PAMS Related Policy Activities:
July 1st – Dosing fees now on the PBS
The first day of the 2023-2024 financial year was fantastic for pharmacotherapy consumers throughout Victoria and the rest of Australia. Pharmacotherapy dosing fees were finally added to the list of medications fully funded through the PBS. After literally 20-30 years of lobbying and advocacy and consumers suffering financially to receive this life-saving treatment, the cost was reduced to approximately $7.50 per month with a Centrelink Health Care Card and $30 per month for those employed. In addition, all people who identify as ATSI have the cost of their pharmacotherapy medication fully funded by the Commonwealth Government. The only downside is the cost is now much higher for those on program with no Medicare card, however we believe this is being investigated.
Pharmacotherapy Service Delivery in Victoria: Prescriber Shortage
In late 2023, PAMS was funded by the DoH to work with the Victorian pharmacotherapy service sector to develop several possible reforms to the Victorian ODT system, this was initially a 24-month project. Early 2024, the project was re-designed to focus on the growing shortage of ODT prescribers in Victoria with recommendations on how to reform/re-develop the system in order to make opioid drug treatment more accessible than it is now. We have formed an advisory committee, a consumer reference group and will have the first part of this project completed by October 2023.
PAMS Meetings : Internal and External
PAMS/HRVic ODT Program Reform Work
· 1-2 hour weekly meetings (internal)
· 1 Hour Weekly Meeting with DH
· All day sector consultation
· Advisory Group Meetings
· Consumer Reference Group Meetings
PAMS-Related Meetings
· PABN 2 Governance Group – SL attends – meetings every 6/8 weeks
· PABN 4 – fortnightly catch-up/check-in attended by DW and SL
· DH – crisis meetings re: prescribers who have retired with little to no notice
HRVic Internal Meetings:
· Fortnightly HRVic staff meeting
· Fortnightly HRVic Team Coordinators meeting
· 1:1 Support meetings – all PAMS staff
· PAMS Group Support and Supervision meetings
· PAMS Staff meeting, (weekly)
· PAMS Finance Meeting
· OH&S meeting (HRVic)
One-off Meetings:
· MSRS and Re-Connexion and PAMS 11/4/24
PAMS Team; Presentations/ Training Delivered to External Stakeholders
PAMS Data:
Total PAMS Cases by Financial Year
Financial Year | Total Number of Cases | Average Number of Cases per Month |
2023-2024 | 774 | 64.5 |
Although we have added more staff over the past few yeaars, the number of annual PAMS cases has been decreasing.
At first glance, this might seem like a drop in demand, but it’s actually a sign of how the landscape is shifting and becoming more challenging.
Here’s what’s been happening:
Cases Are More Complex: It’s taking longer to resolve cases because the situations people are facing are more complicated.
Changes in the Prescriber Workforce: Some of our busiest prescribers have retired, which has left a lot of current participants searching for new support.
Growing Demand for Pharmacotherapy: More people are seeking this type of treatment, putting extra pressure on the system.
Fewer Prescribers in the Field: Unfortunately, fewer healthcare professionals are stepping into this specialized area, even as the need keeps growing.
Shift in Financial Assistance Needs: Up to 20% of cases in previous years related to the cost of the program. Since treatments are now covered by the PBS (Pharmaceutical Benefits Scheme) , fewer people need help paying for them, which is great—but it also shifts where we focus our efforts.
The COVID Effect: The pandemic has changed how services are delivered—telehealth has opened some doors, but it’s also created challenges like access issues and adapting to new take aways guidelines.
PAMS Cases by Month July 2023 – June 2024
July 2023 81
August 2023 65
September 2023 86
October 2023 87
November 2023 80
December 2023 69
January 2024 64
February 2024 63
March 2024 32
April 2024 52
May 2024 53
June 2024 42
Caller Type 2023-2024:
Caller Type | Total Number of Cases |
Missing Data | 2 |
Case Worker | 8 |
Client Case Worker | 7 |
Consumer | 685 |
Current Pharmacy | 2 |
Hospital | 8 |
Nurse | 7 |
Other | 1 |
Pharmacist | 2 |
Prescriber | 12 |
Prison | 6 |
Service Provider | 8 |
Significant other | 26 |
PAMS Demographics 2023-2024:
Gender
Sex | Number of Cases | % of Total for Financial Year |
Missing Data | 2 | 0.3 |
Female | 279 | 36 |
Male | 491 | 63.4 |
Non-binary | 1 | 0.1 |
Transgender | 1 | 0.1 |
Total | 774 | 100 |
Regarding the gender of PAMS service-users, in this reporting period there was almost double the number of males in contact with PAMS compared to females.
