Nicola R Jones1, Suzanne Nielsen2, Michael Farrell3, Robert Ali4, Anthony Gill5, Sarah Larney6, Louisa Degenhardt7. 1. National Drug and Alcohol Research Centre, University of NSW, Sydney NSW 2052, Australia. Electronic address: nicola.jones@unsw.edu.au. 2. Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Melbourne, Australia. Electronic address: suzanne.nielsen@monash.edu.au. 3. National Drug and Alcohol Research Centre, University of NSW, Sydney NSW 2052, Australia. Electronic address: michael.farrell@unsw.edu.au. 4. National Drug and Alcohol Research Centre, University of NSW, Sydney NSW 2052, Australia; School of Medicine, The University of Adelaide, Australia. Electronic address: robert.ali@adelaide.edu.au. 5. NSW Ministry of Health, Level 6, 100 Christie St, St Leonards NSW 2065, Australia. Electronic address: anthony.gill@svha.org.au. 6. National Drug and Alcohol Research Centre, University of NSW, Sydney NSW 2052, Australia; Department of Family Medicine and Emergency Medicine, Université de Montréal and Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Canada. Electronic address: sarah.larney@umontreal.ca. 7. National Drug and Alcohol Research Centre, University of NSW, Sydney NSW 2052, Australia. Electronic address: l.degenhardt@unsw.edu.au.
Abstract
BACKGROUND: There has been much research on the efficacy and effectiveness of opioid agonist treatment (OAT), but less on its implementation and sustainability. A challenge internationally has been recruiting and retaining prescribers. This paper aims to characterise the prescribers in terms of OAT prescribing behaviours. METHODS: Retrospective cohort study in New South Wales, Australia. Participants were 2199 OAT prescribers between 1 st August 2001-19th September 2018.We examined trends in initiation and cessation of OAT prescribers. Adjusted hazard ratios were calculated to estimate prescriber retention, adjusting for year of initiation, practice type, client load and treatment prescribed. RESULTS: The rate of prescribers ceasing OAT prescribing has been increasing over time: a prescriber who initiated between 2016-2017 had over four times the risk of cessation compared with one who initiated before 2001, AHR: 4.77; [3.67-6.21]. The highest prescriber cessation rate was in prescribers who had prescribed for shorter time periods. The annual percentage of prescribers who ceased prescribing among those who prescribed for ≤5 years increased from 3% in 2001 to 20 % in 2017. By 2017 more prescribers were discontinuing prescribing than new prescribers were starting. Approximately 87 % (n = 25,167) of OAT clients were under the care of 20 % of OAT prescribers (n = 202); half had been prescribing OAT for 17+ years. CONCLUSIONS: OAT prescribing is increasingly concentrated in a small group of mature prescribers, and new prescribers are not being retained. There is a need to identify and respond to the reasons that contribute to newer prescribers to cease prescribing and put in place strategies to increase retention and broaden the base of doctors involved in such prescribing.
BACKGROUND: There has been much research on the efficacy and effectiveness of opioid agonist treatment (OAT), but less on its implementation and sustainability. A challenge internationally has been recruiting and retaining prescribers. This paper aims to characterise the prescribers in terms of OAT prescribing behaviours. METHODS: Retrospective cohort study in New South Wales, Australia. Participants were 2199 OAT prescribers between 1 st August 2001-19th September 2018.We examined trends in initiation and cessation of OAT prescribers. Adjusted hazard ratios were calculated to estimate prescriber retention, adjusting for year of initiation, practice type, client load and treatment prescribed. RESULTS: The rate of prescribers ceasing OAT prescribing has been increasing over time: a prescriber who initiated between 2016-2017 had over four times the risk of cessation compared with one who initiated before 2001, AHR: 4.77; [3.67-6.21]. The highest prescriber cessation rate was in prescribers who had prescribed for shorter time periods. The annual percentage of prescribers who ceased prescribing among those who prescribed for ≤5 years increased from 3% in 2001 to 20 % in 2017. By 2017 more prescribers were discontinuing prescribing than new prescribers were starting. Approximately 87 % (n = 25,167) of OAT clients were under the care of 20 % of OAT prescribers (n = 202); half had been prescribing OAT for 17+ years. CONCLUSIONS: OAT prescribing is increasingly concentrated in a small group of mature prescribers, and new prescribers are not being retained. There is a need to identify and respond to the reasons that contribute to newer prescribers to cease prescribing and put in place strategies to increase retention and broaden the base of doctors involved in such prescribing.
Authors: Claire E Kendall; Lisa M Boucher; Amy E Mark; Alana Martin; Zack Marshall; Rob Boyd; Pam Oickle; Nicola Diliso; Dave Pineau; Brad Renaud; Tiffany Rose; Sean LeBlanc; Mark Tyndall; Olivia M Lee; Ahmed M Bayoumi Journal: Harm Reduct J Date: 2017-05-12
Authors: Briony Larance; Louisa Degenhardt; Jason Grebely; Suzanne Nielsen; Raimondo Bruno; Paul Dietze; Kari Lancaster; Sarah Larney; Thomas Santo; Marian Shanahan; Sonja Memedovic; Robert Ali; Michael Farrell Journal: Addiction Date: 2020-02-05 Impact factor: 6.526
Authors: Sarah Larney; Matthew Hickman; David A Fiellin; Timothy Dobbins; Suzanne Nielsen; Nicola R Jones; Richard P Mattick; Robert Ali; Louisa Degenhardt Journal: BMJ Open Date: 2018-08-05 Impact factor: 2.692