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Association of Project ECHO Training With Buprenorphine Prescribing by Primary Care Clinicians in Minnesota for Treating Opioid Use Disorder

IMPORTANCE: Buprenorphine is an approved medication for opioid use disorder (MOUD); however, prescribing buprenorphine is limited by a requirement to obtain a waiver to prescribe it (hereinafter, “DATA [Drug Abuse Treatment Act]–waiver”) and a lack of knowledge of the best practices among clinicians...

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Autores principales: Solmeyer, Anna R., Berger, Aaron T., Barton, Sean L., Nguyen, Benjamin, Bart, Gavin B., Grahan, Brian, Bell, Heather J., DeVine, Kurt M., Merrick, Weston
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675001/
https://www.ncbi.nlm.nih.gov/pubmed/36399352
http://dx.doi.org/10.1001/jamahealthforum.2022.4149
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author Solmeyer, Anna R.
Berger, Aaron T.
Barton, Sean L.
Nguyen, Benjamin
Bart, Gavin B.
Grahan, Brian
Bell, Heather J.
DeVine, Kurt M.
Merrick, Weston
author_facet Solmeyer, Anna R.
Berger, Aaron T.
Barton, Sean L.
Nguyen, Benjamin
Bart, Gavin B.
Grahan, Brian
Bell, Heather J.
DeVine, Kurt M.
Merrick, Weston
author_sort Solmeyer, Anna R.
collection PubMed
description IMPORTANCE: Buprenorphine is an approved medication for opioid use disorder (MOUD); however, prescribing buprenorphine is limited by a requirement to obtain a waiver to prescribe it (hereinafter, “DATA [Drug Abuse Treatment Act]–waiver”) and a lack of knowledge of the best practices among clinicians. OBJECTIVE: To examine how Project ECHO (Extension for Community Healthcare Outcomes) telementoring is associated with changes in DATA-waiver attainment and buprenorphine prescribing among primary care clinicians in Minnesota. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective matched-cohort study of 918 clinicians, ECHO-trained clinicians were enrolled on the date they first attended ECHO (January 3, 2018, to June 11, 2020); comparison clinicians were assigned an enrollment date from the distribution of the first ECHO sessions. The baseline period was 12 months preceding enrollment, with follow-up for 18 months or until June 30, 2020. The ECHO-trained clinicians were a population-based sample of primary care clinicians who treated Medicaid patients in Minnesota 12 months prior to the initiation of ECHO training. This analysis used propensity score matching to select comparison clinicians who were similar across demographic and clinical practice characteristics at baseline in a 2:1 ratio. Follow-up was available for 167 ECHO-trained clinicians (54.6%) and 330 comparison clinicians (53.9%) at 18 months. EXPOSURES: ECHO-trained clinicians attended at least 1 weekly, hour-long ECHO session. Comparison clinicians never participated in any ECHO sessions. MAIN OUTCOMES AND MEASURES: DATA-waiver attainment, any buprenorphine prescribing, and the percentage of patients with opioid use disorder (OUD) who were prescribed buprenorphine. RESULTS: The final sample included 918 clinicians (ECHO-trained [306]; comparison [612]), of whom 620 (67.5%) practiced outside the metropolitan Twin Cities (Minneapolis–St Paul) region. The mean (SD) age of the ECHO-trained clinicians was 46.0 (12.1) years and that of the comparison clinicians was 45.7 (12.3) years. Relative to the changes among the matched comparison clinicians, the ECHO-trained clinicians were more likely to obtain a DATA-waiver (difference-in-differences, 22.7 percentage points; 95% CI, 15.5-29.9 percentage points; P < .001) and prescribe any buprenorphine (16.5 percentage points; 95% CI, 10.4-22.5 percentage points; P < .001) after 6 quarters of follow-up. ECHO-trained clinicians prescribed buprenorphine to a greater share of patients with OUD (a difference of 7.6 percentage points per month; 95% CI, 4.6-10.6 percentage points per month; P < .001), relative to that prescribed by the comparison clinicians. CONCLUSIONS AND RELEVANCE: According to the findings of this matched-cohort study, ECHO telementoring may be associated with greater prescribing of buprenorphine by primary care clinicians. These findings suggest that Project ECHO training could be a useful tool for expanding access to MOUD.
