Pulling it all together: Project Pitch.

After examining the evidence on the structural barriers to access treatment for SUDs, learning about NP-led models for SUDs in Australia and the success of rapid-access to treatment clinics overseas, the following project pitch is proposed using the PICO (Richardson et al., 1995) format:

Can a Nurse Practitioner-led rapid-access clinic improve access and outcomes in community-based treatment for adults with substance use disorders compared to standard of care in a rural/regional Drug and Alcohol service in New South Wales?

Proposed Model

• Patients can self-refer via an online form, via telephone or in person for ambulatory withdrawal management or pharmacotherapy with a NP if they meant to criteria for a SUD using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), (American Psychiatric Association, 2022).

• An appointment will be granted within three days to reflect the optimal time of engaging patients in treatment (Jhoom Roy et al., 2020; Sander et al., 2020).

Figure 3.1: A visual representation of the proposed intake process

Population and treatment model.

• The population identified for this proposal include adults (>18 years old) seeking outpatient withdrawal management or pharmacotherapy for the identified SUDs from the DPMP (O'Reilly & Ritter, 2024). These SUDs have significant unmet treatment demands in NSW.

• Follow-up will be provided by the NP-led model initially, with transfers of care offered for long-term management, such as community counselling and the Opioid Treatment Program, which are already established within this health service.

• This is ideal for the regional/rural setting of this health service, where there are known disparities in accessing health care, and long waitlists to access the public system for addiction treatment. Waitlists only exacerbate these inequities (Bryant et al., 2021).

Figure 3.2: Proposed population and treatments offered

Keeping it trauma informed.

• The new model aims to be trauma informed, as patients will not have to engage in repetitive questioning and assessments, and then wait weeks to months for treatment.

• If patients have to wait longer than same-day access, support will be offered to reduce harm, including:

  • Peer worker support. Already a key part of the current service, peer workers can help reduce anxiety related to accessing treatment, especially those who are socially isolated (Bryant et al., 2021).

  • Harm minimisation. Access to take home naloxone and clean injecting equipment can reduce harms of substance use (Taylor et al., 2021).

    
    

  

Outcomes.

This AOD NP-led model of care will measure outcomes when compared to the current standard of care including:

• Patient engagement.

• Changes in hospital presentations and mortality for SUD-related causes within this local health district.

• Changes in substance use using Australian Treatment Outcomes Profile (Ryan et al., 2014).

• Patient acceptability of the rapid access model and NP facilitated care.

• Staff acceptability of the rapid access model and changes to workload.

Take home message.

Challenges in treatment delivery for people who suffer with SUDs has been highlighted, with the need for innovative ideas to reduce these challenges in NSW, where there is a very large unmet treatment requirement. AOD NP-led models are emerging in Australia and have been well received, inspiring this project to move away from the current medical model of care to a modern, trauma-informed approach aligned to national priorities, which aims to improve treatment uptake, engagement and outcomes for the SUD population.