A VIRTUAL LEARNING COLLABORATIVE FOR PPRNET CLINICIANS

AND STAFF: ALC-TRIP (REPRISE)

Lynne Nemeth, PhD, RN, FAAN

OBJECTIVES Define the concepts of a virtual learning

collaborative and community of practice Review previous PPRNet experience with

Alcohol-TRIP projects Discuss current NIAAA proposal

/opportunity Develop a relevant set of

recommendations to embed in proposal based upon YOUR input

VIRTUAL LEARNING CONCEPTS

VIRTUAL LEARNING COLLABORATIVE Meets the needs of its

members through facilitation of peer-to-peer learning

Use social networking and computer-mediated communication to achieve a shared learning objective

Members share knowledge through text discussions, audio, video, blogs, etc. and propose goals and learning objectives

COMMUNITY OF PRACTICE (COP)“Groups of people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise by interacting on an ongoing basis”(Wenger, 2002)

COP differs from work groups or teams Voluntary membership Goals are less specific/more

adaptable Community exists as long

as members participate

PPRNET EXPERIENCE

TRANSLATING RESEARCH INTO PRACTICE-TRIP

Deep PPRNet experience Operationalized through

site visits, network meetings and performance reports

PPRNet must continue to evolve to meet ongoing advances in evidence, and practice development to sustain excellence

ALCOHOL SCREENING & BRIEF INTERVENTION (SBI) USPSTF (2013) recommends that

clinicians screen adults aged 18 and older for alcohol misuse and provide persons engaged in risky or hazardous behavior with behavioral counseling to reduce misuse. (B)

Primary care is ideal for the early detection and secondary prevention of alcohol-related problems, due to its high contact-exposure to the population

TREATMENT FOR ALCOHOL USE DISORDERS (AUD) 14.6% of people with AUD receive

treatment (NIAAA, 2011)

Engaging people in primary care where treatment and coordination of other medical conditions occurs is an opportunity to improve

Medications approved by FDA include:Disulfaram Oral naltrexoneExtended release naltrexoneAcamprosate

HOW PRACTICES IMPLEMENTED ALCOHOL SBI AND TREATMENT IN AM-TRIP Use note templates Nursing staff screening first 2 questions Clinician f/u BI with identified HRD

patients Prescribe medications for patients

receptive to brief intervention Use “Rethinking Drinking” materials to

educate patients (website, handouts)

(Ornstein et al, 2013)

QUALITATIVE CONCLUSIONS OF AM-TRIP Practices self-organized to adopt specific

approaches to incorporating alcohol screening, intervention and medical management into practice

Screening was readily adopted by nursing staff with a consistent, practice-based approach

Clinicians embraced a willingness to address alcohol use in the context of primary care, gaining experience with some medication use

Most patients were receptive to SBI discussion

Ornstein et al, 2013; Wessell et al, 2014

CURRENT PROPOSAL

DISSEMINATION AND IMPLEMENTATION IS NEEDED Proposal: virtual learning collaborative

(VLC) in PPRNet submitted to NIAAA in Sept

Open to all practices (even if you have participated in a previous study)

Random assignment to VLC or control All practice clinical staff /providers

eligible CME and nursing CE would be provided

for participation

AIMS Develop and implement ALC-TRIP, a multi-

component virtual learning community for primary care staff and providers.

Compare the effectiveness of participation in ALC-TRIP on alcohol screening, brief intervention and use of alcohol medications to practices that have not participated in this learning community, in a nationwide sample of 15 practices in each group.

Conduct a process evaluation of this learning community to examine the strengths, weaknesses, opportunities and threats related to this approach from the perspective of the stakeholders.

RECOMMENDATIONS

INPUT This R25 requires the input of

stakeholders in planning this intervention and an Advisory Board to guide the process and evaluation

Need: Letters of support Need: Practices in AA-TRIP and AM-TRIP

studies as advisors--clinicians and staff Need: your wisdom and experience in

expanding practice team roles

SITE VISITS VS. ONLINE COMMUNITY What are the qualities of site visits and

network meetings that are important to replicate in an on-line community?

Initial site visits seemed like a huge request and time burden for some practices—what concerns arise for this request for participation?

DOSE Monthly webinars? Checking discussions weekly and

contributing your ideas, experiences? 12-18 months for program duration?

YOUR INPUT IS APPRECIATEDAny questions? Letters of support to nemethl@musc.edu