EXT HEALTH NUTRIT
Non Technical Summary
Michigan's overdose deaths increased by 18% in 2016, and nearly three-in-four of Michigan's overdose deaths are attributable to opioids. Due to the relative isolation of residents in rural areas and the lack of access to healthcare providers, telehealth and distance learning (online) strategies are needed to reach Michigan's underserved, vulnerable rural residents in the opioid crisis. The Addressing Rural Opioid Misuse in Michigan Through Evidence-Based Health Education, Telehealth, Distance Learning, and Coalitions initiative uses a multi-level, four-aim approach to respond to the opioid crisis in rural Michigan. The first aim is to work with 15 Communities that Care (CTC) coalitions in the rural counties of Michigan's Upper Peninsula to build awareness and make collaborative plans to implement evidence-based opioid misuse prevention programs. In the second aim we cross-train recovery coaches and CTC coalition members to facilitate evidence-based opioid misuse prevention programs. The third aim is to use Grand Rounds sessions to equip physicians and mid-level healthcare providers across all rural counties in Michigan with the tools and training to make electronic patient referrals into prevention programs. The final aim is to implement evidence-based opioid misuse prevention programs with residents in all Michigan's rural counties and empower them to prevent/reduce opioid misuse by using non-pharmacological approaches to pain management. Michigan State University (MSU) Extension is partnering with the MSU College of Human Medicine on this innovative approach to the opioid crisis in Michigan's rural counties.
Animal Health Component
Research Effort Categories
Goals / Objectives
This project contains four project goals and 5 objectives. The first goal is to coordinate prevention work to decrease risk factors and increase protective factors to prevent opioid misuse in rural Michigan. The objective for goal #1 is to increase awareness of evidence-based programs and cross-referrals into prevention programs between MSU Extension and the 15 Communities that Care Coalition (CTC) within Michigan's Upper Peninsula by the end of the grant period. The second project goal is to increase capacity of recovery coaches and CTC coalition members to reduce opioid misuse through the use of prevention curricula. This goal will be accomplished through the objective of implementing at least 2 train-the-trainer leader training courses with recovery coaches, CTC coalition members, and community volunteers in Michigan's rural counties so they can deliver chronic pain and chronic disease self-management education to rural adults aged 18+ in their local communities. The third goal is to increase familiarity of Extension community-based programs and patient referral pathways among healthcare providers and ultimately increase referrals of patients to education for the prevention and self-management of chronic conditions. The objectives for this goal are to develop an electronic menu of programs and a referral pathway on the MSU Extension website for healthcare providers in rural areas and market/deliver/evaluate healthcare provider training to increase awareness of prevention programs and patient referral pathways. The final project goal is to empower rural residents, ages 18+, to use non-pharmacological approaches for pain management and reduce misuse of opioids. The objective for this goal is to plan, implement, and evaluate virtual prevention programs designed to decrease risk factors and increase protective factors to prevent opioid misuse among rural Michigan's residents, ages 18+.
