Project Hope: Changing Care Delivery for the Substance Abuse Patient

Abstract

Project Hope is a program designed to assist healthcare providers in the assessment, care, referral, and follow-up of the hospitalized substance abuse patient. First implemented in 1990 at what is now called University Hospital in San Antonio, Texas, the program has influenced care in a positive way through change in the attitude and knowledge of personnel, administrators, and community. In this paper, the authors provide an overview of the approaches utilized, improvement process, and outcomes obtained from this project. To formally evaluate the effectiveness of Project Hope, a quasi-experimental, Solomon-Four design study was conducted. Eighty nurses from various educational backgrounds and experience with alcohol were divided into groups by nursing unit. A normative-reeducative intervention was applied as described by Chin and Benne. Test of cognition showed significant change (p < .01) in the experimental group; no significance was found for attitudes change. Reasons for these findings and lessons learned from the process are described.

Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

“…There is evidence that many US physicians are not comfortable, knowledgeable, nor interested in providing care to IDUs. 27,28,31,37,46,47 The fact that roughly twice to three times as many doctors chose to participate in past postal surveys on other subjects suggests that US physicians are reluctant to discuss injection drug use and IDU care in their practice. Other surveys of medical personnel on topics related to injection drug use, including naloxone distribution have reported comparably low response rates.…”

“…26,27 Approximately two-thirds of individuals with addiction will see a primary care or urgent care physician every six months, and many others are regularly examined by other medical specialists. 26,[28][29][30][31][32] Although systematic research on physicians and IDU care has been limited, 28,30,31,[33][34][35] studies suggest that training, attitudes, and self-efficacy factors influence health care provider participation in harm reduction interventions. 8,27,28,[30][31][32][33][34][35][36] Medical professionals may be uncomfortable treating drug users at all, 37 or view drug abusing patients as a particularly difficult population not amenable to intervention, 31 while fearing that their other patients, colleagues, or society at large will perceive caring for IDUs as Bsoftness^on drug abusers.…”

“…38 These concerns may reflect the widespread social perception that drug abuse is a selfinflicted behavior, less worthy of clinical care and treatment. 31 Such attitudes act as barriers to effective and sustained treatment and recovery for patients. 39 A more detailed understanding of these factors is a precondition to success in efforts to bring about greater physician involvement 40 (and with that, broader public support) in the care of IDUs, including changes in legal and institutional policies, as well as training and continuing education of physicians.…”

Determinants of Nurses' Attitudes toward the Care of Patients with Alcohol Problems

“…Items on this scale are divided into 5 subscales shown in Table 1. Although reported in other studies, no reliability or validity psychometrics on the subscales are available [35]. This instrument has been used to examine the attitudes of nurses' at the University Hospital in San Antonio, Texas towards alcoholic patients and is a commonly used tool in Brazilian studies [35, 36].…”

Referrals and Treatment Completion for Prescription Opioid Admissions: Five Years of National Data

“…Further research could investigate HCR to longer term, more intensive outpatient programs by and PO treatment services across referral sources. Overall, there is a general lack of understanding of SUD and its treatment throughout the healthcare system which may be the reason screening for SUD does not occur in a consistent manner (Lawrence, Rasinski, Yoon, & Curlin, 2013; Swenson-Britt, Carrougher, Martin, & Brackley, 2000). In a study of over 23,000 adults receiving health maintenance examinations, one in six patients reported HCPs spoke to them about alcohol use (Arndt, Schultz, Turvey, & Petersen, 2002).…”