COLUMBUS, Ohio — Shared medical appointments, when adopted as part of a whole health approach, helped veterans reduce their opioid use, a nurse and health coach said here.
Alternative and complementary strategies for pain management and encouraging patients to define their own vision for their best possible health were effective opioid reduction strategies for veterans, said Sherry Cox, RN, of the Birmingham VA Medical Center in Alabama, during a break-out session at the Fuld Institute for EBP National Summit.
Veterans with chronic pain who have been using opioids for 20 or 30 years often become “fearful” when others suggest limiting their pain medication, but scare tactics like repeatedly telling pain patients how many people die of opioid overdoses each day are an ineffective strategy for helping people quit or taper their opioids, Cox said.
This program was a continual work in progress, she added at the presentation, noting, “the airplane was in the air and we were still putting seats in it.”
Importantly, Cox and her colleagues helped veterans who wanted to reduce their opioid use and made sure they could do it at a pace that worked for them. She helped implement this program, along with Michael Moates, MD, also of the Birmingham VA Medical Center, and a few other colleagues.
In a phone interview with MedPage Today, Cox and Moates described their work. The “Whole Health Approach for Reducing Opioid Reliance and Utilization” program was piloted across three groups of about 30 veterans, whose mean age was 65.
The initial program ran for about 9 weeks, but at the request of the veterans, the team continued to meet on a monthly basis for about 9 months, and then every 3 months, Moates said. The first group in the program began in November 2016, with a second and third group starting in October 2017 and March 2018, respectively.
In the first session, the instructors explained what safe opioid use looks like. Patients also received a naloxone kit and were taught how to use it, Cox said. Every session included some discussion on a particular aspect of safe use, such as tapering and withdrawal, storage and disposal, and on Suboxone (buprenorphine and naloxone), a medication-assisted treatment used for opioid addiction.
In later sessions, patients learned about specific elements of the “wheel of health” which included spirituality, nutrition, sleep, relationships, energy and flexibility, physical and emotional health, relaxing and healing, and personal and work life, according to documents Moates shared with MedPage Today.
For instance, a nutritionist might explain the benefits of an anti-inflammatory diet in one session, while a yoga teacher might focus on body movement or mindfulness in another session. Other sessions could include discussions with a physical therapist, social worker, chaplain, or a psychologist. Each 90-minute session would include time for individual coaching sessions.
When the program started, there wasn’t an acupuncturist or a chiropractor and there was no one to manage Suboxone prescriptions. Moates himself subsequently applied for and received an x-waiver to manage patients’ Suboxone use. They added the acupuncturist to the program and reached out to a chiropractor in the community who agreed to work with them.
At every session, veterans wrote down on “request cards” their specific wishes for a particular session and early in the program, they also completed a personal heath inventory self-assessment to identify their own strengths and weaknesses.
The team was also willing to let patients go off-script, Moates said.
“We’ve had sessions where we just let them talk … about what matters to them,” he said, which was also “healing.”
And the program saw results. Of 83 patients, 71% saw a statistically significant difference in opioid use, which the team defined as a 10% or greater reduction. And approximately 19 of those 83 patients (23%) quit opioids entirely as of September 2019.
Cox said she noticed a ripple effect when some patients reached their goals.
For instance, those who came into the program to lose weight might then realize they were in less pain after their weight loss and consider tackling their opioid use as well, she said.
One veteran in his mid-60s who had osteoarthritis, a liver transplant, and walked with a cane had been taking 4 oxycodone a day and reduced his use to only 1 pill a day. He made the change after taking up acupuncture, water therapy, and physical therapy, Moates said.
“He’s still on opioids but he’s on a much safer dose than when he started,” Moates noted.
Clearly, no one quit opioids overnight, but after they “graduated” from the program, the veterans pressed its directors to continue the meetings. So, the directors met with the groups monthly and then quarterly, and that was when most of the progress occurred, Cox said.
Beyond the educational aspects of the program, the mutual support and positive influence of their peers helped veterans to reach their goals, Moates said.
“If a veteran sees another veteran making a lifestyle change, I think it motivates them to try a program for themselves,” he said.
Moates, Cox, and Durinda Warren, PhD, RN, a nurse manager also at the Birmingham VA Medical Center, have led mini-residencies in Alabama, Georgia, and Wisconsin teaching other VA clinicians how to replicate the program and several more residencies are planned.
Moates was also selected as a fellow in the Veterans Health Administration’s Shark Tank Competition. He and one or more of his colleagues will help to replicate their program at the VA Boston Healthcare System.
Source: MedicalNewsToday.com
