Client and stakeholder perceptions of a novel, nurse practitioner-led alcohol and other drug ambulatory withdrawal service.

INTRODUCTION: Despite recommendations for ambulatory withdrawal programs appearing in many contemporary alcohol and other drug treatment guidelines, to date there have been few studies exploring such programs from client and service stakeholder perspectives. The aim of this study was to explore both individual and service stakeholder perceptions of a nurse practitioner-led ambulatory withdrawal service on the Gold Coast, Queensland, Australia. METHODS: Data were obtained from three groups: clinicians with knowledge of the service (n = 6); relatives of clients who had used the service (n = 2); and clients who had used the service (n = 10) using a Qualitative Descriptive design. Saldaña's (Saldaña, The coding manual for qualitative researchers. 2013) structural coding framework was used to analyse and code data into themes, with the study reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist (Tong et al. Int J Qual Health Care 2017;19:349-57). RESULTS: Participants noted advantages of the nurse practitioner-led ambulatory withdrawal service, including rapid availability of admission to the service and a person-centred approach. Compared with other ambulatory withdrawal options, clients valued the ability to remain in their own environment, however participants suggested greater follow-up after withdrawal, with the potential of a home visiting service for greater client engagement and treatment retention. DISCUSSION AND CONCLUSIONS: Findings provide evidence to suggest that nurse practitioner-led ambulatory withdrawal services are an acceptable option for a proportion of clients who need rapid access to services when they wish to make changes to their alcohol and/or other drug use. Furthermore, they can provide person-centred care for comorbid physical and mental ill health occurring in addition to psychosocial issues associated with alcohol and/or other drug use.

Barriers and facilitators to becoming an alcohol and other drug nurse practitioner in Australia: A mixed methods study.

Alcohol and other drug (AOD) nurse practitioners have an advanced scope of practice that allows them to diagnose, prescribe pharmacological treatments for alcohol and other substance use disorders, and monitor physical and mental health. The Behaviour Change Wheel (BCW) is used to understand barriers and facilitators to implementation by applying three conditions of behaviour change (capability, opportunity, and motivation-the COM-B framework). The aim of this paper is to describe the current AOD nurse practitioner workforce, and to explore barriers and facilitators to AOD nurse practitioner uptake in Australia. A mixed method approach was used in this study: a survey to determine the current state of the AOD nurse practitioner workforce (n = 41) and qualitative interviews with 14 participants to determine barriers to endorsement and ongoing work as a nurse practitioner. Interview transcripts were analysed using thematic analysis and mapped to the COM-B framework. The AOD nurse practitioner is a highly specialized provider of holistic care to people who use alcohol and other drugs, with AOD nurse practitioners performing advanced roles such as prescribing and medication management. However, there are several barriers to the further uptake of AOD nurse practitioners in Australia, including varied organizational support, a lack of support for the higher study required to become a nurse practitioner and a lack of available positions. Arguably, nurse practitioners are key to addressing prescriber shortages inherent in AOD treatment settings. In addition, they are equipped to provide true holistic care. We recommend that barriers are addressed to expand the AOD nurse practitioner workforce in Australia.

Undergraduate nursing student knowledge and attitudes of healthcare consumers with problematic alcohol and other drug use: A scoping review.

Problematic alcohol and other drug use has a significant societal, personal, and financial burden. Nurses are key in responding to problematic alcohol and other drug use; however, research indicates many nurses hold negative attitudes towards people with substance and alcohol use disorders. Further, little content exists in most undergraduate degrees to address stigma held by new nurses. The objective of this scoping review, structured using Arksey and O'Malley's (International Journal of Social Research Methodology: Theory and Practice, 8 (1), 19-32, 2005) framework, is to examine studies that either explore or attempt to improve the knowledge and attitudes of undergraduate nurses caring for people who use alcohol and other drugs. Our initial search located 610 articles, and after screening, 14 articles were appraised using the Mixed Methods Appraisal Tool (MMAT) and included in this review. Most of the papers appraised were small, localized studies using evaluation methods considered low quality, but showed promising results in addressing stigma and confidence in providing care to people who use alcohol and other drugs. This review indicates that a consistent direction for improving knowledge and attitudes among undergraduate nursing students working with people who use alcohol and other drugs is urgently needed. Further studies of interventions, tested with more rigorous evaluation methodologies, are required to extend existing work in this area.

