ECHO-F Model to Expand Medication Assisted Treatment in Rural Primary Care

ECHO-F 模型扩大农村初级保健的药物辅助治疗

基本信息

项目摘要

Project Summary Opioids, primarily prescription pain relievers and heroin, are the main driver of overdose deaths. Opioids were involved in 28,647 deaths in 2014 and opioid overdoses have quadrupled since 2000 (CDC, 2015). In New Mexico, rates of OUDs are among the highest in the nation-- 28 of its 33 counties rank above the national average in drug overdose death rates (NM DOH, 2016). The challenge of addressing OUDs in New Mexico is exacerbated by devastating primary care shortages and the rural composition of the population with an estimated 58% of NM’s primary care needs unmet (HRSA, 2016) and majority of NM counties (27/33) designated as micropolitan, rural or frontier (Ingram, 2013). Medication-Assisted Treatment (MAT) is an evidence-based and comprehensive approach to treating OUD using FDA approved medications combined with psychosocial and community based services/supports. Despite its potential, it is vastly underutilized in primary care. For rural areas, one of the main sources of health care is the primary care clinic. Efforts to expand MAT have encountered persistent challenges. The Extensions for Community Healthcare Outcomes ECHO© model provides a strong televideo-based strategy for improving practices in primary care. It combines didactic and problem-based learning and has been shown to be effective in improving treatment of Hepatitis C (Arora, 2011). The model has spread widely across a range of health outcomes including behavioral health but little is known about its effectiveness in these new arenas. In fact, a recent review of ECHO studies shows that very little has been published on the model’s efficacy or implementation outcomes (Zhou, 2016). Existing research that documents provider changes in knowledge, attitudes and self-efficacy indicates the model’s strong potential for improving practice in behavioral health (Katzman et al., 2016). Therefore, a study that implements this potentially strong model and includes a focus on implementation outcomes as well as feasibility for behavioral health is long overdue. The present study will implement the ECHO model with a minimum of 80 rural primary care providers across 80 clinics, and include additional clinic staff for comprehensive MAT team training. It will track implementation outcomes and feasibility measures with participating providers. In addition, this study will include added support, as identified/needed, for any provider that does not reach implementation benchmarks within expected timeframes. This combined approach is referred to as ECHO-F and reflects education models such as competency-based learning (US Department of Education, 2016) that provides individualized support, when needed, to help learners achieve desired learning/skills outcomes. Implementation benchmarks achieved via ECHO alone and those that require additional support will be carefully documented to understand the relative contribution of these components and describe possible areas for adaptation of the ECHO model. Specific Aims: 1.Establish infrastructure for ECHO-F training, support and data collection Assemble advisory board; finalize, training schedule and content; data collection instruments; protocols 2.Implement ECHO-F with rural primary care providers: a. Identify & recruit primary care provider practices; minimum of 80 prescribers across 80 clinics with 160 additional clinic staff over 4 years of the study (target: 240 providers total) b. Train in MAT via ECHO model; monitor implementation benchmarks; provide individual support as needed/requested to accomplish benchmarks 