Evaluation of shared medical appointments for opioid relapse prevention in patients receiving medication-assisted treatment in a rural health clinic
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Ashley M. Koch, DNP(c), BSN, RN, ashley.koch@rockets.utoledo.edu
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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.
Type | DNP Capstone Project |
Acquisition | Self-submission |
Review Type | Faculty Approved: Degree-based Submission |
Format | Text-based Document |
Evidence Level | Other |
Research Approach | Translational Research/Evidence-based Practice |
Keywords | Shared Medical Appointment; Medication-Assisted Treatment; Naltrexone; Opioids; Opioid Addiction; Rural Health |
CINAHL Subject(s) | 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 |
Grantor | The University of Toledo |
Advisor | Batten, Susan; Gray, Temeaka; Lee, Carolyn (Carrie) J. |
Level | DNP |
Year | 2016 |
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