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Background: Americans experiencing substance use disorder (SUD) carry a significant chronic disease burden, yet only half use primary care. Patients in treatment for SUD who are connected with primary care typically have better overall health outcomes. Local problem: The identified intensive outpatient program (IOP) had no protocol in place to engage patients with primary care. Methods: This project piloted the development and implementation of an original, evidence-based primary care integration program. It consisted of a psychoeducation group, a referral by case management, and establishment of an internal referral process to affiliated primary care providers (PCPs). Interventions: Following the psychoeducation group, pre and posttests of patient-reported knowledge and attitudes regarding primary care were compared. Participants were contacted to collect further data after IOP discharge. An education and feedback session was held with affiliated PCPs, and an internal referral process was devised by leadership. Results: Mean scores measuring patient knowledge and attitudes regarding primary care increased after participation in the structured psychoeducation group. By time of IOP discharge, 100% (n = 12) of participants had either a referral or scheduled appointment with a PCP in place. At time of follow-up, 90% (n = 9) reported that they had attended or planned to attend their scheduled PCP appointment. Conclusions: A comprehensive integration program in the IOP setting can improve patient engagement with primary care. Quality improvement implementation will require consideration of challenges faced during the pilot involving scheduling, staff buy-in, changes in patient acuity, the electronic medical record, and insurance. [ABSTRACT FROM AUTHOR]

Current evidence-based practice (EBP) literature illustrates the substantial gap in providing quality end-of-life care while studies on palliative care consultation, protocols, and ethics provide valuable assistance in the ICU setting. A paucity of research exists on what EOL practices are used by nurses in delivering palliative care to adult patients in the ICU setting. Providing care that is appropriate and of high quality to patients at the end-of-life is important to nurses and benefits patients and families. The purpose of this research project provided the opportunity for nurse practitioner students to examine end-of-life evidence-based practices in the ICU setting with the specific aims to: 1) better understand ICU nurses' perceptions about palliative care; 2) assess factors which affect the nursing implementation of palliative and end of life care in the ICU, and, 3) evaluate the relationship between nurses' knowledge, attitudes and beliefs regarding EOL care and pain management. A descriptive cross-sectional survey was conducted to describe the current practice of a convenience sample of nurses (n=300) with regards to End-of-Life (EOL) care in the adult medical and surgical intensive care units in 5 hospital settings including patients with cancer. Data was analyzed for descriptive statistics to summarize demographic characteristics with Pearson's r and ANOVA to compare respondent answer by categories. Data analysis at the submission of this demonstrated that nurses in the ICU setting are the first providers of care to discuss Advance Directives (AD's) (72%) with barriers to palliative care identified as beliefs of the patient and family (70%), lack of physician support (55%), inadequate pain control (53%), and a heavy patient assignment (52%). Overall nurses in this study felt that end-of-life care is disjointed for patients, families and healthcare providers, with particular acknowledgement of ineffective pain control, symptom management, and communication The limitations of this EBP based study include the use of a convenience sample of nurse respondents with the need to look further at EOL care best practices with the inclusion of the interdisciplinary team members along with patient/family involvement. In conclusion, educational strategies and targeted methodologies need further examination to enhance EOL care processes in the ICU setting including symptom management and communication. [ABSTRACT FROM AUTHOR]