title: Delivering opioid maintenance treatment in rural and remote settings.
abstract: OBJECTIVE
  This study explored the delivery of opioid maintenance treatment (OMT) from a specialist program in rural and remote New South Wales (NSW), focusing on the viability of the model and strategies for its improvement.
  
  
  METHODS
  Program evaluation examining configuration and delivery, client characteristics and trends in demand, using policy documents, service data and stakeholder consultations (n = 28).
  
  
  METHODS
  The Greater Western Area Health Service, a sparsely populated and large geographic area in NSW.
  
  
  RESULTS
  There were four service hubs or primary sites. Three sites were co-located with hospitals and one within community health, with all sites providing assessment, prescribing, dispensing and limited case management. Staff were mainly trained nurses, while prescribers were visiting specialists or sessional GPs. There was minimal OMT provision by community prescribers and dispensers. In 2009, there were 638 clients. They were younger on average than those in OMT across Australia. The most common principal drug of concern was heroin (37-85% of clients), while around one-fifth of clients identified prescription opioids (18-23%). There was a substantial increase in OMT provision between 2006 and 2009 at three program sites. Staff at the sites had limited capacity to engage primary health services and thus reduce their client load.
  
  
  CONCLUSIONS
  Findings indicate the need to adjust funding to account for increased demand for OMT and to establish a financial incentive for GP prescribers. Dedicated resourcing is needed for a capacity building role to support the uptake of prescribing and dispensing in community services.
authors.affiliation: Centre for Health and Social Research, Australian Catholic University, Melbourne, Victoria, Australia.
authors.forename: Lynda
authors.initials: L
authors.lastname: Berends
authors.affiliation: Turning Point Alcohol & Drug Centre Eastern Health Research, Melbourne, Victoria, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Larner
authors.affiliation: Turning Point, Eastern Health and Monash University, Melbourne, Victoria, Australia.
authors.forename: Dan I
authors.initials: DI
authors.lastname: Lubman
mesh_terms: D000328:Adult; D057191:Capacity Building / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D005260:Female; D006301:Health Services Needs and Demand / Q000191:economics / Q000639:trends; D006556:Heroin Dependence / Q000188:drug therapy / Q000191:economics / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D058850:Opiate Substitution Treatment / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D015397:Program Evaluation; D019035:Rural Health Services / Q000191:economics / Q000600:supply & distribution*; D016320:Substance Abuse Treatment Centers / Q000191:economics / Q000600:supply & distribution*; D000078329:Workforce; D055815:Young Adult
keywords: health program evaluation; management and organisational development in health care; public health; rural workforce development; rural/remote service