Policy Action Plan Presentation Peggie L. Powell, MSN APRN FNP-BC - - PowerPoint PPT Presentation

Policy Action Plan Presentation

Peggie L. Powell, MSN APRN FNP-BC NURS638 Health Policy, Leadership & Advocacy Virginia Commonwealth University

Learning Objectives

• 1. Identify a health policy issue that is linked to quality

and safety in health care and relate it to a theoretical model of policy design.

• 2. Formulate a plan to galvanize support from identified

stakeholders.

• 3. Conduct an environmental scan and SWOT analysis of

the identified health policy issue in relation to the current practice area.

• 4. Examine the economic impact of the health policy

issue.

Health Policy Issue Introduction

• US drug overdose death rate has increased by 137%

since 2000 1

• 40 people die every day due to a prescription opioid
• verdose 2
• 80% of overdose deaths are unintentional 3
• HB 2167 Opioids and buprenorphine; Boards of

Dentistry and Medicine to adopt regulations for prescribing 4

Health Policy Issue’s Relevance to Quality & Safety

• DNP Project: RIOSORD tool to screen for risk of
• verdose and guide naloxone prescribing
• RIOSORD = validated tool, reliability in both the VHA

and IMS populations 5

• EBP approach to:

– improve patient outcomes – increase quality of care – encourage safe opioid use – promote safe opioid prescribing practices

Implication of Policy Inaction

• 14.7% increase in overdose

deaths in Virginia from 2013 - 2014 1

• In 1999, ~23 people died

from abuse of fentanyl, hydrocodone, methadone, and oxycodone 6

• 1,578% increase to 386

individuals by 2013 6

Theoretical Frame of Reference

Kingdon’s Streams Model

An issue gains traction on the policy agenda only when the three separate streams of activity couple with a choice opportunity. 7

Problem Stream:

Defining the problem

Window of Opportunity Policy Stream:

Developing a solution

Politics Stream:

Working the politics

Time

Integrating Health Policy Issue & Theory

Problem Stream Policy Stream Politics Stream

• America’s

prescription opioid epidemic

• Increasing rates of
• verdose deaths
• Increased media

coverage of the epidemic

• Drug related deaths

surpass MVA deaths in Va since 2013 5

• 2014 – Va BOP, naloxone protocol

established 8

• 2014 – Va DBHDS, REVIVE!

Program 6

• 2015 – VDH recommends

SAMHSA toolkit

• 2016 – CDC Opioid Guideline
• 2016 – Va CVS, dispense naloxone

without rx

• March 2017 – Va BOM emergency

guidelines for opioid prescribing (acute and chronic pain) 9

• 2013 – Va Delegate John

O’Bannon, protection for use of naloxone 8

• 2015 – Va General Assembly,

expand access to naloxone

• 2016 – Va General Assembly,

BOM licensees to obtain 2 hours CME 9

• 2016 – Gov. Terry McAuliffe and

Health Commissioner Marissa Levine, opioid addiction a public health emergency in Va 6

• 2016 – US Surgeon General,

TurnTheTideRx campaign 10

Window of Opportunity

• RIOSORD tool – screen for risk of overdose, increase access to naloxone
• Publish DNP project results, influence on naloxone prescribing
• Increase knowledge on RIOSORD tool – presentations; draft letter to CDC

and/or Va BOM

Stakeholder Analysis

• Future impact of the prescribing regulations →

monitor prescription opioid overdose death rate

• Stakeholders relevant to health policy issue:

– government officials – professional organizations – professional sector – public sector

• There are a total of 21 stakeholders.

Stakeholder Identification

• Government
• fficials credited

with commanding attention to the

• pioid crisis
• Lack of opioid

prescribing guidelines partially responsible for the

• pioid epidemic

Government Officials Professional Organizations Professional Sector Public Sector

U.S. Surgeon General

• Dr. Vivek Murthy

Centers for Disease Control and Prevention Physicians Patients Governor Terry McAuliffe (D) Virginia Department of Health Professions Dentists Virginia Secretary of Health and Human Resources

• Dr. William A. Hazel, Jr.

