Opioid Crisis Toolkit Implementation in a Rural Private Practice Primary Care Clinic: A Quality Improvement Project
Opioid Crisis , Opioid Use Disorder , Toolkit
Background: The opioid crisis is preventable and insidious, costing the US billions of dollars and hundreds of thousands of lives over the past several years. Primary care providers have a unique opportunity to screen patients and identify those who are at risk and provide patient education and community resources. educate patients at risk for overdosing on opioids. Purpose: To create an opioid screening toolkit to identify at-risk patients earlier to provide education and interventions for opioid use disorder in a rural primary care clinic over 10 weeks. Methods: Population included a rural private practice primary care clinic consisting of two nurse practitioners, two medical assistants, and one front desk staff member in the Pacific Northwest. Inclusion criteria for screening was 18 years of age presenting for any visit type. Exclusion criteria included current enrollment in a medication assistant treatment (MAT) program. The toolkit consisted of an algorithm, tracking sheet (the Drug Abuse Screening Test (DAST-10) and billing codes), educational handouts, and list of pharmacies with standing orders for naloxone. Staff recorded the DAST-10 scores, intervention, and billing code via the tracking sheet. The number of patients screened was compared to number of eligible patients to determine toolkit utilization. A post survey evaluated perceptions of usefulness and sustainability of the toolkit. Results: Fourteen of 15 patients who met criteria were successfully screened. Education handouts were provided in 57% of encounters. Majority (95%) scored below 3 on the DAST-10, indicating most patients were not at risk for misusing opioids. Billing codes were used in 43% of encounters. Post survey results identified the toolkit as helpful, easy to use and implement into practice. Fifty percent of participants were in favor of the toolkit being permanently implemented into daily practice. Additionally, there was interest in embedding the toolkit into the EMR. Conclusion: The toolkit was helpful and easy to implement into practice. Although the number of patients screened was limited, 95% were successfully screened. Future research would benefit from a larger, more diverse sample size to verify toolkit efficacy.
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