The planned approached of this 24-month project includes the following four aims:Aim 1 will increase coordination of efforts to address the opioid crisis in the rural counties of Michigan's Upper Peninsula (UP). Through Aim 1 MSU Extension will make strategic connections with the 15 Communities That Care (CTC) coalitions that encompass Michigan's UP. Relationship-building meetings among coalition members and MSU Extension staff will provide the opportunity to create a community-driven opioid misuse prevention strategy. An estimated 2 to 4 virtual and/or in-person meetings will be held with the 15 coalitions. The prevention strategy may include such activities as co-branding and cross-marketing prevention work, joint implementation and evaluation of prevention programming for rural residents and cross-training instructors to facilitate evidence-based prevention programs in rural communities.Aim 2 will focus on increasing the capacity of local communities to support peer-to-peer distance-learning prevention programming for rural residents. A train-the-trainer new instructor workshop will be held to equip recovery coaches and coalition network members to implement the evidence-based Chronic Pain Self-Management Program and the Chronic Disease Self-Management Program, which teaches non-pharmacological approaches to pain and symptom management (see Aim 4 for curricula details). There will be an estimated 15 to 30 participants trained as leaders in the curricula. The 5-day train-the-trainer new instructor workshop will be taught by members of the grant's key personnel who are certified Master Trainers for the programs.Aim 3 will provide physicians and mid-level healthcare providers with the tools and training needed to refer patients into evidence-based telehealth/distance learning prevention programs. The target audience of this aim will be physicians, physician assistants, nurse practitioners, nurses, medical assistants and third-year family medicine residents. An electronic menu of evidence-based prevention programs will be developed. The menu will be an electronic version of the RX for Health prescription pads previously piloted and currently being implemented by MSU Extension. The menu will feature prevention programs that are consistently available through telehealth/distance learning modalities. Next, a HIPAA compliant electronic patient referral form and pathway will be created for use by healthcare providers. The referral pathway will generate and send an automated email to the patient with the most current listing of telehealth/distance learning prevention programs. The email will contain a link to MSU Extension's events management platform that will walk the patient through enrollment in his/her preferred prevention course. The email will also be copied to a point person who will be able to follow-up with the patient to answer questions and provide motivational interviewing to support enrollment. Links to the electronic menu, referral form and pathway will be placed on the MSU Extension website, as well as the websites of other organizations/agencies who wish to cross-market and refer participants. Finally, a CME-based one-hour "Grand Rounds" training session will be developed for healthcare providers. The grand rounds training session will (a) increase awareness of the opioid crisis within rural areas and the need for patient referrals and (b) equip healthcare providers with the tools needed to make patient referrals through the use of the electronic menu, referral form and pathway. The grand rounds sessions will be delivered online by the grant team's executive members and key personnel. There will be 8 grand rounds sessions held per year (2 per quarter) across the state.Aim 4 will empower rural residents to use non-pharmacological approaches to pain management and reduce misuse of pain medicine, including opioids and other opioid analgesics. MSU Extension key personnel, trained volunteers (e.g. recovery coaches) and coalition network members, will plan and implement online prevention classes to an estimated 1080 rural residents per year through multi-session evidence-based prevention courses and one-time presentations. One-time presentations (Session Zero classes) will be taught as a strategy to recruit participants into a series of classes. Session Zero classes will include information on alternatives to pain management medication and ways to prevent the misuse of opioids. Rural residents will have access to the following multi-session evidence-based prevention courses:Chronic pain self-management program (CPSMP) and Chronic disease self-management program (CDSMP): CDSMP and CPSMP are evidence-based programs with documented improved outcomes related to pain, fatigue, medication adherence, quality of life, sleep, health distress and communication with doctor, including among patients with depression and serious mental illness. CDSMP and CPSMP are listed as evidence-based programs on the Centers for Medicare & Medicaid Services Evaluation of Community-based Wellness and Prevention Programs. CDSMP and CPSMP are 2½-hour sessions that are taught weekly for six weeks. While most courses will be taught virtually, three series of classes to be taught in a face-to-face setting per year. This will provide accommodation for those residents who do not have easy access to the internet and/or would prefer to be learn in a face-to-face setting.Stress Less with Mindfulness (SLM) Menu: The SLM menu provides an introduction to a variety of mindfulness techniques that are typically taught in a series of 5 weekly one-hour lessons. Documented program outcomes include increased personal self-awareness of stress symptoms and use of mindful breathing and mindful movement to calm the body and mind.RELAX: Alternatives to Anger: The RELAX: Alternatives to Anger program helps participants manage anger and stress and develop the communication and problem solving skills needed for healthy relationships. Through a series of 4 lessons participants learn non-pharmacological approaches to manage psychological pain and foster healthy, supportive interpersonal relationships. Key elements of the program include learning what anger is, what triggers anger, calming down and de-stressing methods, problem solving, communication skills and forgiving and letting go of the past. MSU Extension has been teaching the RELAX program for over 15 years.All participants in Aim 4 will sign up for the courses through MSU Extension's online events management system. They will complete an online pre-survey prior to starting the evidence-based prevention courses and an online post-survey upon completion. Expected outcomes for rural residents include reductions in pain and intake of pain medication, including opioids, increased use of non-pharmacological methods of pain management and increases in confidence, knowledge and skills in pain and chronic disease symptom management.