Nurse Case Management Model for Office-Based Opioid Treatment

The United States is currently experiencing an opioid epidemic. For healthcare providers, providing access and delivering evidence-based treatments, including Medication Assisted Treatment with buprenorphine can be challenging. This is due to the chronic nature of the disease of addiction, lack of providers trained in addiction treatment compared to population needs, insufficient institutional and clinical support, and clinician time constraints. Research suggests utilizing nurse-managed protocols for the management of chronic health conditions, improves access to healthcare services, symptom severity, treatment retention, and medication and treatment adherence. This quality improvement project demonstrates the utility of implementing a Nurse Case Management model in a medical home specializing in addiction including clarifying the role of the RN, supporting the RN working at the highest level of licensure, and creating a pathway to assist in the medication management of patients receiving Medication Assisted Treatment with buprenorphine. Using a t-test for independent samples, the results showed there were no significant changes in the average of nurse-visits (p=0.36), provider visits (p=0.67), and no-shows (p=0.35). However, integration of the QI project did improve nurse and provider role clarification and created a pathway for MAT with buprenorphine. Barriers to this QI project included the medical homes changing parent companies, time and staffing limitations, and transitioning to a new electronic health record. Limitations of this QI project includes small sample size, short duration of intervention time, and small project site with limited support and infrastructure. Future recommendations include further evaluation of Nurse Case Management Models for office-based opioid treatment in organizations with more support and infrastructure and integrating prescribing algorithms for nurses to utilize for buprenorphine dosage adjustments.