Department of Psychiatry and Behavioral Sciences, Health Sciences Center, University of New Mexico, Albuquerque, New Mexico, USA.
Addictions and Substance Abuse Program, University of New Mexico Hospital, Albuquerque, New Mexico, USA.
Subst Abus. 2021;42(4):610-617. doi: 10.1080/08897077.2020.1806184. Epub 2020 Aug 19.
Buprenorphine combined with psychosocial support is the standard of care for treatment of opioid use disorder (OUD) in office-based primary care settings. However, uptake of this treatment has been slow due to a number of addressable barriers including providers' lack of training, staffing concerns, stigma and the need for ongoing support and consultation. This study examined acceptability and feasibility of an online Extensions for Community Healthcare Outcomes (ECHO) model intervention developed to support rural primary care clinics to expand treatment and is part of a larger study tracking the impact of participation in this ECHO on expansion of MOUD in rural primary care. We developed a comprehensive, 12-week online education and mentorship intervention using ECHO aimed at supporting the entire primary care clinic to start or expand treatment using MOUD, psychosocial treatments and recovery supports. We tracked participation and collected feedback using qualitative interviews and post-session questionnaires. Sixty-seven primary care staff across 27 rural clinics in New Mexico participated in the study including 32 prescribers and 35 clinic support staff. Average participation was 4/12 sessions. Post-session questionnaires showed positive feedback, including that 95% or more respondents agreed or strongly agreed that the sessions were relevant and improved their confidence. Qualitative interview themes included strong endorsement of the ECHO curriculum. Clinical duties were the most common barrier to attending sessions. Engagement of 27 clinics, the range of staff and providers who participated, and positive feedback gathered through survey and qualitative interviews provide evidence of feasibility and acceptability of MOUD ECHO to support expansion of this treatment. However, barriers to participation present an important threat to feasibility. Understanding feasibility and acceptability is an important component of research on the impact of ECHO to expand MOUD treatment.
丁丙诺啡联合心理社会支持是治疗门诊初级保健环境中阿片类药物使用障碍（OUD）的标准治疗方法。然而，由于一些可解决的障碍，包括提供者缺乏培训、人员配备问题、污名化以及对持续支持和咨询的需求，这种治疗方法的采用一直很缓慢。这项研究考察了一种在线扩展社区医疗保健结果（ECHO）模型干预措施的可接受性和可行性，该干预措施旨在支持农村初级保健诊所扩大治疗范围，这是一项更大规模研究的一部分，该研究跟踪了参与该 ECHO 对农村初级保健中扩大 OUD 治疗的影响。 我们开发了一种综合的、为期 12 周的在线教育和指导干预措施，使用 ECHO 旨在支持整个初级保健诊所开始或扩大使用 OUD、心理社会治疗和康复支持的治疗。我们通过定性访谈和课后问卷调查来跟踪参与情况并收集反馈。 来自新墨西哥州 27 个农村诊所的 67 名初级保健工作人员参与了这项研究，包括 32 名处方医生和 35 名诊所支持人员。平均参与率为 12 节课中的 4 节。课后问卷调查显示出积极的反馈，包括 95%或更多的受访者同意或强烈同意课程相关且提高了他们的信心。定性访谈主题包括对 ECHO 课程的大力支持。临床职责是参加课程的最常见障碍。 参与的 27 家诊所、参与的员工和提供者的范围以及通过调查和定性访谈收集的积极反馈为支持扩大这种治疗方法的 MOUD ECHO 的可行性和可接受性提供了证据。然而，参与的障碍对可行性构成了重要威胁。了解可行性和可接受性是研究 ECHO 扩大 OUD 治疗影响的重要组成部分。
