Evidence-Based Practice and Applied Nursing Research

Introduction

Evidence-based practice (EBP) is a kind of interdisciplinary model in clinical practice. This model of nursing has been gaining ground since its inception in 1992. It started in medicine as evidence-based medicine (EBM) and spread to other professions such as nursing, education, and economics. It can be described as a “three-legged stool” that works with three basic principles that use the best available research evidence, clinical expertise, and client preferences and values. The process involves making clinical decisions on how to promote health and provide care through integrating the best methods in order to guarantee that patients receive the best available healthcare services from their providers (Kolodny & Frieden, 2018). This paper is going to analyze two journal articles on the topic of opioid abuse and then use Evidence-based practice in analyzing the authors’ methods, as well as, findings. This strategy can be used to analyze articles written on opioid addiction. Opioid addiction is a chronic disease that leads to major social, health, and economic problems to its victims when addicted. They are a class of drugs that act on the nervous system to produce feelings of pain relief and pleasure. In many cases, doctors legally prescribe these drugs to help manage chronic and severe pain. However, continuous use leads to addiction and this is what leads to catastrophic outcomes to the addicts.

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Main discussion

Background of the article

The first journal article that discusses this issue is the Impact of Medication-Assisted Treatment for Opioid Addiction on Medicaid Expenditures and Health Services Utilization Rates in Vermont by Mary Kate Mohlman, Beth Tanzman, Karl Finison, Melanie Pinette, and Craig Jones. The authors start by introducing the increase in opioid addiction rates in the United States and seek to research what can be done to alleviate the issue. The country has seen increasing rates of escalating health care costs, overdose deaths, and the tremendous social costs because of opioid addiction resulting in the need to have policymakers in the country come up with strategies to address the issue, as well as, expand Evidence-Based Practice and Applied Nursing Research 

 The study was conducted to test the logic of investing in a pre-Hub & Spoke baseline for treating and evaluating addicts.  Using a serial cross-sectional design from 2010 to 2015 to evaluate patients with opioid dependence addiction ( 2494 in the control group, 6158 in the intervention group), the study was about studying the access to medical and treatment service expenditures. The study specifically targetted people receiving medication-assisted treatment as compared to people receiving substance abuse treatment without any form of medication. The results indicated that medication-assisted therapy can result in reduced general health care utilization and expenditures such as outpatient emergency department visits, inpatient hospital admissions, and Medicaid beneficiaries with opioid addiction. 

Data Source and Sample Population

The authors reviewed the annual medical expenditures and utilization rates in Vermont Medicaid enrollees for a period of five years. The data was sourced from Vermont’s all-payer claims and the Vermont Health Care Uniform Reporting and Evaluation System. Due to limitations arising from other related systems, the researchers could not use a cohort design for data collection but instead, relied on annual cross-sectional data for the five years under study. The study population comprised of people with Medicaid coverage. The study was done on people between the age of 18–64 years of age and they had claims with VHCURES indicating treatment for opioid addiction between the years under study. Within each year, people that participated in MAT were compared to members with opioid addiction and were receiving medication that was non-MAT therapies in nature. Utilization measures and other forms of expenditure were evaluated for the non-MAT and MAT groups over a period running for six years.  The inclusion criteria for the MAT group were based on data for the two that are buprenorphine and methadone. 

Methadone is given to patients only at designated treatment facilities. Before 2013 in Vermont, buprenorphine was only prescribed in general medical offices. Only authorized physicians were allowed to prescribe it (Kolodny & Frieden, 2018). Non-MAT comparison groups were identified using claims data such as only selecting members who have never received MAT and had in their lifetime received two opioid addiction diagnoses. The treatment for the opioid addiction for the non-MAT people included group and individual intensive outpatient programs, outpatient services, partial hospitalization, residential treatment services, and detoxification identified from the claims data using HCPCS and revenue codes. For every 12 months, non-MAT and MAT members were evaluated using health status and their demographics. Statistic estimates included age, sex, and the province of living arrangement. Wellbeing status pointers included major emotional wellness issue (i.e., schizophrenia, significant dejection, bipolar, and different psychoses), chose ceaseless ailment to analyze such as asthma, consideration shortage hyperactivity issue (ADHD). Others included interminable obstructive aspiratory issue (COPD), congestive heart disappointment, coronary illness, misery, diabetes, and hypertension), and 3 M Clinical Risk Group (CRG) classifications, which were utilized to distinguish contrasts in wellbeing status for different conditions (e.g., malignancy) among the MAT and non-MAT populaces. 

