The Long & Short of it......
The Short......Since its beginnings in 2000, PAMS has evolved on a number of fronts. The service was originally established to help express consumer-related complaints and grievances, but has moved on to the negotiation and solving of these issues. This development was driven by service users, most of who are less interested in making a complaint than having their problem actually solved, usually within a short space of time.
Other developments since the service firstbegan include:
the number of cases dealt with by PAMS has increased annually
the name of the service has changed from MACS (Methadone Advocacy and Complaints Service) to PAMS
the method of data collection and analysis has been computerised
the service has become more widely known across the drug treatment sector
the service has become increasingly professional.
From small beginnings, PAMS has grown into a established service that plays a vital role within the Victorian opiate pharmacotherapy system.
The Pharmacotherapy, Advocacy, Mediation and Support’ (PAMS) Service was conceived by a small group of methadone consumers who used to meet regularly at the office of VIVAIDS (the Victorian Drug User Organisation) in the mid to late 1990s. A number of people in this group had experienced a range of problems with their methadone program they were not able to address effectively on their own.
Further still, the group members felt there was no avenue through which they could get these issues addressed in a timely and effective manner.
As a result, VIVAIDS undertook some qualitative, action based research to investigate the nature of these pharmacotherapy consumer concerns. This report ( ‘pale blue report’ by Kirsty and Nicola) is available upon request from firstname.lastname@example.org.
In the year 2000, Turning Point Alcohol and Drug Centre was funded by the Commonwealth Government to run a number of trials of ‘new’ pharmacotherapies, including buprenorphine (mono formulation), slow release oral morphine and leva alpha acetyl methanol (LAAM). These trials were undertaken as part of the ‘National Evaluation of Pharmacotherapy for Opioid Dependence’ (NEPOD).
Turning Point then agreed to fund VIVAIDS to pilot a telephone service for the pharmacotherapy consumer group to address the need for any of the following:
Information and support
Resolution of complaints and grievances
Although the service was funded by Turning Point, it was available to any pharmacotherapy consumer in Victoria. The service focussed on the resolution of pharmacotherapy consumer related complaints and grievances and was called the ‘Methadone Advocacy and Complaints-resolution Service’ (MACS) and located at the VIVAIDS office in Carlton. MACS was promoted to the methadone consumer group at pharmacies, GP clinics, community health services, NSPs, welfare services, community legal centres and housing agencies. MACS initially operated from a mobile number, it was run by one staff member (who coordinated the service) and was available from 10AM to 6PM, Monday to Friday.
A steering group was established to provide advice and strategic direction for MACS. Members of the steering group included:
A GP (experienced pharmacotherapy prescriber),
A pharmacist (experienced in the dispensing of methadone),
A consumer representative (on a methadone program),
The coordinator of MACS,
A representative from Turning Point (clinical services),
The manager of VIVAIDS
Representatives from other relevant alcohol and drug services.
In keeping with the other VIVAIDS programs and projects, MACS maintained a strong focus on peer support and representation. The methadone consumer group had access to a peer support worker (from MACS/VIVAIDS), GPs had access to another GP prescriber and pharmacists had access to a pharmacist (pharmacotherapy dispenser) through MACS. The GPs and pharmacists who provided support to their peers involved in a MACS case were available on an ‘on call’ basis. VIVAIDS chose to operate MACS in this way because peers have credibility amongst their peer group. It was also because MACS was new and unknown to GPs and pharmacists and the best way to promote it was again, through the respective professions (peer groups).
In practice, this resulted in MACS operating in the following way:
A methadone consumer contacted MACS because he felt that his GP (prescriber) did not understand his need for more than one methadone TAD per week. The consumer maintained that he had just been offered part-time work in a family company; nobody in his family knew he was on the program and he said he could not get to his pharmacy during working hours. The consumer said that if he disclosed to his family that he was on the program, any offer of work would be withdrawn.
The MACS worker would discuss the issue with the consumer and try to work out a possible solution. The consumer said he would require a minimum of 3 TADs per week in order to work for his family. The MACS worker established that the current dosing point was the only pharmacy with a vacancy in the area.
