Posted: February 12th, 2022

Assessment Table

Assessment Table

Use this document to complete the Assessment table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Full APA formatted citation of the selected article. Article #1 Article #2 Article #3 Article #4

Brigham, G. S., Slesnick, N., Winhusen, T. M., Lewis, D. F., Guo, X., & Somoza, E. (2014). A randomized pilot clinical trial to evaluate the efficacy of Community Reinforcement and Family Training for Treatment Retention (CRAFT-T) for improving outcomes for patients completing opioid detoxification. Drug and Alcohol Dependence, 138, 240-243.

Kouimtsidis, C., Reynolds, M., Coulton, S., & Drummond, C. (2012). How does cognitive behavioral therapy work with opioid-dependent clients? Results of the UKCBTMM study. Drugs: education, prevention, and policy, 19(3), 253-258.

Nyamathi, A. M., Nandy, K., Greengold, B., Marfisee, M., Khalilifard, F., Cohen, A., & Leake, B. (2010). Effectiveness of intervention on improvement of drug use among methadone-maintained adults. Journal of Addictive Diseases, 30(1), 6-16.

Prieto, J. T., McEwen, D., Davidson, A. J., Al-Tayyib, A., Gawenus, L., Sangareddy, S. R. P., … & Shlay, J. C. (2019). Monitoring opioid addiction and treatment: Do you know if your population is engaged?. Drug and alcohol dependence, 202, 56-60.

Evidence Level *
(I, II, or III)
Level I Level I Level 1 Level IV
Conceptual Framework

Describe the theoretical basis for the study (If there is no one mentioned in the article, say that here).**

It has been identified in other studies that the use of agonist maintenance therapy(AMT) which utilizes methadone and in recent years the use of buprenorphine has shown to be effective in treating opioid addiction. Existing barriers limits access to AM, detoxification, and psychosocial counseling. These causes high relapse and potentially lethal. As such, proper interventions are needed to reduce relapse and increase retention.

The existing models use Beck’s cognitive model which is bases on learning theory and put more attention on development of skills that cope with drug abuse, self-efficacy and generate lifestyle changes to deal with drug abuse situations.

Motivation interviewing is effectual in reducing substance abuse and HIV related risk behaviors amongst college students. Similarly, it has been identified that MI is effective in dealing with problems related to drinking amongst college students. Other research identified that Group interviews are effective in reducing individual abusing substance.

In opioid addiction care the model used is a continuum of engagement which was guided by the previous work done and refined through consultation with the stakeholders. This model encompasses stages for opioid misuse, opioid poisoning, and estimated OUD in Denver.
Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria).
Participants were enrolled in an intent to treat the program and then they were randomized into two groups for clinical trials at two Ohio locations. The two groups are concerned with significant other (CSOs) and identified participants (IPs).
The pragmatic randomized controlled, parallel-group design was carried to compare standard MMT alone with MMT in conjunction with
CBT. The assessment was done in two sessions. The study was done within 1 year whereby the first assessment was done after six months after the program began.
The study used a randomized trial to compare how effective a three group intervention would be while receiving MM treatment. The 256 members were subdivided into three groups of individual methadone intervention(MI), nurse-led HHP and group MI.
2017 data from Denver Health (DH) was used to create an operational definition for opioid misuse, poisoning and use disorder. Then six stages were developed and patients were assigned to the stages for a specific analysis.
Sample/Setting

The number and characteristics of
patients, attrition rate, etc.

There were 104 participants enrolled in an intent to treat the program. The participants were registered as dyads as IP and CSO. The IPs group were mature individuals qualified for DSM-IV-TR criteria for opioid dependence. The IPs were supposed to have transferred from detoxification to outpatient and have a CSO who was willing to participate.

Sixty participants were randomized where 31 were grouped to MMT and 29 to CBT. The follow up went in two sessions one after 6 months and the other after 12 months.

256 Moderate and heavy alcohol using participants were involved. For the eligible participants, they were given methadone for at least three months those in the age range of 18-55 years and were either moderate or high consumers of alcohol.

This study took place in a clinical setting to be precise Denver Health. Clinicians and certified addiction counselors provide medication to buprenorphine based medication-Helped treatment to patients. The clinicians work together with OBSH to provide patients with outpatient substance and mental health services.

