Technologies to Influence Nursing Practice in Rural Areas Promoting Alcohol Screening

Purpose: Over 23 million individuals in the U.S. are identified as need treatment for alcohol and/or other drug problems, however only 1 in 5 receive treatment. Further, lack of specialist and lack of access to services in rural areas makes Interprofessional Collaborative Practice (IPCP) imperative for the most effective patient care. Social attitudes and stigma associated with the use of alcohol, tobacco and illicit drugs make substance abuse one of the most complex public health issues (Healthy People 2020).  Health professionals must be skilled to identify, assess, and intervene to reduce the risks/effects of substance use.  Implementing new models of interprofessional practice requires innovation, relationship building, networking, and patience. 

The purpose of this presentation is to present an interprofessional practice model to educate rural healthcare teams and apply interprofessional practice to substance use/misuse screening through the use of online technology. This presentation describes an online technology to deliver health care in rural areas.  Rural areas of the U.S. northeast report a higher prevalence of alcohol use compared to urban centers of the region (Eberhardt et al., 2001). Further, the consequences of drug use in rural communities may be greater in rural areas because of limited access to substance use treatment (Dempsey, Bird, & Hartley, 1999). Healthcare teams in rural counties learned and used the universal prevention alcohol and drug use model of Screening, Brief Intervention, and Referral to Treatment (SBIRT) to promote clinical outcomes.

Methods: The intervention includes eight online hours of 1) modules on substance use, 2) interactive case studies designed to include IPCP content, and 3) interprofessional dialogues with site cases. Free continuing education units are provided. Survey data are collected at five time points. Questionnaires included the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ), Drug and Drug Problems Perception Questionnaire (DDPPQ), and the Interdisciplinary Education Perception Scale (IEPS).

Results: Participants were primarily white females from rural regions of Pennsylvania. The majority of participants worked in hospitals (30%), addiction treatment facilities (12%), and community health centers (10%). One third of the participants were nurses, and the remaining participants identified as mental health workers, public health workers, and students. For the AAPPQ, significant increases were noted for Role Adequacy and Role Legitimacy subscales (p<0.05). For the DDPPQ, significant increases were noted for Role Adequacy. On the IEPS, no significant increases were noted after training; however, the Autonomy and Actual Cooperation scales increased significantly after the interprofessional dialogue (p<0.05).

Conclusion: Substance use is a worldwide public-health priority. Annually, 2.5 million people die from the harmful use of alcohol with resulting accidents, violent behavior, and other societal costs. By engaging with the model, practitioners are better able to provide team-based care for substance use.  The IP Dialogues were associated with increased positive attitudes toward interprofessional principles. Linking health professionals in online technology to enhance positive health outcomes is imperative and facilitates connections between fragmented healthcare sectors. Through technology, nurses better understand their role in substance use and risk reduction.