The MACS worker would ensure that permission was obtained from the consumer to contact their GP.
The MACS worker would then contact the GP prescriber who provides peer support to other GPs involved in any MACS ‘case’ (MACS GP). This GP then contacts the consumer’s prescriber and discusses the issue.
The MACS GP then calls the MACS worker and a course of action is agreed upon. For example, a compromise in this scenario might be that the consumer can have a total for 3 TADs per week, but not for 3 days in a row.
The MACS worker then puts to possible solution to the consumer and the MACS GP suggests the same solution to the consumer’s GP prescriber. If all parties agree, no further negotiation is required, if not then both the MACS worker and the MACS GP may go through the same process again until an agreement has been negotiated on behalf of the consumer and his service provider.
Theoretically, this was an equitable, unique and supportive way to operate the service. However, due to the need to depend on the availability of the MACS GP (also a current prescriber with his/her own case load) and the MACS Pharmacist (also running his/her own pharmacy) and to resolve the cases quickly, (often so a consumer could dose within 24 hours), it simply became impractical. As the number of cases dealt with by the service rapidly increased, there was simply not enough time to utilise the services of the MACS GP and Pharmacist. Over time MACS gradually became known to GPs, Pharmacists and the methadone consumer group.
After running the pilot for 12 months, (funded by Turning Point), VIVAIDS had collected enough data to indicate that MACS was a useful and effective service. VIVAIDS took the data to the Victorian Department of Health, (Drugs Policy and Services) and they agreed to fund the service. The Victorian Department of Health (DoH) have continued to fund the service to this day.
After buprenorphine was approved by the TGA and registered on the PBS, meaning it became available as a treatment for opioid dependence in Victoria, MACS changed its name to the ‘Pharmacotherapy Advocacy and Complaints-resolution Service’ (PACS).
However, PACS had a problem in as the name included the word ‘complaint’. Unfortunately, this resulted in GPs and Pharmacists feeling that “somebody had complained” (about them). This left providers feeling ‘on the back foot’ and defensive before any conversation had taken place. PACS was also compromised by the fact that it had no powers of enforcement to effectively deal with consumer complaints and grievances. If a pharmacotherapy provider did not want to negotiate with the PACS worker, there was often very little the service could do resulting in consumers feeling frustrated, powerless and that they had wasted their time. Interestingly enough, the majority of consumers in direct contact with PACS did not want to make complaints as such, they had problems they wanted resolved effectively and efficiently. These issues culminated in the name and the focus of the service changing.
PACS changed its name to the ‘Pharmacotherapy Advocacy, Mediation and Support’ (PAMS) Service.
This new name accurately reflects the role of the PAMS Service.
PAMS SYSTEMIC ADVOCACY
The PAMS service primarily works on resolving individual pharmacotherapy consumer-related problems and concerns.
Through its work, the service develops a unique perspective into and an understanding of the Victorian Pharmacotherapy
Service System. This specific knowledge and insight is often requested by policymakers, researchers and
For example PAMS has been involved in the following:
Sub-Optimal Dosing of Methadone in Victoria
Role of Methadone Take Away Doses in NSW and Victoria
Post-Surveillance Marketing of Buprenorphine-Naloxone (Suboxone)
Pharmacotherapy Funding Models Study
Review of the Pharmacotherapy Rural Outreach Workers (PROW)
Review of the Victorian Pharmacotherapy Program (2010)
Review of the Specialist Pharmacotherapy Service (2013)
Harm Minimisation Committee (Pharmaceutical Society of Australia, Victorian Branch)
Victorian Department of Health – Pharmacotherapy Reform Advisory Committee
Inner East Medicare Local Pharmacotherapy Committee
Pharmacotherapy Policy for Maintenance Pharmacotherapy for Opioid Dependence (2008) – Victorian Pharmacotherapy Guidelines
Pharmacotherapy Policy for Maintenance Pharmacotherapy for Opioid Dependence (2013) – Victorian Pharmacotherapy Guidelines
Buprenorphine-Naloxone Prescribing for Non-Registered GPs (2013)