Author ORCID Identifier

https://orcid.org/0009-0009-7406-3868

Semester

Summer

Date of Graduation

2026

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Committee Chair

Billie Vance

Committee Member

Julie Kmiec

Committee Member

Georganne Henson

Committee Member

Jin Cheng

Abstract

Introduction: Alcohol use disorder (AUD) is common among veterans and is associated with poor health outcomes. Although extended-release naltrexone (XR-NTX) is an effective treatment, maintenance injections at the VA Pittsburgh Healthcare System are only available at the main medical center, requiring many veterans to travel long distances each month.

Purpose: The purpose of this evidence-based practice policy analysis was to evaluate the feasibility of offering XR-NTX injections at Community-Based Outpatient Clinics (CBOC) and develop a policy recommendation to improve access to care.

Intervention: This project examined the current XR-NTX administration process and compared it with alternative approaches used within the Veterans Health Administration. Existing policies, stakeholder input, staff surveys, and veteran travel data were used to guide the analysis.

Methods: The Agency for Healthcare Research and Quality Data-Driven Policy Analysis Framework guided the project. Data collection occurred through policy review, stakeholder interviews, and anonymous surveys of CBOC nursing and nurse managers to identify perceived barriers. The findings were used to evaluate policy options and identify evidence-informed policy recommendations.

Results: More than half (55.1%) of veterans receiving XR-NTX at VAPHS lived closer to a CBOC than the main medical center. Staff supported expanding XR-NTX administration to CBOCs but identified the need for education, a standardized protocol, and clear pharmacy and workflow processes. Review of policies from other VA healthcare systems showed that XR-NTX is initiated at the main medical center, while subsequent maintenance injections are administered at CBOCS.

Conclusions: Revising the current standard operating procedure and providing staff training may reduce travel burden and improve access to treatment for veterans with AUD. Allowing veterans to receive XR-NTX maintenance injections at CBOCs while maintaining specialty care oversight at the main medical center is a practical way to improve access to evidence-based care.

 

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