Clients Who Identify as Aboriginal or Torres Strait Islander (ATSI)
ATSI | Number of Cases | % of Total for Financial Year |
No | 692 | 89.4 |
Yes | 82 | 10.6 |
Total | 774 | 100 |
At Risk of Homeless (residing in unstable accommodation)
At risk of homelessness? | Number of Calls | % of Total for Financial Year |
Yes | 36 | 4.7 |
No | 738 | 95.3 |
Total | 774 | 100 |
Homeless (no residential or fixed address)
Homeless | Number of Calls | % of Total for Financial Year |
No | 746 | 96.4 |
Yes | 28 | 3.6 |
Total | 774 | 100 |
Age Group Summary
Financial Year | Mean Age | Min Age | Max Age | Number of Cases |
2021-2022 | 42.10 | 19.50 | 76.60 | 922 |
2022-2023 | 42.70 | 18.90 | 73.50 | 998 |
2023-2024 | 43.50 | 17.60 | 78.60 | 774 |
The average age of a PAMS caller has steadily increased from 42 years and one month in 2021-2022 to 43 years and 5 months in 2023-2024.
Age Groups
Age Group | Number of Cases | % of Total for Financial Year |
Missing Data | 3 | 0.4 |
<15 years | 1 | 0.1 |
15-19 years | 1 | 0.1 |
20-24 years | 16 | 2.1 |
25-29 years | 60 | 7.8 |
30-34 years | 113 | 14.6 |
35-39 years | 96 | 12.4 |
40-44 years | 164 | 21.2 |
45-49 years | 120 | 15.5 |
50-54 years | 88 | 11.4 |
55-59 years | 51 | 6.6 |
60+ years | 61 | 7.9 |
Total | 774 | 100 |
New Callers
First Call | Number of Cases | % of Total for Financial Year |
Missing Data | 10 | 1.3 |
Don't know/unsure | 2 | 0.3 |
No | 284 | 36.7 |
Yes | 478 | 61.8 |
Total | 774 | 100 |
A significant number of those in contact with PAMS are calling us for the first time and our return clients are at approximately 36.7%.
Income
Income | Number of Cases | % of Total for Financial Year |
Missing Data | 2 | 0.3 |
Benefit/pension | 583 | 75.3 |
Casual | 27 | 3.5 |
Full time employment | 93 | 12 |
N/A | 7 | 0.9 |
Other | 7 | 0.9 |
Part time employment | 36 | 4.7 |
Self-employed | 9 | 1.2 |
Work Cover | 10 | 1.3 |
Total | 774 | 100 |
The majority of all PAMS service users receive a Centrelink benefit of some form, (75.3%), followed by those full-time employed, (12%) and part-time employed (4.7%).
Treatment Type
Treatment | Number of Cases | % of Total for Financial Year |
Suboxone (Detox) | 2 | 0.3 |
Buprenorphine (Subutex) | 13 | 1.7 |
Buvidal monthly | 101 | 13 |
Buvidal weekly | 7 | 0.9 |
Methadone | 368 | 47.5 |
Pain Relief - Other | 1 | 0.1 |
Sublocade monthly | 59 | 7.6 |
Suboxone | 205 | 26.5 |
Missing Data | 18 | 2.3 |
Total | 774 | 100 |
The majority of those in contact with PAMS are either currently on, wanting to start/re-start a methadone program, (47.5%), followed by buprenorphine-naloxone film, (26.5%), Buvidal monthly (13%) and Sublocade monthly (7.6%).
On Program at Time of Contact with PAMS?
On Program? | Number of Cases | % of Total for Financial Year |
Missing Data | 2 | 0.3 |
Previously on program | 4 | 0.5 |
Waiting to re-start | 168 | 21.7 |
Waiting to start | 60 | 7.8 |
Yes | 540 | 69.8 |
Total | 774 | 100 |
Almost 70% of all those in contact with PAMS during the 2023-2024 financial year are in treatment at the point of contact with the service, a further 21.7% are wanting to re-start and just under 8% are wanting to start for the first time.
Treatment Time
Time of Current Program? | Number of Cases | % of Total for Financial Year |
Missing Data | 7 | 0.9 |
Waiting to Start/Re-start | 212 | 27.4 |
Up to one week | 6 | 0.8 |
One to four weeks | 21 | 2.7 |
One to Three Months | 43 | 5.6 |
Four to Six Months | 38 | 4.9 |
Seven up to twelve Months | 26 | 3.4 |
One to Three Years | 138 | 17.8 |
Four to Six Years | 90 | 11.6 |
Seven to Nine Years | 42 | 5.4 |
Ten or more years | 121 | 15.6 |
Treatment Time Not Known | 25 | 3.2 |
Not currently on program | 5 | 0.6 |
Total | 774 | 100 |
Out of those already on program at point of contact with PAMS in 2023-2024, almost 18% were on their current program for 1-3 years, almost 16% were on the current program for 10 years or more and almost 12% were on the current program for 4-6 years.
Follow-Ups Per Case (A ‘follow-up’ is a phone call, SMS, email sent to any party involved in the consumer’s case).
