Peer reviewed, US origin article
Analyze the evidence summary tool of the research study to address the following in the discussion:
a. Identify the outcomes specific to the intervention measured by the research team.
In the research study performed by Englander et al. (2019) it was determined that acute-care healthcare settings lacked the systems and processes to treat patients with substance use disorder (SUD). With the lack of appropriate intervention, while hospitalized, most patients do not seek or engage in SUD treatment outside of the hospital. A study was put into place for all eligible Medicaid patients with SUD to be placed in a program called IMPACT (the Improving Addiction Care Team). This program provided an interdisciplinary approach to patient care with physicians trained in addiction medicine, social workers, and recovery peers. The program offered the patient with SUD pharmacotherapeutic medication, behavior treatment modification coaching, and reduction in harm information, and linked the patient to an appropriate outpatient healthcare setting for continued care.
The outcomes resulting from the implementation of an IMPACT protocol were a dramatic increase in patients that were engaged in outpatient SUD treatment after hospitalization (17.2% 6 months before IMPACT and 38.9% within 34 days of discharge from the hospital). Patients that were addicted to opioids demonstrated higher compliance with seeking outpatient treatment than any other substance abuse group (Englander et al., 2019).
b. Considering implementation fidelity, identify the steps you would take to translate/implement this intervention in a practice setting.
Implementation fidelity is defined as the level to which a research study is implemented as intended. This is an intentional effort to mirror the research study processes and steps to obtain the desired outcomes. When a high level of implementation fidelity is used there is an increased chance of successful outcomes. Implementation fidelity and outcome evaluations are used to determine the true merit of implementation success in the healthcare setting (Nurjono et al., 2019). To maintain implementation fidelity for this research study, only Medicaid patients aged 18-64 years of age would be able to qualify for the program. Each patient would be required to have at least one SUD diagnosis (not including tobacco use) within the time frame of 14 months. Patients treated in SUD treatment programs before hospitalization would be able to participate in the research study. Patients admitted to general medicine, family medicine, surgery, cardiology, and patients requiring long-term antibiotics would be eligible to be referred to the program.
Upon referral into the program, physicians trained in addiction medicine and the social workers would complete the initial assessment which would include a DSM-5 SUD diagnosis assessment. Patient goals for treatment while hospitalized would be established and documented. SUD pharmacotherapy would be offered to each patient based on the SUD. Reduction in self-harm information and behavioral modification education would also be provided. A detailed plan to continue treatment in the outpatient setting would be developed with the help of the patient and support system (Nurjono et al., 2019).
Resources:
Englander, H., Dobbertin, K., Lind, B.K., Nicolaidis, C., Graven, P., Dorfman, C., & Korthuis, P.T. (2019). Inpatient Addiction Medicine Consultation and Post-Hospital Substance-Use Disorder Treatment Engagement: A Propensity – Matched Analysis. Journal of General Internal Medicine, 34(12), 2796-2803. https://doi.org/10.1007/s11606-019-05251-9Links to an external site.
Nurjono, M., Shrestha, P., Ang, I.Y.H., Shiraz, F., Yoong, J.S.Y., Toh, S.A.E.S., & Vrijhoef, H.J.M. (2019). Implementation fidelity of a strategy to integrate service delivery: learnings from a transitional care program for individuals with complex needs in Singapore. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-3980-x