Feasibility and acceptability of an online ECHO intervention to expand access to medications for treatment of opioid use disorder, psychosocial treatments and supports

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Keywords:

• Implementation science
• ECHO model
• medications for treatment of opioid use disorder
• primary care
• rural

Acknowledgments

Thanks to Rebecca Fowler, Jerrilynn Ritz, Magdalena WcWethy, Justin Martinez and Jesus Fuentes for recruitment and data collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Drs. Salvador, Bhatt, Sussman, Jacobsohn and. Maley have all contributed substantially to the conception and design of the MAT ECHO intervention. Drs. Salvador and Sussman additionally have led the design and implementation of the associated study, and Dr. Bhatt has contributed substantially to data analysis and interpretation. Dr. Myers and Heidi Rishel Brakey led data analysis and interpretation. Dr. Salvador, Dr. Sussman, Ms. Rishel Brakey, and Ms. Alkafaji, have all contributed significantly to data acquisition including database development, data collection, and data cleaning and storage. All authors listed participated in interpretation of data and presentation of data for the present manuscript. Drs. Salvador, Bhatt, Sussman, Jacobsohn, Maley, Ms. Alkafaji and Ms. Rishel Brakey contributed to the drafting of this article including conception of the idea for this publication, literature review, and its contribution to the literature and to the advancement of public health. All authors have reviewed this final manuscript version and give final approval.

Data availability statement

Data for this manuscript can be made available upon reasonable request to the corresponding author.

Additional information

Funding

This work was supported by the Agency for Healthcare Research and Quality [1R18HS025345]; and the University of New Mexico Clinical and Translational Science Center [CTSC, UL1TR001449]. 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.