Nursing Knowledge of Alcohol and Other Drugs (AOD) in a Regional Health District: An Exploratory Study.

Nurses remain at the forefront of direct patient care due to the nature of their role; they are in a position to provide assessment, response and referral of individuals in healthcare settings with problematic alcohol and other drug (AOD) use. We aim to determine the AOD knowledge of nurses in a regional health district in Australia and the awareness of an AOD service operating in the clinical environment. We employed a cross-sectional online survey, with descriptive and correlational analysis performed to explore relations between knowledge and both assessment and referral practices for individuals with problematic AOD use. Results indicate good knowledge of the AOD service, with confidence to refer to the service associated with recent contact. Lower satisfaction levels with the AOD service were found in nurses who had no recent contact with the service. Awareness of the service was also positively associated with completion of the electronic AOD assessment. These results indicate that the presence of experienced AOD clinicians may increase familiarity with AOD services and increase screening. Given the link between familiarity and comfort with the AOD service and referral, establishing specialised AOD nursing positions remains an important strategy. We argue that the presence of specialised AOD nurses has a flow on effect in maintaining continuing screening and encouraging nurses to refer individuals with problematic AOD use for ongoing care and treatment.

The clinician impact and financial cost to the NHS of litigation over pregabalin: a cohort study in English primary care.

OBJECTIVES: Following litigation over pregabalin's second-use medical patent for neuropathic pain, National Health Service (NHS) England was required by the court to instruct general practitioners (GPs) to prescribe the branded form (Lyrica) for pain. Pfizer's patent was found invalid in 2015, a ruling subject to ongoing appeals. If the Supreme Court appeal in February 2018, whose judgement is awaited, is unsuccessful, the NHS can seek to reclaim excess prescribing costs. We set out to describe the variation in prescribing of pregabalin as branded Lyrica, geographically and over time; to determine how clinicians responded to the NHS England instruction to GPs; and to model excess costs to the NHS attributable to the legal judgements. SETTING: English primary care. PARTICIPANTS: English general practices. PRIMARY AND SECONDARY OUTCOME MEASURES: Variation in prescribing of branded Lyrica across the country before and after the NHS England instruction, by practice and by Clinical Commissioning Group; excess prescribing costs. RESULTS: The proportion of pregabalin prescribed as Lyrica increased from 0.3% over 6 months before the NHS England instruction (September 2014 to February 2015) to 25.7% afterwards (April to September 2015). Although 70% of pregabalin is estimated to be for pain, including neuropathic pain, only 11.6% of practices prescribed Lyrica at this level; the median proportion prescribed as Lyrica was 8.8% (IQR 1.1%-41.9%). If pregabalin had come entirely off patent in September 2015, and Pfizer had not appealed, we estimate the NHS would have spent £502 million less on pregabalin to July 2017. CONCLUSION: NHS England instructions to GPs regarding branded prescription of pregabalin were widely ignored and have created much debate around clinical independence in prescribing. Protecting revenue from 'skinny labels' will pose a challenge. If Pfizer's final appeal on the patent is unsuccessful, the NHS can seek reimbursement of excess pregabalin prescribing costs, potentially £502 million.

Holographic stripes.

We construct inhomogeneous asymptotically anti-de Sitter black hole solutions corresponding to the spontaneous breaking of translational invariance and the formation of striped order in the boundary field theory. We find that the system undergoes a second-order phase transition in both the fixed density and fixed chemical potential ensembles, for sufficiently large values of the axion coupling. We investigate the phase structure as a function of the temperature, axion coupling, and the stripe width. The bulk solutions have striking geometrical features related to a magnetoelectric effect associated with the existence of a near-horizon topological insulator. At low temperatures, the horizon becomes highly inhomogeneous and tends to pinch off.