Improving Options and Access for People With a Substance Use Disorder: A Service Evaluation of a Novel Nurse Practitioner-Led Ambulatory Model of Care for Withdrawal Management.

Abstract

Introduction: People with substance use disorder (SUD) often find inpatient clinical settings impractical due to personal preferences or obligations. Ambulatory programs provide crucial engagement opportunities. This study examined the effectiveness and acceptability of a Nurse Practitioner-led Community Withdrawal Programme (NPCWP) for individuals with SUD.

Methods: An observational, non-randomised before-and-after study evaluated NPCWP participation on substance use, quality of life, psychological and physical outcomes, and service experience. Summary statistics described demographic characteristics and results from the Australian Treatment Outcomes Profile and Your Experience of Service survey. Comparative analyses of Australian Treatment Outcomes Profile data assessed changes in substance use and health status from NPCWP commencement to discharge.

Results: Forty participants commenced the program; two were excluded from the final analysis due to incomplete data at discharge. Most participants used alcohol (37/38, 97.4%), with 14 (39.5%) reporting cessation of alcohol use by discharge. Significant reductions in median (IQR) days of alcohol [28(26-28) to 3(0-6); p < 0.001], cannabis [28(16-28) to 3(0-10); p = 0.002] and tobacco use [28(28-28) to 28(10-28); p = 0.012] were observed between NPCWP commencement and discharge. Median scores (IQR) for quality of life [6(4-7) vs. 8(6-9); p < 0.001], psychological health [4(3-6) vs. 7(6-8); p < 0.001] and physical health [4(3-5) vs. 7(6-8); p < 0.001] between treatment commencement and discharge also significantly improved. Most participants reported a positive NPCWP experience.

Discussion and conclusions: The NPCWP offered clear treatment guidelines, with interventions based on objective withdrawal management measures. A nurse practitioner-led ambulatory model appeared acceptable to eligible individuals, effective in improving outcomes, and safe, with no reported adverse events.