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spelling pubmed-96750012022-12-05 Association of Project ECHO Training With Buprenorphine Prescribing by Primary Care Clinicians in Minnesota for Treating Opioid Use Disorder Solmeyer, Anna R. Berger, Aaron T. Barton, Sean L. Nguyen, Benjamin Bart, Gavin B. Grahan, Brian Bell, Heather J. DeVine, Kurt M. Merrick, Weston JAMA Health Forum Original Investigation IMPORTANCE: Buprenorphine is an approved medication for opioid use disorder (MOUD); however, prescribing buprenorphine is limited by a requirement to obtain a waiver to prescribe it (hereinafter, “DATA [Drug Abuse Treatment Act]–waiver”) and a lack of knowledge of the best practices among clinicians. OBJECTIVE: To examine how Project ECHO (Extension for Community Healthcare Outcomes) telementoring is associated with changes in DATA-waiver attainment and buprenorphine prescribing among primary care clinicians in Minnesota. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective matched-cohort study of 918 clinicians, ECHO-trained clinicians were enrolled on the date they first attended ECHO (January 3, 2018, to June 11, 2020); comparison clinicians were assigned an enrollment date from the distribution of the first ECHO sessions. The baseline period was 12 months preceding enrollment, with follow-up for 18 months or until June 30, 2020. The ECHO-trained clinicians were a population-based sample of primary care clinicians who treated Medicaid patients in Minnesota 12 months prior to the initiation of ECHO training. This analysis used propensity score matching to select comparison clinicians who were similar across demographic and clinical practice characteristics at baseline in a 2:1 ratio. Follow-up was available for 167 ECHO-trained clinicians (54.6%) and 330 comparison clinicians (53.9%) at 18 months. EXPOSURES: ECHO-trained clinicians attended at least 1 weekly, hour-long ECHO session. Comparison clinicians never participated in any ECHO sessions. MAIN OUTCOMES AND MEASURES: DATA-waiver attainment, any buprenorphine prescribing, and the percentage of patients with opioid use disorder (OUD) who were prescribed buprenorphine. RESULTS: The final sample included 918 clinicians (ECHO-trained [306]; comparison [612]), of whom 620 (67.5%) practiced outside the metropolitan Twin Cities (Minneapolis–St Paul) region. The mean (SD) age of the ECHO-trained clinicians was 46.0 (12.1) years and that of the comparison clinicians was 45.7 (12.3) years. Relative to the changes among the matched comparison clinicians, the ECHO-trained clinicians were more likely to obtain a DATA-waiver (difference-in-differences, 22.7 percentage points; 95% CI, 15.5-29.9 percentage points; P < .001) and prescribe any buprenorphine (16.5 percentage points; 95% CI, 10.4-22.5 percentage points; P < .001) after 6 quarters of follow-up. ECHO-trained clinicians prescribed buprenorphine to a greater share of patients with OUD (a difference of 7.6 percentage points per month; 95% CI, 4.6-10.6 percentage points per month; P < .001), relative to that prescribed by the comparison clinicians. CONCLUSIONS AND RELEVANCE: According to the findings of this matched-cohort study, ECHO telementoring may be associated with greater prescribing of buprenorphine by primary care clinicians. These findings suggest that Project ECHO training could be a useful tool for expanding access to MOUD. American Medical Association 2022-11-18 /pmc/articles/PMC9675001/ /pubmed/36399352 http://dx.doi.org/10.1001/jamahealthforum.2022.4149 Text en Copyright 2022 Solmeyer AR et al. JAMA Health Forum. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Solmeyer, Anna R.
Berger, Aaron T.
Barton, Sean L.
Nguyen, Benjamin
Bart, Gavin B.
Grahan, Brian
Bell, Heather J.
DeVine, Kurt M.
Merrick, Weston
Association of Project ECHO Training With Buprenorphine Prescribing by Primary Care Clinicians in Minnesota for Treating Opioid Use Disorder
title Association of Project ECHO Training With Buprenorphine Prescribing by Primary Care Clinicians in Minnesota for Treating Opioid Use Disorder
title_full Association of Project ECHO Training With Buprenorphine Prescribing by Primary Care Clinicians in Minnesota for Treating Opioid Use Disorder
title_fullStr Association of Project ECHO Training With Buprenorphine Prescribing by Primary Care Clinicians in Minnesota for Treating Opioid Use Disorder
title_full_unstemmed Association of Project ECHO Training With Buprenorphine Prescribing by Primary Care Clinicians in Minnesota for Treating Opioid Use Disorder
title_short Association of Project ECHO Training With Buprenorphine Prescribing by Primary Care Clinicians in Minnesota for Treating Opioid Use Disorder
title_sort association of project echo training with buprenorphine prescribing by primary care clinicians in minnesota for treating opioid use disorder
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675001/
https://www.ncbi.nlm.nih.gov/pubmed/36399352
http://dx.doi.org/10.1001/jamahealthforum.2022.4149
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