Purpose: Our aims were to compare the impact of a team of interprofessional providers working with office-based addiction (OBAT) nurses across three community health centers on 1) the presence of nurse sensitive indictors and 2) impact of care on time to stabilization in patients taking buprenorphine. Through the lens of the nursing role effectiveness model, nursing interventions related to care coordination and transition management in patients on medication-assisted treatment were examined.
Background: Interprofessional teams are useful in providing complex care to patients with substance use disorder. Predictors of treatment outcomes such as age, socioeconomic status, and social supports have been studied in addiction treatment. The individual contributions of the OBAT nurse to the team approach are not well understood. Understanding the role of the OBAT nurse in relation to other team members may contribute to the design of team based care delivery models.
Methods: A cross-sectional study of 382 patients in OBAT programs from three community health centers was conducted. Documentation from interprofessional team members was reviewed and collected in REDCap. Linear regression was conducted to identify significant factors in predicting time to stabilization, defined as achieving a third opiate-free toxicology screen. Logistic regression was used to identify significant associations between patient demographics, care team members, and documented interventions. Analyses of aggregate data were conducted, as well as analyses split by community health center for comparison. SPSS version 27 was used to conduct the analyses.
Results: Care coordination and transition management indictors were present in all programs. Overall, patients’ time to stability on buprenorphine was decreased by approximately five months when a recovery coach was on the OBAT nurses’ team (p=0.03) and by seven months when the patient was referred for and received counseling services (p=0.001). Interestingly, the presence of the OBAT nurse in combination with a recovery coach significantly influenced attention to patients’ housing stability and food security. When analyzed by community health center, counseling significantly decreased time to stability in one health center’s patients (p=0.01), while significantly increasing time to stability in another health center’s patients (p=0.02). Counseling had no significant effect on time to stability in the third health center. In one health center, the nurse sensitive indicator, care coordination, operationalized as goal setting significantly reduced time to stability (p=0.04). Goal setting was a significant predictor of time to stability in all health centers. Another predictor of time to stability in two of the health centers was the OBAT nurses’ attention to harm reduction techniques, 96% (p
PhD, NEA-BC, CNP,
Administrative Director and Nurse Practitioner,
Massachusetts General Hospital