Project ECHO and Primary Care Buprenorphine Treatment for Opioid use Disorder: Implementation and Clinical Outcomes

Abstract

Background: Our rural health system sought to (1) increase the number of primary care clinicians waivered to prescribe buprenorphine for treatment of opioid use disorder (OUD) and (2) consequently increase the number of our patients receiving this treatment. Methods: We used the Project for Extension for Community Health Outcomes (ECHO) tele-education model as an implementation strategy. We examined the number of clinicians newly waivered, the number of patients treated with buprenorphine, the relationship between clinician engagement with ECHO training and rates of buprenorphine prescribing, and treatment retention at 180 days. Results: The number of clinicians with a waiver and number of patients treated increased during and after ECHO training. There was a moderate correlation between the number of ECHO sessions attended by a clinician and number of their buprenorphine prescriptions (r ¼ 0.50, p ¼ 0.01). The 180-day retention rate was 80.7%. Conclusions: Project ECHO was highly effective for increasing access to this evidence-based treatment. The high retention rate in this rural context indicates that most patients are increasing their likelihood of favorable outcomes.

Direct and Indirect Effects of a Project ECHO Longitudinal Clinical Tele-Mentoring Program on Viral Suppression for Persons With HIV: A Population-Based Analysis

“…One study from a program designed to support treatment of opioid use disorder found a moderate correlation between number of buprenorphine prescriptions and number of sessions attended, an observation aligned with our findings. 39 Our analysis also identified a positive indirect effect of Project ECHO on VL suppression, with statistically significant improvements for patients of lower-volume providers who do not participate in Project ECHO themselves but work in the same clinic system as a provider who does participate. This is an intentional goal of Project ECHO: to promote care champions who will share knowledge and resources with local colleagues.…”

Buprenorphine Utilization and Prescribing Among New Jersey Medicaid Beneficiaries After Adoption of Initiatives Designed to Improve Treatment Access

“…[33][34][35] Support for buprenorphine prescribers like that provided by New Jersey's 2 MAT COEs, can also increase buprenorphine prescribing. [35][36][37] Importantly, synergistic factors unique to New Jersey may account for the changes in buprenorphine use and prescribing observed in this study.…”

Impact of Policy Change on Access to Medication for Opioid Use Disorder in Primary Care

“…In addition, in primary care, where providers rely on referral networks and specialists for co-management of complex conditions, access to addiction medicine specialists and behavioral health providers is crucial. Interventions that connect PCPs with specialists, provide continuing education, and increase access to behavioral health providers have been shown to increase the number of waivered PCPs and MOUD access in primary care 31–35 . To address the lack of clinical capacity endorsed by some PCPs, interventions that expand telemedicine prescribing and establish MOUD comanagement with nurse care managers and pharmacists also have been successful 36–38 .…”

“…Interventions that connect PCPs with specialists, provide continuing education, and increase access to behavioral health providers have been shown to increase the number of waivered PCPs and MOUD access in primary care. [31][32][33][34][35] To address the lack of clinical capacity endorsed by some PCPs, interventions that expand telemedicine prescribing and establish MOUD comanagement with nurse care managers and pharmacists also have been successful. [36][37][38] Stigma, although a well-documented barrier to buprenorphine treatment in primary care in the past, 17 did not emerge as a prominent barrier in our study.…”