Evaluation of Processes and Procedures for Care of the Opioid Recipient Patient in the Primary Care Setting

Introduction: Chronic non-cancer pain is far reaching, affecting over 100 million Americans (Zgierska et al., 2018). Opioids are commonly prescribed for chronic pain, with approximately 20% of patients presenting to primary care offices with symptoms of pain or pain-related diagnoses (Dowell, Haegerich, & Chou, 2016). As a result, opioid prescribing rates are increasing at a faster rate for primary care practice compared with other specialties (Dowell et al., 2016). Within the United States population, it is estimated that three percent to four percent of the adult population are prescribed long-term opioids for the treatment of chronic non-cancer pain (Dowell et al., 2016). The use of opioid pain medication presents serious risks for patients receiving them, including overdose and opioid use disorder (Dowell et al., 2016). Long-term use of opioids for chronic pain is controversial and has been linked to dose-dependent harm, addiction, overdose, and death (Zgierska et al., 2018). Approximately 85% of those who misuse opioids obtain their main drug supply from opioid prescriptions (Zgierska et al., 2018). On the basis of Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria, it is estimated that 1.9 million Americans abuse or are dependent on prescription opioids (Dowell et al., 2016). Opioid-related deaths in the United States have increased dramatically, making this a national public health crisis (Zgierska et al., 2018). Objectives: The primary study objective is to assess whether evidence-based practice guidelines are being followed regarding the care being delivered to opioid recipient patients. Methods: This is a quality improvement project that will include a retrospective evaluation of quality measures for evidence-based care being delivered to opioid recipients. This project will occur at a primary care office that is part of a large mid-western healthcare system. Resources needed for this project include access to patient charts located at the primary care clinic, use of a laptop, space within the primary care clinic in which to work, and materials needed to produce a toolkit. Additional resources include collaboration with the site mentor and office manager, utilization of information technology (IT) personnel, and consultations with a statistician. To be included in the analysis, patients must meet the following inclusive criteria: age greater than or equal to 18 years old; active patient status (seen in the past three years); have a primary care provider within this office; do not have a diagnosis of malignant neoplasm or hospice status; and have at least one opioid prescription in the past 45 days that was not prescribed for acute pain. Medical records will be reviewed for adult patients at the primary care clinic who are currently prescribed opioids. Furthermore, medical records will be assessed for quality measures of evidence-based care. Evidence-based action plans and a toolkit will be presented and provided to the primary care office’s leaders, providers, and staff to continue to improve measures reflecting organizational goals and measurement targets. Results: Expected results include potential gaps of continual improvement in evidence-based care that is being provided to patients in the primary care setting. Conclusions: Expected conclusions include identified areas of quality measures for evidence-based care

Success Rates of Second Semester Anatomy Students in Online and On-Ground Classes at a Community College in East Tennessee

Educators expect the number of institutions offering online courses and the number of students enrolling in these courses to increase as many students, particularly nontraditional students, discover the advantages of online content delivery. Online courses require new methods of communication between students and faculty as well as discovering new ways to build relationships, earn student trust, conduct appropriate assessment, and deliver useful course content. Many institutions—public, private, and for-profit—offer a wide variety of online coursework but faculty, employers, and the public have expressed concerns about the quality of online course content. In particular, online delivery of coursework in the natural and physical sciences, courses previously offered only in an on-ground format because of their laboratory components, has raised questions about efficacy. The current study was designed to investigate whether there were significant differences in student success between online and on-ground second semester anatomy courses at a community college in East Tennessee during a 5-year period. Statistical analyses were conducted on the following variables: lecture final examination grade, final lecture course grade, final laboratory course grade, sex, age, and content delivery for students enrolled in online and on-ground Anatomy 2 courses at the participating community college. The results of this study indicated that the most successful students in Anatomy 2 lecture and laboratory classes were older (nontraditional-aged) male and female students who attended on-ground classes. Older students in on-ground classes were more likely to earn an A in both lecture and laboratory classes than younger (traditional-aged) students. On-ground male and female students also gained admission into the nursing program at a greater rate than did male and female students from online sections. While age apparently made no difference in the admission rate for female students, older male students from on-ground sections had a greater admission rate than younger male students

Wai Through Kānāwai: Water for Hawaii's Streams and Justice for Hawaiian Communities

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