January 2021- June 2022, funded by Scottish Drug Deaths Taskforce
Aim: This study aims to understand the role and potential of Primary Care in preventing drug-related deaths in areas of extreme deprivation in order to inform future policy, practice and research.
Objectives:
- To understand and describe the health and social care needs of people at increased risk of DRD, and current models of care in selected Deep End GP Practices.
- To explore key stakeholders’ views and experiences of the service delivery system, models of care and interventions designed to prevent DRD.
- To understand the perceived impact and confounding effects of COVID-19 on the role of Primary Care as part of a systems approach for the prevention of DRD, and other health inequalities, to be better prepared for future epidemics/public health emergencies.
- To recommend strategic level, organisational level, clinical practice level, and professional level workforce development opportunities in order to improve responses to the prevention of DRD, with a view to future intervention and complex systems research.
Methods: This is a mixed methods study using an in-depth comparative case study approach and complex systems perspective. It draws on systems thinking and a complex systems perspective that conceptualises determinants of poor health and health inequalities as a consequence of multiple inter-related factors within a connected whole. It provides comparative analysis of qualitative and descriptive quantitative data for each of two case study sites. Data were collected from interviews with drug dependent patients and affected family members in the two GP practices; staff working in partner agencies to deliver treatment and care to drug users; policymakers and commissioners involved in the drug treatment field.
Key findings:
- GPs and primary care teams address complex unmet physical and mental health needs, navigate complex systems of care, and manage complex treatment plans. Consequently, the ‘drug problem’ should be reframed and not treated in isolation.
- Caring for individuals and families affected by drug use should sit alongside other initiatives in primary care that aim to address health inequalities and health justice.
- Responsibilisation, and community and self-stigma are barriers to people who use drugs accessing services before and during moments of crisis.
- Family members and peers are key in providing informal care and support but can lack access to information and support.
- Effective ‘shared care’ models, which include GPs and primary care teams, rely on a well-functioning wider system of care, a highly skilled multidisciplinary workforce, good communication and collaboration, adequate resources, and a robust infrastructure, including good leadership, management, and governance. Shared care needs to be developed further to enhance the contribution that GPs and primary care teams can make to the prevention of drug-related harms and deaths.
- The COVID19 pandemic highlighted how precarious shared care models can be when faced with problems across the whole system of care.
Research team: Joint PI: Dr. Aileen O’Gorman, University of the West of Scotland (UWS) and
Professor Anne Whittaker, NMAHP Research Unit, University of Stirling.
Co-investigators: Professor Roy Robertson (University of Edinburgh), Professor Stewart Mercer (University of Edinburgh), Dr Alison Munro (University of Dundee), Dr Andrea Mohan (University of Dundee), Professor Betsy Thom, Middlesex University.
Contact: Betsy Thom, b.thom@mdx.ac.uk
