Barriers and perceived usefulness of an ECHO intervention for office-based buprenorphine treatment for opioid use disorder in North Carolina: A qualitative study

Abstract

Background

Medication treatment for opioid use disorder (M-OUD) is underutilized, despite research demonstrating its effectiveness in treating opioid use disorder (OUD). The UNC Extension for Community Healthcare Outcomes for Rural Primary Care Medication Assisted Treatment (UNC ECHO for MAT) project was designed to evaluate interventions for reducing barriers to delivery of M-OUD by rural primary care providers in North Carolina. A key element was tele-conferenced sessions based on the University of New Mexico Project ECHO model, comprised of case discussions and didactic presentations using a “hub and spoke” model, with expert team members at the hub site and community-based providers participating from their offices (i.e., spoke sites). Although federal funders have promoted use of the model, barriers for providers to participate in ECHO sessions are not well documented. Methods: UNC ECHO for MAT included ECHO sessions, provider-to-provider consultations, and practice coaching. We conducted 20 semi-structured interviews to assess perceived usefulness of the UNC ECHO for MAT intervention, barriers to participation in the intervention, and persistent barriers to prescribing M-OUD. Results: Participants were generally satisfied with ECHO sessions and provider-to-provider consultations; however, perceived value of practice support was less clear. Primary barriers to participating in ECHO sessions were timing and length of sessions. Participants recommended recording ECHO sessions for viewing later, and some thought incentives for either the practice or provider could facilitate participation. Providers who had participated in ECHO sessions valued the expertise on the expert team; the team’s ability to develop a supportive, collegial environment; and the value of a community of providers interested in learning from each other, particularly through case discussions. Conclusions: Despite the perceived value of ECHO, barriers may prevent consistent participation. Also, barriers to M-OUD delivery remain, including some that ECHO alone cannot address, such as Medicaid and private-insurer policies and availability of psychosocial resources.

Keywords:

• Primary health care
• medication assisted treatment
• opioid use disorder
• ECHO
• implementation barriers

Author contributions

Christopher M. Shea led this qualitative study effort, led development of the interview guide, participated in conducting interviews, led data analysis, and led the manuscript writing. AG participated in developing the interview guide, led the interviews, participated in data analysis, and contributed substantially to writing the manuscript. SG is the principal investigator, led the overall study and intervention design for UNC ECHO for MAT, contributed to this qualitative study effort, the interview guide, participated in interpretation of the findings, and contributed to the manuscript. Each author reviewed the final version of the manuscript.

Additional information

Funding

This project was funded by the Agency for Health Care Research and Quality [1R18HS025065-01] and the North Carolina Department of Health and Human Services [TI17014]. Alex Gertner received support from the National Institute on Drug Abuse [F30DA044668]. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of AHRQ, NC DHHS, or NIDA.