NR714-60286 Week 6 Evidence Synthesis and Tables MP

NR714-60286 Week 6 Evidence Synthesis and Tables MP

The Purpose of this synthesis paper is to educate health care professionals about opioid addiction. This will allow care for our patients to be unbiased. This education will reduce addiction and unfair treatment of patients. The eight national practice problems that we face are heart disease, obesity, diabetes, COPD, mental illness, cancer, patient safety and addiction. Opioid is the practice problem that I chose to do research on due to it being growing problem that we face. The sources I used were the CDC, the US burden of disease and six evidence-based articles. 

“Opioid addiction has caused 3,333 deaths in 1990. These numbers have increased to 18,238 in 2016 nationwide (The U.S. Burden of Disease Collaborators)”. ” In October 2017, the US Department of Health and Human Services declared the opioid crisis a public health emergency (Hagemeier, May 11, 2018)”.  Opioid is the cause of 1 death every 13 minutes. Opioid addiction affects the patient, family, healthcare professional and the economy.  ” Opioid addicted people use significantly more healthcare resources, such as ED visits, physician outpatient visits, and inpatient hospital stays (Hagemeier, May 11, 2018)”.  In 2007 drug use disorders ranked number 14 when it came to the most premature deaths (The U.S. Burden of Disease Collaborators). Then in 2017 this rank moved up to number 3 when it came to premature deaths. In New York the number 2 cause of death and disability is drug use disorders (The U.S. Burden of Disease Collaborators). This problem cannot fix itself we must learn about it, how to spot it, how to prevent it and how to help the people who have been affected by it. 

The first article I used was “The risks of opioid treatment: Perspectives of primary care practitioner and patients from safety -net clinics” by Emily E Hurstak, MD, Margot Kushal, MD, Jamie Chang, PHD, Rahel Ceasar, PHD, Kara Zamora, MA, Christine Miaskowski RN PHD and Kelly Knight, PHD. This article discusses how chronic pain can cause misuse or overdose of opioids. Interviews of 23 Pcp’s were conducted to review thoughts and communication on opioids. The main ideas from this study were that pcp’s were afraid of prescribing opioids due to overdose, patients were concerned mainly with addiction, and patients were bothered by protocols that are in place to reduce opioid misuse. Education for both pcp’s and patients is ideal for reduction in stigma. This article was a Level III and great quality. I would use this article for my project. “Limitation was listed in the article as lack of clinical observations (Hurstak, et al., 2017)”. The information was clear and well presented. 

NR714-60286 Week 6 Evidence Synthesis and Tables MP

The second article I used was “Making the business case for an addiction medicine consult service: a qualitative analysis” by Kelsey C. Priest and Dennis McCarty. This article discussed how hospitals have a huge role in care for opioid addicted patients. They discussed how administrators should support and develop addiction medicine consults. Fifteen interviews were done with doctors from 14 U.S. hospitals.  A directed content analysis was used to review the information attained from these interviews. The main message from this study was that hospitals should improve their care delivery system by using addiction medicine consult services in order to better care for opioid addicted patients. This article was a Level III and lower quality. I would use this article for my project. No limitation was listed. 

The third article was “Assessment of health services for people who use drugs in Central Asia: findings of a quantitative survey in Kazakhstan and Kyrgyzstan” by Moritz Rosenkranz, Nina Kerimi, Madina Takenova, Antti Impinen, Mirlan Mamyrov, Peter Degkwitz, Heike Zurhold and Marcus-Sebastian Martens. This study discussed the lack of access and ustilization of health care services by opioid addicted patients. They were given a questionnaire asking about health and barriers. The study was split in two groups one that registered with the Narcological Register and a group that are not registered. The results of the study showed that treatment for patients addicted to opioids are much more available for patients registered to Narcological Register. This article was a Level III and great quality. I would use this article for my project. “The limitation in this article is that the utilization of health services is probably overestimated (Rosenkranz, et al., 2016)”. This study was informative and clear.

