Association of MOUD ECHO Participation on Expansion of Buprenorphine Prescribing in Rural Primary Care.

IF 2.8 3区 医学 Q2 SUBSTANCE ABUSE Substance abuse Pub Date : 2023-10-01 Epub Date: 2023-10-30 DOI:10.1177/08897077231198971
Julie G Salvador, Orrin B Myers, Snehal R Bhatt, Vanessa Jacobsohn, Larissa Lindsey, Rana S Alkhafaji, Heidi Rishel Brakey, Andrew L Sussman
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Abstract

Background: Lack of access to buprenorphine to treat Opioid Use Disorder is profound in rural areas where over half of small and remote rural counties have no buprenorphine prescriber. To increase prescribing, an online, Medication of Opioid Use Disorder (MOUD) Extensions for Community Healthcare Outcomes (ECHO) was developed that addressed known barriers to the startup and expansion of treatment. The objective of the present study was to determine the relationship between participating in MOUD ECHO sessions and prescribing of buprenorphine for OUD in rural primary care.

Methods: Using non-random, rolling-recruitment from Feb 2018 to October of 2021, all rural primary care clinics in New Mexico were contacted via phone call and fax to recruit providers (Physicians, Nurse Practitioners, and Physician Assistants) who had no or limited buprenorphine experience to enroll in this study. Participation in the MOUD ECHO was tracked across the 12 week series. Start-up and expansion of buprenorphine treatment was measured every 3 months for up to 2 years using 5 implementation benchmarks spanning training completion, obtaining licensure, prescribing and adding patients. Using a dose-response intention to treat type analysis, associations between number of sessions and benchmark achievement were analyzed using logistic regression.

Results: Eighty providers were enrolled, mostly female (66%) white (82%), non-Hispanic (82%), and mostly nurse practitioners (51%) or MDs (38%). Achievement of prescribing benchmarks at 6 months was significantly increased by attendance at MOUD ECHO sessions including obtaining training and licensure Odds Ratio (OR = 1.24; P = .001); starting to prescribe (OR = 1.31; P = .004), and adding patients (OR = 1.14; P = .025).

Conclusions: This study provides compelling evidence that MOUD ECHO participation may significantly increase the number of providers implementing this treatment and adding patients onto their panels. The dose-response approach helps address current gaps in ECHO research that call for more rigorous examination of the ECHO model's impact on provider practice improvements.

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MOUD ECHO协会参与扩大农村初级保健中的丁丙诺啡处方。
背景:在农村地区,缺乏丁丙诺啡治疗阿片类药物使用障碍的机会是严重的,因为超过一半的偏远农村小县没有丁丙诺菲处方医生。为了增加处方,开发了一个在线的阿片类药物使用障碍(MOUD)社区医疗保健结果扩展(ECHO),解决了启动和扩大治疗的已知障碍。本研究的目的是确定参加MOUD ECHO会议与在农村初级保健中为OUD开具丁丙诺啡处方之间的关系。方法:从2018年2月到2021年10月,通过非随机滚动招募,通过电话和传真联系新墨西哥州所有农村初级保健诊所,招募没有或有限丁丙诺啡经验的提供者(医生、执业护士和医生助理)参加本研究。对12个缔约方参与谅解备忘录ECHO的情况进行了跟踪 周系列。丁丙诺啡治疗的启动和扩展每3次测量一次 最多2个月 使用5个实施基准,涵盖培训完成、获得许可、开处方和增加患者。使用剂量反应意向治疗类型分析,使用逻辑回归分析疗程次数和基准成绩之间的关联。结果:80名提供者被纳入,其中大多数是女性(66%)、白人(82%)、非西班牙裔(82%),大多数是执业护士(51%)或MD(38%)。在6时达到规定基准 通过参加MOUD ECHO会议,包括获得培训和执照的比值比(OR = 1.24;P = .001);开始开处方(或 = 1.31;P = .004),并添加患者(OR = 1.14;P = .025)。结论:这项研究提供了令人信服的证据,表明MOUD ECHO的参与可能会显著增加实施这种治疗并将患者加入其小组的提供者数量。剂量反应方法有助于解决目前ECHO研究中的空白,这些空白要求更严格地检查ECHO模型对提供者实践改进的影响。
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来源期刊
Substance abuse
Substance abuse SUBSTANCE ABUSE-
CiteScore
5.90
自引率
2.90%
发文量
88
审稿时长
>12 weeks
期刊介绍: Now in its 4th decade of publication, Substance Abuse journal is a peer-reviewed journal that serves as the official publication of Association for Medical Education and Research in Substance Abuse (AMERSA) in association with The International Society of Addiction Medicine (ISAM) and the International Coalition for Addiction Studies in Education (INCASE). Substance Abuse journal offers wide-ranging coverage for healthcare professionals, addiction specialists and others engaged in research, education, clinical care, and service delivery and evaluation. It features articles on a variety of topics, including: Interdisciplinary addiction research, education, and treatment Clinical trial, epidemiology, health services, and translation addiction research Implementation science related to addiction Innovations and subsequent outcomes in addiction education Addiction policy and opinion International addiction topics Clinical care regarding addictions.
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