Association of MOUD ECHO Participation on Expansion of Buprenorphine Prescribing in Rural Primary Care

Julie G Salvador; Orrin B Myers; Snehal R Bhatt; Vanessa Jacobsohn; Larissa Lindsey; Rana S Alkhafaji; Heidi Rishel Brakey; Andrew L Sussman

doi:10.1177/08897077231198971

Association of MOUD ECHO Participation on Expansion of Buprenorphine Prescribing in Rural Primary Care

Subst Abus. 2023 Oct;44(4):282-291. doi: 10.1177/08897077231198971. Epub 2023 Oct 30.

Authors

Julie G Salvador¹, Orrin B Myers², Snehal R Bhatt¹, Vanessa Jacobsohn¹, Larissa Lindsey³, Rana S Alkhafaji¹, Heidi Rishel Brakey⁴, Andrew L Sussman²

Affiliations

¹ Department of Psychiatry and Behavioral Sciences, University of New Mexico, Health Sciences Center, Albuquerque, NM, USA.
² Department of Family and Community Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
³ Addictions and Substance Abuse Programs, University of New Mexico Hospital, Albuquerque, NM, USA.
⁴ Clinical and Translational Science Center, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.

PMID: 37902036
DOI: 10.1177/08897077231198971

Abstract

Background: Lack of access to buprenorphine to treat Opioid Use Disorder is profound in rural areas where over half of small and remote rural counties have no buprenorphine prescriber. To increase prescribing, an online, Medication of Opioid Use Disorder (MOUD) Extensions for Community Healthcare Outcomes (ECHO) was developed that addressed known barriers to the startup and expansion of treatment. The objective of the present study was to determine the relationship between participating in MOUD ECHO sessions and prescribing of buprenorphine for OUD in rural primary care.

Methods: Using non-random, rolling-recruitment from Feb 2018 to October of 2021, all rural primary care clinics in New Mexico were contacted via phone call and fax to recruit providers (Physicians, Nurse Practitioners, and Physician Assistants) who had no or limited buprenorphine experience to enroll in this study. Participation in the MOUD ECHO was tracked across the 12 week series. Start-up and expansion of buprenorphine treatment was measured every 3 months for up to 2 years using 5 implementation benchmarks spanning training completion, obtaining licensure, prescribing and adding patients. Using a dose-response intention to treat type analysis, associations between number of sessions and benchmark achievement were analyzed using logistic regression.

Results: Eighty providers were enrolled, mostly female (66%) white (82%), non-Hispanic (82%), and mostly nurse practitioners (51%) or MDs (38%). Achievement of prescribing benchmarks at 6 months was significantly increased by attendance at MOUD ECHO sessions including obtaining training and licensure Odds Ratio (OR = 1.24; P = .001); starting to prescribe (OR = 1.31; P = .004), and adding patients (OR = 1.14; P = .025).

Conclusions: This study provides compelling evidence that MOUD ECHO participation may significantly increase the number of providers implementing this treatment and adding patients onto their panels. The dose-response approach helps address current gaps in ECHO research that call for more rigorous examination of the ECHO model's impact on provider practice improvements.

Keywords: ECHO; buprenorphine; opioids; primary care; rural; treatment.

MeSH terms

Buprenorphine* / therapeutic use
Female
Humans
Male
Opiate Substitution Treatment
Opioid-Related Disorders* / drug therapy
Physicians*
Primary Health Care

Substances

Buprenorphine