For reasons for guaranteeing a sufficiently extensive subsample, the CRG classifications were assembled into five classes: narcotic dependent just (which incorporated those dependent or subject to narcotics with no comorbidities or convoluting analyze); having a background marked by huge intense infection, a solitary minor unending ailment, or minor ceaseless illness in various organ frameworks (Kolodny & Frieden, 2018). Having a solitary predominant or moderate constant sickness; having a critical endless ailment in different organ frameworks; and having the prevailing endless malady in at least three organ frameworks, metastatic and confused malignancies, or calamitous conditions. Individuals with cases demonstrating pre-and perinatal consideration or HCV energy were additionally distinguished. A proportion of progression of enlistment in (“Medicaid in the Prior Year”) was allotted for a part that was taken a crack at Medicaid amid both the investigation period year and the earlier year.

Data analysis 

The all-out Expenditures show incorporated the expenses of every single therapeutic administration and the expenses related to narcotic enslavement medications, for both the MAT gathering and the non-MAT gathering, as depicted previously. The complete Expenditures without Treatment show rejected all narcotic enslavement treatment expenses to decide the effect of MAT on medicinal uses alone. All use results, use rates recorded were balanced for fractional enlistment inside the timetable year, and the autonomous factors included MAT status, sexual orientation, age gathering, pre-and perinatal status, and HCV status. Medicaid in earlier year status and wellbeing status as estimated by CRGs was also considered. Constant infections and emotional wellness issues were barred from the relapse since they were included by the CRGs. The autonomous variable of MAT vs. non-MAT was made as a twofold variable, as were “Ladies with pre-and perinatal consideration”, HCV, and “Medicaid in the earlier year (Gottlieb S, Woodcock, 2017). The remaining were staggered pointer factors – the model balanced for age and sex bunches utilizing guys 18– 34 as the reference gathering and wellbeing status dependent on CRG bunches utilizing “narcotic dependent just” as the reference gathering.

Evaluation of whether the evidence presented supports the outcome of the study and implications for future research

Given that complete medicinal services consumptions did not vary essentially (p-value 0.07) even with the greater expenses of MAT administrations and prescriptions, the viewpoint for a statewide program concentrated on giving support to MAT is ideal. While the all-out addictions treatment costs were higher for the MAT gathering, these were counterbalanced by much lower social insurance uses, showing an inconsequential in cost contrast between the MAT and non-MAT gatherings. While causation cannot be resolved in this investigation, the outcomes, alongside solid proof that support MAT is increasingly successful at accomplishing treatment maintenance and lessening narcotic use, present an influential contention for growing a MAT-focused sedative compulsion treatment program all through the territory of Vermont. 

At the finish of this current examination’s time span (mid-2013), Vermont, through its social insurance conveyance change program, the Vermont Blueprint for Health, started to reveal a thorough administrations’ configuration based on MAT and the open door for Health Homes offered under the Affordable Care Act. The objective of this program, otherwise called Hub (OTPs) and Spoke (OBOT or buprenorphine-recommending suppliers), was to grow access to methadone, improve methadone treatment programs by connecting Health Home Services with essential and network benefits, and getting clinical staff to help and supplement essential consideration to suppliers waivered to endorse buprenorphine. 

The consequence of this investigation fill-in is a solid benchmark by which to assess Vermont’s Hub and Spoke program and to survey whether the decrease in medicinal expenses has proceeded under the program’s administration upgrades. In addition, the technique utilized in this investigation will be extended to dissect the effects of MAT past social insurance; for example, detainment rates, work rates, and rates of kid and family benefits. These ensuing investigations will give a more full comprehension of the societal expenses and funds of narcotic dependence and treatment.

Limitation of the study

While VHCURES information has been approved as a dependable information source, they have a few constraints applicable to this investigation. In the first place, as referenced over, the de-distinguished status of VHCURES makes associate examinations troublesome. Along these lines, we utilized a yearly cross-sectional for every year in the investigation time frame. 