Virginia Prescription Monitoring Program Nurse Practitioners Virginia State Health Commissioner

• Dr. Marissa Levine

Board of Medicine Physician Assistants Senator A. Benton “Ben” Chafin, Jr. (R) Senate District 38 Board of Dentistry Pharmacists Delegate Todd E. Pillion (R) House District 4 Board of Nursing Health Insurances Board of Pharmacy Medical Society of Virginia

Stakeholder Differentiation

High Influence, Less Interested High Influence, Highly Interested

 Board of Pharmacy  Board of Dentistry  U.S. Surgeon General Dr. Vivek Murthy  Governor Terry McAuliffe (D)  Virginia Secretary of Health and Human Resources Dr. William A. Hazel, Jr.  Virginia State Health Commissioner Dr. Marissa Levine  Senator A. Benton “Ben” Chafin, Jr. (R)  Delegate Todd E. Pillion (R)  Centers for Disease Control and Prevention  Virginia Department of Health Professions  Virginia Prescription Monitoring Program  Board of Medicine  Medical Society of Virginia

Low Influence, Low Interested Low Influence, Highly Interested  Patients  Board of Nursing  Physicians  Nurse Practitioners  Physician Assistants  Dentists  Pharmacists  Health Insurances

Stakeholder Mobilization

Patients

• Over the next three months, all patients on chronic
• pioid therapy will be educated on the new

prescribing regulations, medications not to co- prescribe with an opioid, and reasons to prescribe naloxone.

Healthcare Providers

• Over the next six months, co-prescribers of high

risk medications will be asked to wean patients off benzodiazepines and/or hypnotic sleep medications.

Environmental Scanning

Social

Opioid prescribing higher in Mecklenburg County 11 More likely to use opioids: older adults (>40 yr), women, and non-Hispanic whites 11

Technological

EPCS Mandatory in July 2020 for Virginia 12 Drugfreeva.org Website/app to fight heroin and prescription opioid use

Environmental

6% increase in overdose deaths from 2014-2015 in Virginia 11 38.7% increase in heroin overdose deaths 11

Economics

Education & income less in Mecklenburg County 13 Unemployment rate is greater 13 Sept 2017: Unemployment rate 5.1% (Meck. Co.) vs. 3.6% (Virginia) 13

Political

Controlled substance education for providers 9 April 1, 2017 Virginia Medicaid ARTS program launched 14 October 25, 2017 President Trump declares

• pioid crisis a public health

emergency 15

SWOT Analysis

• Delineates

perspectives on action

• f the emergency
• pioid prescribing

regulations

• Without regulations

prescribing practices may not change and the overdose death rate would continue to climb, worsening the crisis.

Helpful

to achieving the objective

Harmful

to achieving the objective

Internal Origin

(attributes of the organization)

Strengths

 Improved prescribing practices  Addresses both acute and chronic pain  Includes treatment for addiction  May increase recognition of opioid misuse  May reduce death rates from overdose  Reduction in # of opioid prescriptions  Reduce amount of opioids on street  Increased access to naloxone

Weakness

 Does not address management of established patients  Time consuming for providers and other health care professionals to become educated on treatment of pain and identification/referral for addiction  No control over illicit opioid use or availability

External Origin

(attributes of the environment)

Opportunities

• Introduce pain management and addiction

treatment education to health care provider curricula

• Mandatory training for providers,

pharmacists, and other healthcare providers

• Restructure chronic opioid therapy

initiation (do not start with an opioid)

• Reduce concomitant use of high risk

medications (i.e., benzodiazepine and

• pioid)
• Increase ability for providers to identify

addiction and refer for treatment

• Incorporate EHR technology to

electronically prescribe controlled substances

Threats

 Provider resistance  Reduced patient satisfaction  Need for increased monitoring; time consuming  Continued increase in overdose death rate due to illicit use  Availability of heroin and fentanyl  Cost of health care provider training  Possible lack of funding by President Trump