NR714-60286 Week 6 Evidence Synthesis and Tables MP

The fourth article I used was “Factors Associated with Perceived Abuse in the Health Care System Among Long Term Opioid Users: A Cross Sectional Study” by Heather Palis, Kirsten Marchanda, Defen Penga, Jill Fikowski, Scott Harrison, Patricia Spittal, Martin T.Schechter, and Eugenia Oviedo-Joekes. This study talks about how abuse in any form is prevalent in long term use of opioids. A cross sectional study was done. Opioid users were asked series of questions about their drug use and abuse they have endured. After answering the questions, the majority had experience abuse or neglect. A high level of abuse by people in healthcare was perceived in 50% of these people.  This article was a Level III and great quality. I would use this article for my project. “The limitation in this study was that the researcher was unable to identify whether patient perceptions of abusive acts resulted from the actions of providers or from the health care system (Palis, et al.,2016)”.

 The fifth article I used was “Risk factors for addiction among patients receiving prescribed opioids: a systematic review protocol” by Amber Cragg, Jeffrey P. Haul, Stephanie A. Woo, Christine Liu, Mary M. Doyle-Waters and Corinne M. Hoh. This article discusses how to avoid addiction of opioids in patients using prescribed opioids. Different studies were gathered and reviewed. They concluded that in order to reduce addiction in patients using prescribed opioids we must understand risk factors as well as following prescribing guidelines by healthcare professionals. This article was a Level III and great quality. I would use this article for my project. “The limitation in this study was stated as that meta-analysis will only be used if the risk factors measured in the primary studies are homogenous across studies/the inclusion of publications in English, French, and German and quantitative publications only( Cragg, et al., 2017)”.

The last article I used was “The impact of chronic pain on opioid addiction treatment: a systematic review protocol” by Brittany B Dennis, Monica Bawor, James Paul, Michael Varenbut, Jeff Daiter, Carolyn Plater, Guillaume Pare, David C Marsh, Andrew Worster, Dipika Desai, Lehana Thabane and Zainab Samaan. This article discusses how pain can cause relapse and the importance of opioid maintenance treatment guidelines. A systemic review was done to obtain this information. Understanding the information found on how comorbidities, mental health and chronic pain is linked to negative outcomes for patients. This article was a Level III and great quality. I would use this article for my project. No limitations were noted in this article.

In conclusion all the articles had in common that awareness and education is essential for minimizing opioid misuse, addiction and deaths. There must be guidelines in place to avoid the mishaps that can occur when start opioids. We must also know our patients and know what factors play a role in addiction. These articles were all level III. The Quality of all the articles were high quality except for article 2 which was low quality. All these articles are suitable as evidence to address my research question.


Article Number


Author  and Date


Evidence Type

Sample, Sample Size,  Setting
Findings That Help Answer the EBP Question
Observable Measures


Limitations

Evidence Level, Quality

     1
Emily E Hurstak, MD, Margot Kushal, MD, Jamie Chang, PHD, Rahel Ceasar, PHD, Kara Zamora, MA, Christine Miaskowski RN PHD and Kelly Knight, PHD2017

Qualitative

“23 pcp’s46 patients6 safety net health care stings in San Francisco”N/A
The difference in how clinicians and patients see opioid use and addiction. In order to reduce risk clinicians and patients need to know, understand and discuss these risks. Lack of clinical observationsIII High quality

