Over the last year, the service delivered 208 clinics and supported 1,082 individuals through 3,550 client presentations. Over the last 6 months, there has been a 12.5% increase in client presentations per clinic. A survey of PAT respondents showed 73% had accessed Directions’ services more than 10 times, and more than 89% had accessed more than 5 times. When asked if Directions helped with difficulties in other areas of their lives, demonstrating the holistic impact of the service PAT respondents indicated the following:
- 96.5% rated the quality of the services they received from Directions as either ‘Excellent’ or ‘Good’.
- 99% indicated that Directions provides the kind of assistance they want
- 85% indicated that the services they received from Directions were better than other AOD services they had previously attended
- 99% were satisfied with the services they received.
Directions’ reflection
Since February 2024, the PAT GP and Nurse operating at outreach sites attended 3 emergency calls for help nearby the PAT bus. All 3 emergencies required resuscitations for people experiencing opioid overdose. None of the people assisted were active Directions clients. In all 3 cases, the clients were unresponsive and not breathing when PAT team arrived. The PAT team were able to revive the 3 clients with CPR, including airway management, and administered further doses of Nyxoid. Emergency services attended each resuscitation with Police aiding with chest compressions in one case, and the client’s regaining consciousness in the other 2 cases. In each case, it was residents that alerted the PAT team to the overdoses and were actively seeking assistance. In 2/3 cases, residents had already administered Nyxoid (Naloxone) to treat a possible overdose and commenced CPR before the PAT team arrived. This reflects that the community is responding to the training and awareness of overdose management offered through PAT services and Directions’ Needle Syringe Program.
Directions has successfully navigated the Pharmaceutical Benefits Scheme changes regarding Opioid Maintenance Treatment, in particular access to depot medication, a replacement in the treatment of heroin and methadone dependence. Prior to Buvidal being listed on the PBS, it was supplied by the wholesaler free of charge to Directions. Once Buvidal was listed on the PBS, Directions were unable to continue sourcing free supplies from the wholesaler – it could only be dispensed by a pharmacy on production of a PBS prescription. This would have resulted in clients being responsible for the co-payment, which ranges from $7.70 for concession card holders per prescription through to around $400 for clients who are ineligible for Medicare.
A workable system has been implemented with an ACT pharmacy that maintains our capacity to provide Buvidal for clients who present on outreach, including opportunistic treatment for clients in withdrawal. Funding from ACT Health to cover the client co-payment has meant clients can continue to access Buvidal free of charge.