A pilot program out of the University of Colorado College of Nursing at the Anschutz Medical Campus effectively trained nurse practitioners (NPs) and physician assistants (PAs) to deliver Medication for Opioid Use Disorders (MOUD), thus expanding patient access to care for substance use disorder.
As a result of that effective pilot, the Colorado state legislature also passed a bill to expand MOUD in 17 rural counties adversely affected by the opioid epidemic.
A study on the pilot project, published in the July issue of the Journal of Substance Abuse Treatment, outlined the program’s twofold goals and how it worked to integrate advanced practice providers, like NPs and PAs, into care management.
The program sought to “increase the number of NP/PA providers waivered to prescribe MOUD, and to increase the availability of services for patient access in these rural counties, with some of the highest opioid overdose rates in the state,” said lead author Associate Professor Tanya Sorrell, PhD, PMHNP-BC.
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Separate figures corroborate this. Access to treatment for opioid use disorder is left wanting nationwide, but disparities are stark in rural areas. A February 2020 Government Accountability Office (GAO) report showed that rural areas in particular lack for medication-based opioid use disorder treatment.
Given the success NPs and PAs have had in expanding access to primary care in rural areas, Sorrell’s pilot aimed to leverage APP expertise to expand MOUD access. The pilot was also enabled by a 2016 Colorado state legislature law allowing NPs and PAs to prescribe MOUD.
“This opened up a unique opportunity for Colorado to expand MOUD services across the state and potentially reduce the impact of the opioid epidemic in our state,” Sorrell asserted.
This latest pilot program built on that law, establishing training opportunities rather than simply saying NPs and PAs can prescribe MOUD.
“This program provided the training and support for them to lead as MOUD providers as well,” Sorrell added. “By adding nurse practitioners and physician assistants confident in prescribing MOUDs, we were able to increase availability of services for Pueblo and Routt counties. We went from two clinical providers at three sites to 15 MOUD waivered providers, and from caring for 99 clients to more than 1000 in less than two years.”
This intervention came at a good time for Colorado, which has the 12th highest self-reporting of non-medical opioid use in the country. Despite the prevalence of OUD and SUD, resources for treatment left much to be desired.
One in three Coloradans said they did not have access to MOUD treatment, the researchers said. One in five said even if they wanted to get substance use help, they could not because there was not a provider in their county.
This pilot has chipped away at that problem and prompted the Colorado state legislature to pass SB19-001, a bill that would expand MOUD into 17 hard-hit counties across the state.
But there is still room for improvement, Sorrell said. Many patients still face care access barriers because of lack of medical transportation, affordability and limited Medicaid or private payer reimbursement for the care, and, of course, social stigma.
“One agency, initially framed their services as pain management versus substance abuse treatment to help overcome some of the stigma associated with substance abuse. Thankfully, with the notable care and treatment provided to clients in that area, now that agency is a leader in the community, and known for its substance use treatment services,” said Sorrell.
Ideally the medical industry and US culture writ large could overcome those stigma issues by tackling stigma head on rather than by creating workarounds to avoid stigma. However, this current method is a good short-term solution that seriously improves patient access to care right now.
Source: PatientEngagement HIT