Major Variables Studied

List and define dependent and independent variables DV-Treatment refusing person

IV- CRAFT-T participants, TAU for CSOs
TAU for IPs
DV-Opioid dependent client

IV- Coping skills, outcome expectancies, self-efficacy DV- patient undergoing methadone maintenance

IV-individual and group MI, and nurse-led HHP DV- Opioid addiction in Denver

IV- Opioid poisoning. opioid use disorder, opioid misuse
Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done).
In this study, random intercept mixed-model logistic regression testing was used to test both groups.
In this study protocol analysis was used to measure sessions that are allocated to clients for treatment.
In this study stepwise procedure was used to construct multiple linear regression per outcome measure having higher significant predictor from the bivariate analysis.
To estimate those individuals with a disorder in Denver, the calculation was carried out based on percentage of Coloradans aging 12 and above who disclosed heroin use or pain reliever disorder in the year 2015 to 2016 to estimate the population of those affected in the year 2017 in Denver

Data Analysis Statistical or
Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data).
CRAFT-T clients show took a long time to dropout which approached significance with a hazard ratio of 0.57 and p = 0.058 which indicates that they were as likely to drop out at any given point as TAU participants by 57%. For the CRAFT-T clients who had family CSOs, they showed a longer time to drop out with a hazard ratio of 0.40 and p < 0.01

From an analysis of the relationship between changes in outcome expectancy and the CBT sessions attended show that there is a correlation between CBT sessions attended(p=0.02, r=0.48) and expectancy that is negative from the decrease of heroin use at 12 months.
Drug intake had significantly improved in the two MI programs .For instance, within the MI intervention groups( p= 0.0003) drug intake had significantly reduced.
For MAT patients at DH, only 60% of them adhered to the prescribed treatment
Findings and Recommendations

General findings and recommendations of the research
The participants that had parental family CSO had higher treatment retention as compared to those that did not.
This study recommended CRAFT as a promising intervention that can be used to treat opioid-related illness.
The patients who were offered both standard methadone maintenance therapy(MMT) and CBT showed significant improvement and had a lower emotional discharge compared to the 31 who received only MMT.
This study found that both MI carried out for individuals and group sessions was potent in advocating for improvement in drug use behavior.
This study found out that there is a large rift between patients that need treatment and the capacity to treat them. Creating a periodic jurisdiction-wide assessment could help optimize the design strategies and care for OUD to actively address the gap that exists along with the continuum care.
Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of the study?

What are the risks associated with the implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice?

Strength
On the primary outcome measure there was no missing data.

Weakness
Distorted estimate if the effect size.
Lack of generalizability.
Small sample size.

Weaknesses
Small sample size.
Limited findings.

Weaknesses
Self-reported data which might lead to biasness
The study is limited to urban clients attending MM

The information was accessed in DH this can undermine rating of fulfillment for non-DH pharmacies.
The estimates are relies on individual data this can create underestimation of the OP, OUD, and OM burdens.

Key findings

IPs that were assigned to the CRAFT group had a reduction of opioid usage as compared to those who were not allocated to the group.
It was found that there is a positive correlation for cognitive avoidance months, logical analysis and emotional discharge all at 6 months.
Improvement in risky behaviors that related to drug usage was majorly impacted by the lifetime trade of sex, social support, recruitment site, and recent IDU could help in the construction of interventions for the most vulnerable groups to those who are in need.
Most of the clients with opioid-induced predicaments did not receive MAT and also there were limited resources and capacity at the national level.

Outcomes

Improved treatment retention and drug use for the patients suffering from opioid addiction

There was a reduction in heroin usage by the patients after undergoing therapy.

Both individual and group MI performed well in promoting a significant reduction of opioid abuse.

The use of the continuum of care model optimizes design strategies and care that address the gaps that exist in the continuum of care.
General Notes/Comments

This study tries to find interventions that can help patients with substance use disorder to motivate patients to take treatments.

There is a need for further development in this field.

Future research on this study using toxicology findings can contribute much to this field.

A high-level view of continuum opioid addiction can aid in identifying areas of opportunities, better monitor accuracy of diagnosing, and efficient patient engagement.

*These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide

• Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

• Level II
Quasi-experimental studies, a systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

• Level III
Nonexperimental, a systematic review of RCTs, quasi-experimental with/without meta-analysis, a qualitative, qualitative systematic review with/without meta-synthesis

• Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
• Level V
Literature reviews, quality improvement, program Assessment, financial Assessment, case reports, nationally recognized expert(s) opinion based on experiential evidence

**Note on Conceptual Framework

• The following information is from Walden academic guides which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework

• Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework.

• As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study is unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.”

• Theoretical and conceptual frameworks provide evidence of academic standards and procedure. They also offer an explanation of why the study is pertinent and how the researcher expects to fill the gap in the literature.

• Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two.

References

The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing dvidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019 from https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf

Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your” House”. Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26.

Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. Retrieved October 23, 2019 from https://academicguides.waldenu.edu/library/conceptualframework

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