Issue Identification 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 student’s DNP scholarly project. 2. Demonstrate how the issue is relevant to quality and safety in health care. 3. Examine the implications of health policy inaction. 4. Relate the identified health policy issue to a theoretical model of policy design.
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 overdose 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 overdose 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 Policy Stream : Opportunity Developing a solution Politics Stream : Working the politics Time
Integrating Health Policy Issue & Theory Problem Stream Policy Stream Politics Stream • • • America’s 2014 – Va BOP, naloxone protocol 2013 – Va Delegate John established 8 prescription opioid O’Bannon, protection for use of • naloxone 8 epidemic 2014 – Va DBHDS, REVIVE! • • Program 6 Increasing rates of 2015 – Va General Assembly, • overdose deaths 2015 – VDH recommends expand access to naloxone • • Increased media SAMHSA toolkit 2016 – Va General Assembly, • coverage of the 2016 – CDC Opioid Guideline BOM licensees to obtain 2 • hours CME 9 epidemic 2016 – Va CVS, dispense naloxone • • Drug related deaths without rx 2016 – Gov. Terry McAuliffe and • surpass MVA deaths March 2017 – Va BOM emergency Health Commissioner Marissa in Va since 2013 5 guidelines for opioid prescribing Levine, opioid addiction a public (acute and chronic pain) 9 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
Learning Objectives 1. Identify a health policy issue that is linked to my DNP scholarly project. (Slide 3) 2. Demonstrate how the issue is relevant to quality and safety in health care. (Slide 4) 3. Examine the implications of health policy inaction. (Slide 5) 4. Relate the identified health policy issue to a theoretical model of policy design. (Slides 6-7)
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/
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