Engaging the reluctant GP in care of the opiate misuser: Pilot study of change-orientated reflective listening (CORL)

BACKGROUND: The GP is central to plans for improved general health care and increased availability and delivery of addiction treatment to drug misusers in the UK. Attention to the actual quality of overall primary care, rather than just the treatment of dependence, has, however, been limited. OBJECTIVES: The purpose of this study was to test the feasibility of delivery and potential value of a brief motivational enhancement intervention targeting the quality of primary care given to opiate misusers by GPs. METHOD: This study had an observational 'before and after' design with follow-up assessment after 2-3 months. The target population was all GPs in two Primary Care Groups who had neither attended training events nor were involved in the treatment of drug dependence (n = 66), who were then approached via a telephone-administered change-orientated reflective listening intervention, based on principles of motivational interviewing, with informational adjunct. Outcome measures for the study sample (n = 29) were overall therapeutic commitment and motivation to follow up and actual clinical activity and willingness to deliver specified general health care interventions for drug misusers. RESULTS: Across the study sample, therapeutic commitment improved over time, whilst motivation did not. Change among individual practitioners in receipt of the intervention was observed in both positive and negative directions, and in four of the positive changers, this was judged attributable to the intervention. Positive changes were more than twice as frequent as negative changes. CONCLUSIONS: The direction and extent of change detected were encouraging. Further initiatives are needed to influence practitioner motivation, based on improved understanding of GPs' views on the delivery of primary care for drug misusers.