Date of Graduation

Fall 12-11-2020

Document Type

Project

Degree Name

Doctor of Nursing Practice (DNP)

College/School

School of Nursing and Health Professions

Department/Program

Nursing

Program

Executive Leader DNP

First Advisor

Dr. Mary Lynne Knighten

Second Advisor

Dr. Sara Horton-Deutsch

Abstract

Problem: The most recent data from the Centers for Disease Control and Prevention (CDC, 2018b) suggest that 130 Americans die from an opioid overdose each day, thus creating an unprecedented number of opioid-related deaths in the United States to date.

Context: Of particular interest to the author and this DNP project is that Veterans are twice as likely to die from an opioid overdose, compared to the average American, making this epidemic a priority for Veterans Health Administration (Wilkie, 2018).

Interventions: The author developed a 9-session Opioid Safety Shared Medical Appointment (SMA) program to reduce opioid reliance in Veterans using an 8-member interdisciplinary team. Comparisons were made of 90 participants who received training via Cohort I, comprised of 30 participants led by a patient-aligned care team (PACT) that met monthly over 9 months and included health coaching, to Cohort II, comprised of 30 participants led by a PACT team that met weekly over 9 weeks and excluded health coaching, to Cohort III (control), comprised of 30 participants who received training via routine, status quo, in-office education. The curriculum was based on a whole health model and introduced self-care modalities and opioid safety education. A comprehensive whole health toolkit was developed containing resource materials and educational handouts for Veterans to use throughout the course of the opioid SMA.

Outcome Measures: Outcome measures for evaluation of this evidence-based project include morphine equivalent daily dose (MEDD), pain scores, and use of complementary alternative modalities (CAMs).

Results: Data analysis revealed the only cohort with a statistically significant reduction in MEDD was Cohort I with health coaching (p < 0.0064). Cohort II (without health coaching) did not have a significant reduction in MEDD (p < 0.64) but did have a significant reduction in pain scores (p < 0.02) and a significant increase of CAMs (p >.01). Cohort III (control group in-office education) did not have a significant reduction in MEDD (p < 0.88) or pain scores (p < 0.26) and had no significant increase in the use of CAMs (p < 0.33). However, findings of this work across all three cohorts included clinically significant improvements in MEDD, pain scores, and use of CAMs.

Conclusions: Using whole health SMAs may provide an effective, evidenced-based, cost-effective approach to managing chronic pain, decreasing MEDD and pain scores, and increasing CAM use among Veterans. While results support the clinical significance of this model, findings warrant additional investigation.

Key words: opioids, Veteran, Veterans Administration, reliance, whole health, shared medical appointments

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