Barriers and perceived usefulness of an ECHO intervention for office-based buprenorphine treatment for opioid use disorder in North Carolina: A qualitative study
Barriers and perceived usefulness of an ECHO intervention for office-based buprenorphine treatment for opioid use disorder in North Carolina: A qualitative study
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DOI：
10.1080/08897077.2019.1694617
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发表时间：
2019-12-06
期刊：
影响因子：
3.5
通讯作者：
Green, Sherri L.
中科院分区：
文献类型：
--
作者：
Shea, Christopher M.;Gertner, Alex K.;Green, Sherri L.
背景：阿片类药物使用障碍（M-OUD）的药物治疗未得到充分利用，尽管研究表明其治疗阿片类药物使用障碍（OUD）的有效性。北卡罗来纳大学农村初级保健药物辅助治疗社区卫生保健成果推广项目（北卡罗来纳大学药物辅助治疗项目ECHO）旨在评估减少北卡罗来纳农村初级保健提供者提供M-OUD障碍的干预措施。一个关键要素是基于新墨西哥大学项目ECHO模式的远程会议，包括案例讨论和使用“中心和辐条”模式的教学演示，由中心站点的专家团队成员和社区提供者从其办公室（即辐条站点）参与。尽管联邦资助者已经推广了该模式的使用，但提供者参与ECHO会议的障碍并没有很好的记录。方法：针对MAT的UNC ECHO包括ECHO会话、提供者对提供者咨询和实践指导。我们进行了20次半结构化访谈，以评估UNC ECHO对MAT干预的感知有用性、参与干预的障碍以及开M-OUD处方的持续障碍。结果：参与者对ECHO会话和提供者对提供者咨询总体满意；然而，实践支持的感知价值不太清楚。参加ECHO会议的主要障碍是会议的时间和时间。与会者建议录下ECHO会话供以后观看，一些人认为对实践或提供者的奖励可以促进参与。参加人道主义事务部会议的提供者重视专家小组的专门知识；团队建立支持性、合议性环境的能力；一个有兴趣相互学习的提供者社区的价值，特别是通过案例讨论。结论：尽管认知到ECHO的价值，但障碍可能会阻碍持续参与。此外，M-OUD交付的障碍仍然存在，包括一些单靠ECHO无法解决的问题，如医疗补助和私人保险政策以及社会心理资源的可用性。
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.