      2
Kelsey C. Priest and Dennis McCartyNovember 8,2019Qualitative
“15 board certified or board eligible addiction medicine physiciansFrom 14 U.S hospitals”
N/A
Creation of tools to help support addiction medicine consultIII lower quality
3Moritz Rosenkranz, Nina Kerimi, Madina Takenova , Antti Impinen , Mirlan Mamyrov , Peter Degkwitz , Heike Zurhold and Marcus-Sebastian Martens2016Quantitative
“two different groups of drug users in Kazakhstan and Kyrgyzstan”
N/A
Discuss barriers of healthcare to drug addicted people“that the utilization of health services  is probably overestimated”III High Quality
4Heather Palisa,b, Kirsten Marchanda,b, Defen Penga, Jill Fikowskia,b, Scott Harrisonc , Patricia Spittala,b, Martin T. Schechtera,b, and Eugenia Oviedo-Joekesa,bMixed method/cross sectional study
175 participants from canada
N/A
High levels of abuse in healthcare and life in those patients that were addictedKnowledge of this is important for healthcare professionals when treating and caring for these patients“unable to identify whether patient perceptions of abusive acts resulted from the actions of providers, or from the health care system”III High Quality
5Amber Cragg1, Jeffrey P. Hau1, Stephanie A. Woo, Christine Liu, Mary M. Doyle-Waters and Corinne M. Hohl1Systematic review


N/A
Discussed factors that may contribute to developing addiction.Prior studies“only be able to perform meta-analysis if the risk factors measured in the primary studies are homogenous across studies/the inclusion of publications in English, French, and German and quantitative publications only”III High Quality
6Dennis, B. B., Bawor, M., Paul, J., Varenbut, M., Daiter, J., Plater, C., … Samaan, ZSystematic review


N/A
Identify the most recent treatment guidelines and how pain can cause relapsePrior studiesNone notedIII High Quality
/


N/A

.

REFERENCES

Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States. Surveillance Special Report 2pdf icon (Links to an external site.). Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018

 Cragg, A., Hau, J.P., Woo, S.A. et al. Risk factors for addiction among patients receiving prescribed opioids: a systematic review protocol. Syst Rev 6, 265 (2017). 

Dennis, B. B., Bawor, M., Paul, J., Varenbut, M., Daiter, J., Plater, C., Pare, G., Marsh, D. C., Worster, A., Desai, D., Thabane, L., & Samaan, Z. (2015). The impact of chronic pain on opioid addiction treatment: a systematic review protocol. Systematic reviews4, 49. https://doi.org/10.1186/s13643-015-0042-2

Hagermeier, N. E. (n.d.). Introduction to the Opioid Epidemic: The Economic Burden on the Healthcare System and Impact on Quality of Life. AJMC.  

Heather Palis, Kirsten Marchand, Defen Peng, Jill Fikowski, Scott Harrison, Patricia Spittal, Martin T. Schechter & Eugenia Oviedo-Joekes (2016) Factors Associated with Perceived Abuse in the Health Care System Among Long-Term Opioid Users: A Cross-Sectional Study, Substance Use & Misuse, 51:6, 763-776,DOI: 10.3109/10826084.2016.1155605

NR714-60286 Week 6 Evidence Synthesis and Tables MP

 Hurstak, E. E., Kushel, M., Chang, J., Ceasar, R., Zamora, K., Miaskowski, C., & Knight, K. (2017). The risks of opioid treatment: Perspectives of primary care practitioners and patients from safety-net clinics. Substance Abuse38(2), 213–221. doi: 10.1080/08897077.2017.1296524

Priest, K. C., & Mccarty, D. (2019). Making the business case for an addiction medicine consult service: a qualitative analysis. BMC Health Services Research19(1). doi: 10.1186/s12913-019-4670-4

Rosenkranz, M., Kerimi, N., Takenova, M., Impinen, A., Mamyrov, M., Degkwitz, P., … Martens, M.-S. (2016). Assessment of health services for people who use drugs in Central Asia: findings of a quantitative survey in Kazakhstan and Kyrgyzstan. Harm Reduction Journal13(1). doi: 10.1186/s12954-016-0093-2

The U.S. Burden of Disease Collaborators. The state of U.S. health, 1990–2016 burden of diseases, injuries, and risk factors among U.S. states. JAMA, 319(14), 1444–1472. doi:10.1001/jama.2018.0158

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