Friedman Sarah A, Lewandowski Michael, Patterson Denis G, Snyder Paul, Sangoleye Dotun, Jorgensen Troy C, Militante Nathan, Lavi Mordechai S
Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, 1664 North Virginia Street, Reno, NV 89557, United States.
Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Nevada, 1664 North Virginia Street, Reno, NV 89557, United States.
Health Educ Res. 2025 May 15;40(3). doi: 10.1093/her/cyaf019.
Previous evaluations of the pain care-related Extension for Community Healthcare Outcomes (ECHO) telementoring programmes found that long-term programmes (16-52 weeks) improve clinician knowledge, self-efficacy, and prescribing practices. We evaluated a 6- to 7-week Pain Management ECHO in Nevada Medicaid clinician networks. We collected pre- and post-knowledge and self-efficacy scores from 15 of 18 unique ECHO participants (83% response rate). We derived opioid prescribing outcomes from 44 894 Medicaid pharmacy claims records from 11 ECHO participants and 10 comparison clinicians. The three outcomes included any opioid (binary), non-opioid pain medication (binary), and opioid dose (continuous). Logistic regressions using difference-in-difference (DID) estimated the ECHO treatment effects. Knowledge scores (75% to 82%) and self-efficacy scores (3.4-4.1) increased after ECHO participation. After ECHO participation, opioid prescribing decreased, and non-opioid prescribing increased; changes in both outcomes were above and beyond changes in the comparison group (any opioid DID treatment effect: -0.6 percentage points; non-opioid pharmacologic: 1.1 percentage points). Incremental changes across three domains of Moore's Framework for continuing medical education provide evidence supporting a short-duration ECHO intervention in partnership with Medicaid managed care. Promulgation of this less resource-intensive approach can sustainably aid clinicians in managing pain experienced by Medicaid beneficiaries.
先前对社区医疗保健成果扩展计划（ECHO）中与疼痛护理相关的远程指导项目的评估发现，长期项目（16 - 52周）可提高临床医生的知识水平、自我效能感和处方实践能力。我们对内华达州医疗补助临床医生网络中为期6至7周的疼痛管理ECHO项目进行了评估。我们从18名独特的ECHO参与者中的15名收集了知识和自我效能感的前后测分数（回复率83%）。我们从11名ECHO参与者和10名对照临床医生的44894份医疗补助药房报销记录中得出阿片类药物处方结果。这三个结果包括任何阿片类药物（二元变量）、非阿片类疼痛药物（二元变量）和阿片类药物剂量（连续变量）。使用双重差分法（DID）的逻辑回归估计了ECHO的治疗效果。参与ECHO项目后，知识分数（从75%提高到82%）和自我效能感分数（从3.4提高到4.1）有所增加。参与ECHO项目后，阿片类药物处方减少，非阿片类药物处方增加；这两个结果的变化均超出了对照组的变化（任何阿片类药物的DID治疗效果：-0.6个百分点；非阿片类药物：1.1个百分点）。摩尔继续医学教育框架三个领域的增量变化为与医疗补助管理式医疗合作开展短期ECHO干预提供了支持证据。推广这种资源密集度较低的方法可以持续帮助临床医生管理医疗补助受益人的疼痛。