Secondly, the dataset did not take into account the estimation of methadone costs in detachment. The HCPCS program code, which is utilized to recognize MAT individuals accepting methadone and their treatment costs, consolidates prescription and wellbeing home administrations (Gottlieb S, Woodcock, 2017). Besides, methadone is absent in drug store claims, restricting the capacity to discover treated individuals and segregate methadone medicine costs. The information may incorporate some inclination because of the impact of exceptions. While exceptions were topped at the 99th percentile, they could at present conceivably impact the outcomes given the little example measure. In any case, since the yearly dollar sums were predictable (information not appeared), this impact is likely insignificant. 

The second article to be analyzed in this research paper is the ‘The effectiveness of opioid substitution treatments for patients with opioid dependence: a systematic review and multiple treatment comparison protocols’ by Brittany et al. The authors start by stating that Opioids are psychoactive pain-relieving drugs endorsed for relief from discomfort and palliative consideration. Due to their addictive potential, exertion and cautiousness in controlling solutions, it is expected to maintain a strategic distance from abuse and reliance. Notwithstanding the exertion, the commonness of narcotic use issue keeps on rising. Narcotic substitution treatments are regularly used to treat narcotic reliance; in any case, there is insignificant accord regarding, which treatment is best. Accessible medicines incorporate methadone, heroin, buprenorphine, just as naltrexone. This precise audit plans to survey and analyze the impact of all accessible narcotic substitution treatments on the treatment of narcotic reliance. 

Methodology

The authors looked up Medline, EMBASE, PubMed, PsycINFO, Web of Science, Cochrane Library, Cochrane Clinical Trials Registry, World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. The title, theoretical, and full-content screening will be finished in the copy. Whenever suitable, different treatment examination Bayesian meta-systematic techniques will be performed to conclude synopsis insights evaluating the viability of all narcotic substitution treatments regarding maintenance and reaction to treatment (as estimated though proceeded with narcotic maltreatment). 

While this survey does not exhaustively address non-pharmacological intercessions for sedative fixation, when utilized alone, these methodologies ought to be considered to lie outside the area of first-line proof based treatment. Authentic information shows poor results in patients given just psychosocial intercessions. Regardless of whether constrained or deliberate, come back to sedative use approaches 80% inside two years of serious private treatment. While a methodical survey by the Cochrane joint effort demonstrates some psychosocial mediations might be better than others, a different audit found that psychosocial intercession alone was mediocre compared to methadone upkeep for such results as maintenance in treatment and decrease in sedative positive pee toxicology tests (Gottlieb S, Woodcock, 2017). This later audit additionally showed a pattern for more noteworthy mortality in psychosocial versus methadone treatment, a finding that was upheld in different reports from populaces that get no treatment, psychosocial treatment just, or the individuals who intentionally cease pharmacotherapy

Results 

Utilizing proof picked up from this methodical survey, we foresee spreading a target audit of the current accessible writing on the adequacy of all narcotic substitution treatments for the treatment of narcotic use issue. The consequences of this efficient survey are basic to further upgrade of clinical practice independence medication.

Conclusion

Broad research demonstrates that every one of the three accessible drugs used to treat sedative dependence has better treatment results than non-prescription based treatments. Expanded maintenance lessens mortality, improves social capacity, and is related to diminished medication use and improved personal satisfaction. In this manner, these prescriptions help patients accomplish “recuperation” as it is presently defined. While methadone and buprenorphine seem to have better results than both oral and intramuscular naltrexone, more straightforward correlations are required (Gottlieb S, Woodcock, 2017). Further work is expected to recognize and anticipate the treatment reaction to help individualize prescription decision. Until such information is accessible, it is reasonable, and inside a patient’s entitlement to an educated decision, for treatment experts to give data with respect to these standard treatment choices, their normal results, and potential unfriendly impacts, and enable the patient to pick the prescription that best suits his or her need.

References

Gottlieb S, Woodcock J. Marshaling FDA benefit-risk expertise to address the current opioid

abuse epidemic. JAMA. 2017;318:421–422

Kolodny A, Frieden TR. Ten steps the federal government should take now to reverse the opioid

addiction epidemic. JAMA. 2017;318:1537–1538. 

Han B, Compton WM, Blanco C, Crane E, Lee J, Jones CM. Prescription opioid use, misuse, anduse disorders in U.S. adults: 2015 national survey on drug use and health. Ann Intern Med. 2017;167:293–301. 

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