Els Duff is an assistant professor in the College of Nursing, Rady Faculty of Health Sciences, University of Manitoba and is a nurse practitioner (NP). Dr. Duff has completed large and small scale projects related to nurses and nurse practitioners in Canada and Internationally. Her research interests include nurse practitioner practice and substance use, nurse education, or health human resources using health data linkage from administrative data, GIS geographical data visualization, developing infographics, qualitative methods, quantitative methods, and content mapping/synthesis.
Node Funded Project (January 2021)
Title: Utilizing Nurse Practitioners to Increase Access to Opioid Agonist Therapy: A Cross-sectional Study in the Prairie Provinces
Primary Investigator: Els Duff, University of Manitoba
Dr. Tammy O’Rourke, Diana Ashfied, Ashley Devenney, Cindy Fehr, Shahid Shams, Steven Wintoniw
This CRISM node project builds on a study of nurse practitioner (NP) practice patterns, such as prescribing, in Alberta, Manitoba, and Saskatchewan to identify barriers/facilitator associate to NP-led opioid agonist therapy (OAT). Canada is currently in the midst of an opioid epidemic. Despite consuming the second highest volume of prescription opioids in the world per capita, Canadians still face steep barriers to access treatment for opioid misuse disorder. Current efforts to address this crisis include prescribing a class of opioid drugs known as OAT in the hopes of reducing untoward risks, such as hospitalization and death attributed to street opioid use. NPs prescribe all classes of drugs, including high-risk, controlled medications, such as OAT, yet no studies have examined the OAT prescribing practices of NPs. Consequently, this study will be the first known study to examine the environments and OAT practices of NPs. Moreover, this study will provide high-quality survey data to inform the extent of NP-led OAT prescribing in Alberta, Manitoba and Saskatchewan. This project serves to address the gap in research by examining the prevalence of NPs prescribing OAT and fulfilling a vital community need. This research will be fundamental to inform OAT service delivery as the first known study in Canada to examine NPs as a point of access to care for substance users. The CRISM support will be used to develop a CIHR grant on priority funding that addresses optimization of system adaptation and organization of care and the healthcare workforce.
Our 2021 findings reveal that there are a scarce number of nurse practitioner (NP) prescribers in Manitoba, Saskatchewan, and Alberta which maybe a significant contributing factor for access to safe opioids. We are researching the lack of regulated opioid prescribers further, as in Canada, physicians and NPs who meet specified education and practice requirements are authorized to prescribe Methadone or Buprenorphine for opioid use disorder. Yet, a limited number of physicians and NPs have adopted OAT as routine practice even though it has been available in Canada for the past 60 years. This problem needs further examination, given the increasing opioid deaths.