Date of Graduation

Spring 5-17-2019

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Family Nurse Practitioner

First Advisor

Dr. Alexa Curtis

Second Advisor

Dr. Trinette Radasa

Abstract

Abstract

Objectives: The purpose of this Doctorate in Nursing Practice (DNP) project was to improve health outcomes among underserved residents of Nevada county by increasing access to inter-professional team-based medication assisted therapy (MAT) for opioid use disorder. The over-arching goal of this DNP project was to develop evidence based, interdisciplinary, nurse-managed MAT services through the initiation of the pilot program for the newly developed MAT patient delivery system and the development of evidence-based nurse practitioner process protocols.

Methods: This DNP project involved the coordination of an evidence-based, structured, nurse-managed MAT group on Wednesdays at Community Recovery Resources (CoRR) Grass Valley. The group was led by an interdisciplinary team and was attended by patients who were on a stable dose of an opioid agonist medication. The patients were required to attend the newly structured Wednesday group to obtain their Suboxone medication refill and any clinical concerns that the patient had or issues with their current maintenance therapy dose could be addressed by the provider at that time. Education regarding opioid use disorder, the use of Suboxone in the treatment of opioid use disorder as well as common side effects of the medication was provided during the group. The DNP author also assisted with the development of evidence-based nurse practitioner process protocols for the clinic site.

Results: The retention rate for the patients in the newly developed MAT patient delivery system exceeded the established benchmark goal of 60%. The initial results of the patient satisfaction surveys regarding the MAT program were overwhelmingly positive. In addition, to accommodate the increased number of MAT patients who expressed interest in the new group format, an additional MAT group day was added on Tuesdays with plans to expand the group format to additional CoRR campuses. The results of the provider satisfaction surveys regarding the MAT program will be added once all results are received.

Conclusion:Medication-assisted treatment (MAT) has proven to be the most effective evidence-based treatment option for patients with opioid dependence combined with psychosocial treatment. Treatment of opioid misuse disorder with buprenorphine and naloxone and/or buprenorphine has been proven to be safe and an effective treatment option in the office-based setting to decrease opioid use and cravings. Due to the new and evolving nature of the field of substance abuse and medication assisted treatment, it would be beneficial to obtain further research regarding best practices for providing MAT services to underserved non-metropolitan communities.

Keywords: medication-assisted treatment, opioids, substance use disorder, drug abuse, heroin, overdose deaths, opioid addiction, buprenorphine, opioid related disorders, rural, primary health care, mortality, and safety net.

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