BOSTON – The Baker-Polito Administration, in partnership with the state’s Advanced Practice Nursing (APRN) programs and professional organizations, physician assistant programs, the Massachusetts Association of Physician Assistants, the Massachusetts League of Community Health Centers, and all affiliated community health centers have agreed to expand the reach and use of the pioneering core competencies established previously for the prevention and management of prescription drug misuse.
This set of cross-institutional core competencies will ensure advanced practice nurses and physician assistants educated in the Commonwealth, as well as community health center employees, receive enhanced training in primary, secondary, and tertiary prevention strategies regarding prescription drug misuse.
“Agreeing upon and expanding these core competency standards is another major step for the prevention and management phases of fighting the opioid epidemic,” said Governor Charlie Baker, in a press release. “As we search for new ways to bend the trend in this public health epidemic, we appreciate the hard work and collaboration that prescriber and academic communities have demonstrated and look forward to continuing this partnership with our nurses, physician assistants and members of the medical community.”
This first-in-the-nation partnership has been expanded with the establishment of cross-institutional core competencies for the prevention and management of prescription drug misuse that will reach the approximately 2,000 enrolled APRN students, 900 enrolled physician assistant students, and the 50 community health centers representing the organizational membership of the Massachusetts League of Community Health Centers.
“Educating our clinicians on prescribing practices for opioids is critical to mitigating the opioid epidemic in the future,” said Health and Human Services Secretary Marylou Sudders. “We are pleased to stand with our health care partners to further advance the training and education of our current and future health care practitioners.”
The agreement follows similar partnerships with the Commonwealth’s three dental schools, Massachusetts Dental Society, the Commonwealth’s four medical schools and the Massachusetts Medical Society on sets of groundbreaking medical and dental education core competencies for the prevention and management of prescription drug misuse. Practitioner training about addiction and safe prescribing practices was a key strategy recommendation of the opioid working group.
“Substance misuse is a chronic disease, and we must treat it as one, starting with education of our clinicians,” said Public Health Commissioner Monica Bharel, MD, MPH. “We must approach the treatment of this disease taking into account the multiple needs of the individual, not just substance misuse.”
“As nurse practitioners, we are pleased to have this opportunity to partner with the Governor on this important initiative,” said Stephanie Ahmed, DNP, FNP-BC, DPNAP, President, Massachusetts Coalition of Nurse Practitioners. “Nurse Practitioners can play a significant role in mitigating the impact of the opioid epidemic through responsible prescribing, participation in the prescription monitoring program, educating and engaging patients around treatment options and behavioral therapy. We have made significant inroads on improving health through such targeted initiatives and I do believe we are on a path toward positive change with the implementation of the competencies and academic/practice partnerships.”
“I am elated and very proud of the Physician Assistant programs in Massachusetts for taking this critical step toward addressing the opioid abuse epidemic and educating our future providers and prescribers,”said Sheri Talbott MS, PA-C President, Massachusetts Association of Physician Assistants.
“The state’s growing opiate crisis is directly related to the challenge of caring for patients’ physical and behavioral health needs in an integrated way,” said James W. Hunt, Jr., president and CEO of the Massachusetts League of Community Health Centers. “The Governor’s Core Competencies serve as an excellent framework for making sure clinicians are well equipped to provide the addiction prevention and treatment services patients need.”
ADVANCED PRACTICE REGISTERED NURSE CORE COMPETENCIES
Primary Prevention Domain – Preventing Prescription Drug Misuse:Screening, Evaluation, and Prevention
- Evaluate a patient’s pain using age, gender, and culturally appropriate evidence-based methodologies. For pediatrics, the assessment should reflect an understanding of opioid neurobiology and the effect on the developing brain.
- Evaluate a patient’s risk for substance use disorders by utilizing age, gender, and culturally appropriate evidence-based communication skills and assessment methodologies, supplemented with relevant available patient information, including but not limited to health records, family history, prescription dispensing records (e.g. the Prescription Drug Monitoring Program or “PMP”), drug urine screenings, and screenings for commonly co-occurring psychiatric disorders (especially depression, anxiety disorders, and PTSD).
- Identify and describe potential pharmacologic and non-pharmacologic treatment options including opioid and non-opioid pharmacologic treatments for acute and chronic pain management, along with patient communication and education regarding the risks and benefits associated with each of these available treatment options.
Secondary Prevention Domain – Treating Patients At-Risk for Substance Use Disorders: Engage Patients in Safe, Informed, and Patient-Centered Treatment Planning
- Describe substance use disorder treatment options, including medication-assisted treatment, as well as demonstrate the ability to appropriately refer patients to addiction specialists and treatment programs for both relapse prevention and co-occurring psychiatric disorders.
- Prepare evidence-based and patient-centered pain management and substance use disorder treatment plans for patients with acute and chronic pain with special attention to safe prescribing and recognizing patients displaying signs of aberrant prescription use behaviors.
- Demonstrate the foundational skills in patient-centered counseling and behavior change in the context of a patient encounter, consistent with evidence-based techniques.
Tertiary Prevention Domain – Managing Substance Use Disorders as a Chronic Disease: Eliminate Stigma and Build Awareness of Social Determinants
- Recognize the risk factors for, and signs of, opioid overdose and demonstrate the correct use of naloxone rescue.
- Recognize substance use disorders as a chronic disease by effectively applying a chronic disease model to the ongoing assessment, management of the patient and communication across specialties and disciplines.
- Recognizing the clinician’s own and societal stigmatization and biases against individuals with substance use disorders and associated evidence-based medication-assisted treatment.
- Identify and incorporate relevant data regarding social determinants of health into treatment planning for substance use disorders.