Financial & Economic Impact

$78.5 billion every year at least 16 $28.9 billion for added health care & substance abuse treatment costs 16

>14% of aggregated costs funded by public health insurance programs 16 ~25% of aggregate economic burden funded by state and local government 16

Learning Objectives

• 1. Identify a health policy issue that is linked to quality

and safety in health care and relate it to a theoretical model of policy design. (Slides 3-7)

• 2. Formulate a plan to galvanize support from identified
• stakeholders. (Slides 9-11)
• 3. Conduct an environmental scan and SWOT analysis of

the identified health policy issue in relation to the current practice area. (Slides 12-13)

• 4. Examine the economic impact of the health policy
• issue. (Slide 14)

References

1. Rudd, R. A., Aleshire, N., Zibbell, J.E., & Gladden, R.M. (2016, January 1). Increases in drug and opioid overdose deaths: United States, 2000-2014. Morbidity and Mortality Weekly Report, 64(50);1378-82. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm 2. American Public Health Association. (2017). Prescription drug overdose. Retrieved from https://www.apha.org/topics-and-issues/prescription- drug-overdose 3. Dowell, D., Haegerich, T. M., & Chou, R. (2016, March 18). CDC guideline for prescribing opioids for chronic pain – United States, 2016. MMWR Recommendations and Reports; 65(1): 1-49. doi: http://dx.doi.org/10.15585/mmwr.rr6501e1 4. Opioids and buprenorphine; Boards of Dentistry and Medicine to adopt regulations for prescribing, H. B. 2167, 2017 Regular Session Va.

• Legis. (2017).

5. Zedler, B., Saunders, W., Joyce, A., Vick, C., & Murrelle, L. (2015). Validation of a screening risk index for overdose or serious prescription opioid- induced respiratory depression. Poster session presented at the 2015 American Academy of Pain Medicine Annual Meeting, National Harbor, MD. 6. Virginia Department of Behavioral Health & Developmental Services. (2014). REVIVE! Opioid overdose and naloxone education for Virginia. Retrieved from http://www.dbhds.virginia.gov/individuals-and-families/substance- abuse/revive 7. Multiple Streams. (n.d.). Retrieved September 22, 2017 from the Political Frames Wiki: https://politicalframes.wikispaces.com/Multiple+Streams 8. Lowe, J. (2014, May 21). REVIVE! opioid overdose prevention for the Commonwealth of Virginia [PowerPoint slides]. Retrieved from http://www.vrha.org/webinars_31_24881083.pdf 9. Virginia Board of Medicine. (n.d.). Announcements. Retrieved September 23, 2017 from https://www.dhp.virginia.gov/medicine/

• 10. U.S. Department of Health & Human Services. (n.d.). The Surgeon General’s call to end the opioid crisis. Retrieved from http://turnthetiderx.org/
• 11. Centers for Disease Control and Prevention. (2016b, December 16). Opioid overdose. Retrieved from

https://www.cdc.gov/drugoverdose/index.html

• 12. Haggerty, E. (2017, September 29). Digital transformation in e-prescribing. Health IT Outcomes. Retrieved from

https://www.healthitoutcomes.com/doc/digital-transformation-in-e-prescribing-0001

• 13. Virginia Labor Market Information. (n.d.). Labor force data. Retrieved October 28, 2017 from

https://data.virginialmi.com/vosnet/lmi/default.aspx?pu=1&plang=E

• 14. Department of Medical Assistance Services. (n.d.). Addiction and Recovery Treatment Services. Retrieved from

http://www.dmas.virginia.gov/Content_Pgs/bh-home.aspx

• 15. Johnson, C. K. & Colvin, J. (2017, October 25). Trump readies opioid plan, but some worry it won’t be enough. Associated Press News. Retrieved

from https://www.apnews.com/215d3940a6a141a980ffd9518ec0b9d5/Trump-readies-opioid-plan,-but-some-worry-it-won%27t-be-enough

• 16. Florence, C. S., Zhou, C., Luo, F., & Xu, L. (2016). The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United

States, 2013. Medical Care, 54(10), 901-906.

Questions