Date of Award

Fall 2023

Project Type

Clinical Doctorate

College or School

CHHS

Department

Nursing

Program or Major

Doctor of Nursing Practice (DNP)

First Advisor

Lauryn Frost

Second Advisor

Joseph O'Leary

Third Advisor

Rachel Baldus

Abstract

Background: The issue of substance use disorder (SUD) has demonstrated a growing prevalence both in the United States (U.S.) and globally. Effective treatment modalities have been devised for individuals afflicted by SUD, thereby enabling their post-treatment prognosis to be parallel to that of patients with other chronic diseases, such as diabetes. However, several factors or barriers impede individuals with SUD from assessing treatment. These barriers encompass financial constraints stemming from inadequate insurance coverage and high cost, the stigma surrounding SUD, which results in patient's hesitancy to seek treatment treat, adverse societal attitudes, collateral social percussions like work hour losses and disruptions in social life, deficiencies in healthcare provider training, diminished provider confidence in addressing addiction, institutional support in implementing treatment approach for SUD, shortage of mental health professionals, a dearth of patient awareness, and lengthy service waitlists.

Purpose: Limited scholarly research or quality improvement projects have been conducted to address evidence-based treatment approaches for SUD patients. One promising avenue to mitigate treatment challenges for patients with SUD is the utilization of telehealth services. This quality improvement project focused on scrutinizing and employing an outpatient telehealth treatment modality for SUD patients, specifically appraising the effectiveness of telehealth as a treatment approach. In tandem, healthcare providers and support staff were duly educated concerning telehealth applications as a treatment approach for SUD and using telehealth and assessment tools.

Local Problem: Telehealth for outpatient withdrawal management was introduced at Kolmac Centers during the tumultuous COVID-19 pandemic. Nevertheless, its effectiveness remains to be evaluated. The primary objective of this project was to reintroduce the utilization of telehealth for withdrawal management (WM) and determine the effectiveness and safety of using telehealth to manage withdrawal symptoms in outpatients with SUDs.

Methods: A quantitative design was used for the project.

Interventions: This project juxtaposed the effectiveness of outpatient telehealth withdrawal management for individuals with SUDs against traditional in-person or in-patient treatment modalities. Furthermore, it probed into the perceptions of healthcare staff concerning the usefulness and effectiveness of telehealth as a mode of care delivery of withdrawal management services.

Results: An array of metrics was scrutinized for patients undergoing WM via telehealth, encompassing the number of patients commencing WM through telehealth, those successfully concluding WM via telehealth, and those subsequently transitioning into an intensive outpatient program (IOP). Over an eight-week project duration, 96% of all patients (155) who commenced telehealth WM successfully completed the program, with a minimal count of six patients discharged before completion. Furthermore, 94% of patients who completed the WM program transitioned into IOP. The results gleaned from the Technology Acceptance Model (TAM) questionnaire post-implementation underscored a significant upswing in the number of providers and support staff who strongly agreed and agreed significantly increased from the answers given pre-implementation. Following the educational in-service, healthcare providers and support staff evinced a heightened comfort level with telehealth for WM, deeming it efficacious and instrumental in enabling the clinic to deliver a more comprehensive service to patients with SUD.

Conclusions: Despite the relatively modest scale of this quality improvement initiative, the findings prominently highlight a substantial augmentation in the rates of patients completing WM and transitioning into IOP programs.

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