Evaluation of Shared Medical Appointments for Opioid Relapse Prevention in Patients Receiving Medication-Assisted Treatment in a Rural Health Clinic

24.00
Hdl Handle:
http://hdl.handle.net/10755/621176
Category:
Full-text
Format:
Text-based Document
Type:
DNP Capstone Project
Level of Evidence:
Other
Research Approach:
Translational Research/Evidence-based Practice
Title:
Evaluation of Shared Medical Appointments for Opioid Relapse Prevention in Patients Receiving Medication-Assisted Treatment in a Rural Health Clinic
Author(s):
Koch, Ashley M.
Additional Author Information:
Ashley M. Koch, DNP(c), BSN, RN; ashley.koch@rockets.utoledo.edu
Advisors:
Batten, Susan; Gray, Temeaka; Lee, Carolyn (Carrie) J.
Degree:
DNP
Degree Year:
2016
Grantor:
University of Toledo
Abstract:

The United States is facing an opioid epidemic.  Access to medication-assisted treatment (MAT) is recognized as one crucial strategy in decreasing opioid abuse rates and improving population health through mitigation of infectious disease and overdose deaths.  However, it has been reported that individuals suffering from opioid-use disorders have limited access to MAT.  A synthesis of evidence supported project implementation of shared medical appointments (SMAs) for opioid relapse prevention as a means to support implementation of MAT, increase patient access to treatment, and promote social support in opioid abuse recovery.  Accordingly, this project aimed to develop, implement, and evaluate a SMA for medical surveillance follow-up of opioid dependent patients receiving injectable naltrexone for opioid relapse prevention in a rural health clinic that is embedded within an outpatient behavioral health site.  The practice change was guided by The Model for Evidence-Based Practice Change, and each component of the Chronic Care Model was integrated into each SMA’s design.  A family nurse practitioner-led SMA was conducted once every 28 days, for three consecutive visits.  SMAs served in replacement of participants’ individual follow-up medical appointments.  Ten individuals who met project inclusion criteria were invited to participate in the project; participant attendance varied over the course of the project. Project results indicated that SMAs for medical surveillance of opioid dependent patients in a rural health clinic were feasibly implemented, demonstrated a high degree of participant and SMA facilitator satisfaction, and produced modest organizational revenue.  The SMAs of the project demonstrated an intrinsic ability to increase the FNP’s capacity of treating patients, thus translating to SMAs’ capability of enhancing access to MAT in the project’s population.  The integration of the CCM into the project’s design and continuous process improvement strategies promoted feasibility in project implementation and contributed to clinically significant individual outcomes in regards to opioid cravings and hepatitis screening.  Moreover, peer support, a characteristic that is inherent of SMAs and essential in opioid relapse prevention, proved to enhance medical care delivery.

Keywords:
Shared Medical Appointment; Medication-Assisted Treatment; naltrexone; Opioid; Opioid Addiction; Rural Health
CINAHL Headings:
Appointments and Schedules--Methods; Appointments and Schedules; Naltrexone--Therapeutic Use; Naltrexone; Rural Health Centers; Substance Abuse--Drug Therapy; Narcotic Antagonists--Therapeutic Use; Narcotic Antagonists; Substance Dependence--Drug Therapy; Substance Dependence
Note:
This work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.
Repository Posting Date:
2017-01-09T19:21:53Z
Date of Publication:
2017-01-09

Full metadata record

DC FieldValue Language
dc.contributor.advisorBatten, Susanen
dc.contributor.advisorGray, Temeakaen
dc.contributor.advisorLee, Carolyn (Carrie) J.en
dc.contributor.authorKoch, Ashley M.en
dc.date.accessioned2017-01-09T19:21:53Z-
dc.date.available2017-01-09T19:21:53Z-
dc.date.issued2017-01-09-
dc.identifier.urihttp://hdl.handle.net/10755/621176-
dc.description.abstract<p>The United States is facing an opioid epidemic.  Access to medication-assisted treatment (MAT) is recognized as one crucial strategy in decreasing opioid abuse rates and improving population health through mitigation of infectious disease and overdose deaths.  However, it has been reported that individuals suffering from opioid-use disorders have limited access to MAT.  A synthesis of evidence supported project implementation of shared medical appointments (SMAs) for opioid relapse prevention as a means to support implementation of MAT, increase patient access to treatment, and promote social support in opioid abuse recovery.  Accordingly, this project aimed to develop, implement, and evaluate a SMA for medical surveillance follow-up of opioid dependent patients receiving injectable naltrexone for opioid relapse prevention in a rural health clinic that is embedded within an outpatient behavioral health site.  The practice change was guided by The Model for Evidence-Based Practice Change, and each component of the Chronic Care Model was integrated into each SMA’s design.  A family nurse practitioner-led SMA was conducted once every 28 days, for three consecutive visits.  SMAs served in replacement of participants’ individual follow-up medical appointments.  Ten individuals who met project inclusion criteria were invited to participate in the project; participant attendance varied over the course of the project. Project results indicated that SMAs for medical surveillance of opioid dependent patients in a rural health clinic were feasibly implemented, demonstrated a high degree of participant and SMA facilitator satisfaction, and produced modest organizational revenue.  The SMAs of the project demonstrated an intrinsic ability to increase the FNP’s capacity of treating patients, thus translating to SMAs’ capability of enhancing access to MAT in the project’s population.  The integration of the CCM into the project’s design and continuous process improvement strategies promoted feasibility in project implementation and contributed to clinically significant individual outcomes in regards to opioid cravings and hepatitis screening.  Moreover, peer support, a characteristic that is inherent of SMAs and essential in opioid relapse prevention, proved to enhance medical care delivery.</p>en
dc.formatText-based Documenten
dc.language.isoen_USen
dc.subjectShared Medical Appointmenten
dc.subjectMedication-Assisted Treatmenten
dc.subjectnaltrexoneen
dc.subjectOpioiden
dc.subjectOpioid Addictionen
dc.subjectRural Healthen
dc.titleEvaluation of Shared Medical Appointments for Opioid Relapse Prevention in Patients Receiving Medication-Assisted Treatment in a Rural Health Clinicen_US
dc.typeDNP Capstone Projecten
thesis.degree.grantorUniversity of Toledoen
thesis.degree.levelDNPen
dc.description.noteThis work has been approved through a faculty review process prior to its posting in the Virginia Henderson Global Nursing e-Repository.-
dc.primary-author.detailsAshley M. Koch, DNP(c), BSN, RN; ashley.koch@rockets.utoledo.eduen
thesis.degree.year2016en
dc.type.categoryFull-texten
dc.evidence.levelOtheren
dc.research.approachTranslational Research/Evidence-based Practiceen
dc.subject.cinahlAppointments and Schedules--Methodsen
dc.subject.cinahlAppointments and Schedulesen
dc.subject.cinahlNaltrexone--Therapeutic Useen
dc.subject.cinahlNaltrexoneen
dc.subject.cinahlRural Health Centersen
dc.subject.cinahlSubstance Abuse--Drug Therapyen
dc.subject.cinahlNarcotic Antagonists--Therapeutic Useen
dc.subject.cinahlNarcotic Antagonistsen
dc.subject.cinahlSubstance Dependence--Drug Therapyen
dc.subject.cinahlSubstance Dependenceen
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