Financial Year | Average Number of Follow Ups per Case | Maximum Number per Case | Minimum Number per Case |
2019-2020 | 7.7 | 75 | 0 |
2020-2021 | 8.8 | 94 | 0 |
2021-2022 | 8.1 | 67 | 0 |
2022-2023 | 10.9 | 92 | 0 |
2023-2024 | 11.6 | 177 | 0 |
The table above demonstrates that the work undertaken (per PAMS case) has steadily increased over the last 3 years. This finding supports the increasing complexity of PAMS cases.
Time Taken to Resolve
Time | Number of Cases | % of Total for Financial Year |
1 to 4 hours | 64 | 8.3 |
15 to 30 days | 60 | 7.8 |
31 or more days | 70 | 9 |
4 to 7 days | 162 | 20.9 |
5 hours to a day | 91 | 11.8 |
8 to 14 days | 87 | 11.2 |
Less than 1 hour | 20 | 2.6 |
One to 3 days | 216 | 27.9 |
Total | 774 | 100 |
The table above indicates the amount of time it takes to resolve PAMS cases in the 2023-2024 financial year. Again, this data supports the complexity of the PAMS cases, (e.g. due to the growing shortage of pharmacotherapy prescribers, PAMS staff can find it takes longer to source a new prescriber for current and new program participants in comparison to previous years.
Treatment Retention and Initiation
Treatment Initiation and Retention | Number of Cases | % of Total for Financial Year |
Retained in ORT due to PAMS intervention | 531 | 68.6 |
Re-started ORT due to PAMS intervention | 134 | 17.3 |
Started ORT due to PAMS intervention | 51 | 6.6 |
N/A | 54 | 7 |
Total | 774 | 100 |
The above table indicates that close to 70% of all those in contact with PAMS in 2023-2024 were retained on their current pharmacotherapy program because of the intervention by PAMS. A further 17% re-started pharmacotherapy and almost 7% started for the first time.
Program at Point of Last Contact?
On Program | Number of Cases | % of Total for Financial Year |
Missing Data | 15 | 1.9 |
No | 10 | 1.3 |
Yes | 607 | 78.4 |
Unsure | 132 | 17.1 |
N/A | 6 | 0.8 |
Total | 774 | 100 |
Importantly, almost 80% of all PAMS service users in 2023-2024 were on program at the point of last contact with PAMS.
PAMS Service User Satisfaction:
Satisfaction | Number of Cases | % of Total for Financial Year |
Very satisfied | 712 | 92 |
Not asked | 17 | 2.2 |
Not satisfied | 2 | 0.3 |
Satisfied | 39 | 5 |
Total | 774 | 100 |
Primary Reason for Contacting PAMS and Associated Primary Outcome:
There are often multiple reasons an opioid dependent person chooses to contact the PAMS Service. In consultation with the service user, PAMS staff identify the issue that needs resolving ‘most urgently’. For example, a person may contact PAMS and raise the following issues:
" I am prescribed 95mg of methadone daily, with 5 TADs p/w by Dr Blah and I dose at Pharmacy 4 More, my last dose was 2 days ago!"
" I had to attend a funeral last week, and I forgot I had an appointment to see my prescriber."
" I went into the pharmacy today and they told me my script has expired and they can’t dose me."
" I called medical reception, and they said there are no appointments until next Tuesday which is 5-days away!"
The issues in the above example include the following:
script expired
missed dose
missed prescriber appointment
Of these, the issue preventing the person getting a dose is the expired script, this is therefore the primary issue in the above example. With permission from the consumer, the PAMS staff member would likely do the following: consult with the pharmacy and confirm the date of last dose, dosing history etc, liaise with the medical clinic and book the next available appointment on behalf of the consumer, if possible, obtain an interim script from the regular prescriber if not arrange a deputising prescriber etc.
The outcomes in this case would therefore include: information, advocacy, debriefing/support, prescriber appointment made with the primary outcome being either deputising prescriber arranged or negotiated script issue.
Satisfaction | Number of Cases | % of Total for Financial Year |
Very satisfied | 712 | 92 |
Not asked | 17 | 2.2 |
Not satisfied | 2 | 0.3 |
Satisfied | 39 | 5 |
Total | 774 | 100 |
The most reported primary issue for PAMS service users in 2023-2024, accounting for 12.6% of all PAMS cases was people reporting their current prescriber had either retired or moved on, (no longer prescribing). A new prescriber was located by PAMS staff in 85% of these cases.
The second most reported primary issue for all PAMS service users in 2023-2024 was “trouble sourcing both prescriber and pharmacy” at 11% of all PAMS cases. PAMS staff were able to sort a new prescriber and dosing point in 72% of these cases.
The third most reported primary issue for those in contact with PAMS during the 2023-2024 financial year was “trouble distance prescriber”, meaning the caller has a prescriber, however they can no longer physically attend to a face-to-face appointment due to the distance the consumer is required to travel. In 78% of these cases, PAMS staff located a new, appropriate and accessible prescriber.
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