Implementation of a medical education programme for addictions MDT members to improve knowledge and confidence in managing substance users with complex comorbidities

BACKGROUND: Public Health England (PHE) has highlighted a rising number of deaths due to addiction, and notable changes in patient profiles. Management is now frequently intertwined with medical comorbidities and polypharmacy, as the patient group presents with more complex needs. Early detection is vital to minimise harm. Mental health frequently needs treating in tandem, but ‘cross-referral’ services can fail to recognise or meet these needs. A cohesive, confident multidisciplinary team (MDT) is vital for holistic care and accelerating recovery in cost-effective ways. Furthermore, MDTs are uniquely placed to effectively broker communications between multiple care inputs. METHODS: MDT members of an addictions centre participated in a three-and-a-half-months education programme, encompassing eight PHE-recommended topics. These related to physical and mental health substance misuse sequelae, and specific population treatment needs. RESULTS: There was a statistically significant improvement in all areas including: recognising early physical and/or mental health deterioration signs, providing basic health advice and appropriate escalation. Regarding PHE topics, biggest mean improvements were in managing substance misuse with physical comorbidities and pregnancy (38.2% and 35.9% respectively, p<0.0001). Additionally, biological mechanisms increased 26.0%, physical health consequences 24.2%, hepatic disorders 31.7%, older people 31.3%, homeless populations 31.8% and coexisting mental health 24.6% (all p≦0.002). Confidence communicating concerns to internal and external clinicians also increased (14% and 21%, respectively, p≦0.001). CONCLUSION: A teaching programme improved MDT knowledge and confidence in early detection, escalation and communication of physical and mental comorbidities associated with substance misuse. This intervention should support harm reduction strategies on individual and wider-community levels. Introducing an education programme ensures a sustainable approach to workforce development and helps facilitate holistic care cost-effectively. Clear communication between multiple ‘cross-referral’ services involved with complex needs is essential for comprehensive integrated care.