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 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

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 Professional Professional Public • Government Officials Organizations Sector Sector officials credited U.S. Surgeon General Centers for Disease Control Physicians Patients Dr. Vivek Murthy and Prevention with commanding Governor Terry McAuliffe Virginia Department of Dentists (D) Health Professions attention to the Virginia Secretary of Health Virginia Prescription Nurse Practitioners and Human Resources Monitoring Program opioid crisis Dr. William A. Hazel, Jr. Virginia State Health Board of Medicine Physician Assistants Commissioner • Lack of opioid Dr. Marissa Levine Senator A. Benton “Ben” Board of Dentistry Pharmacists prescribing Chafin, Jr. (R) Senate District 38 guidelines partially Delegate Todd E. Pillion (R) Board of Nursing Health Insurances House District 4 responsible for the Board of Pharmacy opioid epidemic Medical Society of Virginia

Stakeholder Differentiation High Influence, Less Interested High Influence, Highly Interested  Board of Pharmacy  U.S. Surgeon General Dr. Vivek Murthy  Board of Dentistry  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 • Over the next three months, all patients on chronic opioid therapy will be educated on the new prescribing regulations, medications not to co- prescribe with an opioid, and reasons to prescribe Patients naloxone. • Over the next six months, co-prescribers of high risk medications will be asked to wean patients off benzodiazepines and/or hypnotic sleep Healthcare medications. Providers

Environmental Scanning Environmental Economics Political Social Technological Controlled substance EPCS 6% increase in overdose Education & income education for providers 9 Opioid prescribing higher in deaths from 2014-2015 in Mandatory in July 2020 for less in Mecklenburg Virginia 11 Mecklenburg County 11 Virginia 12 County 13 April 1, 2017 Virginia Medicaid ARTS 38.7% increase in Drugfreeva.org program launched 14 heroin overdose More likely to use opioids: older Website/app to fight heroin deaths 11 Unemployment rate is adults (>40 yr), women, and and prescription opioid use greater 13 non-Hispanic whites 11 October 25, 2017 President Trump declares opioid crisis a public health emergency 15 Sept 2017: Unemployment rate 5.1% (Meck. Co.) vs. 3.6% (Virginia) 13

SWOT Helpful Harmful to achieving the objective to achieving the objective Strengths Weakness  Improved prescribing practices  Does not address management of Analysis (attributes of the organization)  Addresses both acute and chronic pain established patients  Includes treatment for addiction  Time consuming for providers and other  May increase recognition of opioid health care professionals to become Internal Origin misuse educated on treatment of pain and • Delineates  May reduce death rates from overdose identification/referral for addiction  Reduction in # of opioid prescriptions  No control over illicit opioid use or perspectives on action  Reduce amount of opioids on street availability  Increased access to naloxone of the emergency opioid prescribing regulations Opportunities Threats • Without regulations  Introduce pain management and addiction  Provider resistance (attributes of the environment) treatment education to health care prescribing practices  Reduced patient satisfaction provider curricula  Need for increased monitoring; time  Mandatory training for providers, External Origin may not change and consuming pharmacists, and other healthcare  Continued increase in overdose death providers the overdose death  Restructure chronic opioid therapy rate due to illicit use initiation (do not start with an opioid)  Availability of heroin and fentanyl  Reduce concomitant use of high risk rate would continue to  Cost of health care provider training medications (i.e., benzodiazepine and  Possible lack of funding by President opioid) climb, worsening the Trump  Increase ability for providers to identify addiction and refer for treatment crisis.  Incorporate EHR technology to electronically prescribe controlled substances

Financial & Economic Impact >14% of aggregated costs $78.5 billion every funded by public year at least 16 health insurance programs 16 $28.9 billion for ~25% of aggregate added health care economic burden & substance funded by state abuse treatment and local government 16 costs 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)