3. Conduct a systematic assessment of implementation and feasibility factors: a. Describe ECHO-F participation (participants; in televideo sessions & individualized supports provided) b. inferential analysis of baseline data and ECHO-F participation related to accomplishment of implementation benchmarks. c. Final reports; adaptation of ECHO-F model; develop/submit multi-site effectiveness study of ECHO-F This study will be supported within an exceptionally research strong, rurally focused, collaborative environment. The Department of Psychiatry and Behavioral Sciences (DPBS) at the University of NM Health Sciences Center is the largest academic health complex in the state. The study PI, Julie Salvador, PhD, with DPBS has led many federally funded rural studies in rural NM, including a study of a model to improve evidence-based practice implementation and successfully recruited over 300 providers in this study. The main study partner is the Department of Family and Community Medicine (DFCM) and study co-investigator Andrew Sussman, PhD, has led many primary care-based research projects statewide and is director of a practice based research network in the state. The ECHO model was developed by Sanjeev Arora, MD at UNM who will provide guidance in the model and who has directly trained the ECHO MAT expert in this study, Snehal Bhatt, MD. William Miller, PhD, developer of Motivational Interviewing has trained study MI lead Jennifer Hettema, PhD, directly. Michael Bogenschutz, MD, will provide research consultation and is nationally known for his opioid use and substance use disorders research.
项目摘要 阿片类药物,主要是处方止痛药和海洛因,是过量死亡的主要驱动因素。阿片类药物 2014年有28,647人死亡,阿片类药物过量自2000年以来翻了两番(CDC,2015)。在……里面 新墨西哥州的出生率在全国名列前茅--33个县中有28个在全国排名以上。 药物过量死亡率的平均水平(新墨西哥州卫生部,2016)。在新墨西哥州解决ODS的挑战是 破坏性的初级保健短缺和农村人口构成加剧了这种情况 估计58%的NM初级保健需求未得到满足(HRSA,2016)和大多数NM县(27/33) 被指定为微型、农村或边疆(英格拉姆,2013年)。药物辅助治疗(MAT)是一种 联合使用FDA批准的药物治疗OUD的循证综合方法 提供心理社会和社区服务/支持。尽管它的潜力很大,但在 初级保健。对于农村地区,初级保健诊所是卫生保健的主要来源之一。努力实现 Expansion MAT遇到了持续的挑战。 社区医疗保健成果扩展Echo?模型提供了强大的基于远程视频的 改进初级保健做法的战略。它结合了指导性学习和基于问题的学习,并具有 已被证明在改善丙型肝炎治疗方面是有效的(Arora,2011)。这一模式得到了广泛的推广 包括行为健康在内的一系列健康结果,但对其在 这些新竞技场。事实上,最近对ECHO研究的回顾表明,关于Echo的研究发表的很少 模型的有效性或实施结果(周,2016)。文档提供商的现有研究 知识、态度和自我效能感的变化表明该模式具有改进实践的强大潜力 在行为健康方面(Katzman等人,2016)。因此,一项实施这一潜在强大模型的研究 并将重点放在实施结果以及行为健康的可行性上,这是早就应该的。 本研究将在全国至少80个农村初级保健提供者中实施ECHO模式 80个诊所,并包括额外的诊所工作人员,以进行全面的垫子团队培训。它将跟踪实施情况 与参与提供者的结果和可行性措施。此外,这项研究将包括添加 根据确定/需要,为未达到以下实施基准的任何提供商提供支持 预期的时间范围。这种组合方法被称为Echo-F,它反映了如下教育模式 作为基于能力的学习(美国教育部,2016),提供个性化支持,当 需要,以帮助学习者实现预期的学习/技能结果。通过以下方式实现的实施基准 仅限ECHO和需要额外支持的项目将被仔细记录,以了解相关 这些组成部分的贡献,并描述了回声模型可能适用的领域。 具体目标: 1.为ECHO-F培训、支持和数据收集建立基础设施 组建咨询委员会;最后确定培训时间表和内容;数据收集工具;协议 2.在农村初级保健提供者中实施ECHO-F: A.确定并招募初级保健提供者做法;在80家诊所至少80名处方医生,160名 在研究的4年内增加诊所工作人员(目标:总共240名提供者) B.通过ECHO模型进行MAT培训;监控实施基准;提供个人支持,如 完成基准所需/所需 3.对实施和可行性因素进行系统评估: A.描述ECHO-F的参与情况(参与者;参加电视视频会议并提供个性化支持) B.基线数据的推论分析和ECHO-F参与与实现 实施基准。 C.最终报告;ECHO-F模型的改编;开发/提交ECHO-F的多站点有效性研究 这项研究将在一个特别强大的、专注于乡村的、协作的研究中得到支持 环境。新墨西哥州健康大学精神病学和行为科学系 科学中心是该州最大的学术健康综合体。研究,Julie萨尔瓦多,博士,与 DPBS在新墨西哥州农村地区领导了许多由联邦资助的农村研究,包括一项改进模式的研究 循证实践的实施,并在这项研究中成功招募了300多名提供者。主 研究伙伴是家庭和社区医学部(DFCM)和研究合作调查员安德鲁 萨斯曼博士曾在全州范围内领导过许多以初级保健为基础的研究项目,并是一家诊所的负责人 基于该州的研究网络。回声模型是由新墨西哥州大学医学博士Sanjeev Arora开发的,他将 在模型中提供指导,谁在这项研究中直接培训了回声垫专家Snehal Bhatt, 马里兰州威廉·米勒博士,激励访谈的开发者,培训了研究MI的负责人Jennifer Hettema, 博士学位,直接。Michael Bogenschutz医学博士将提供研究咨询,他以他的 阿片类药物使用和物质使用障碍研究。

项目成果

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Julie G. Salvador其他文献

5.47 THE IMPACT OF NURTURING PARENTING ON HARMFUL ATTITUDES IN A PREGNANT-POSTPARTUM RESIDENTIAL SUBSTANCE ABUSE TREATMENT CENTER COHORT
  • DOI:
    10.1016/j.jaac.2016.09.305
  • 发表时间:
    2016-10-01
  • 期刊:
  • 影响因子:
  • 作者:
    Shawn S. Sidhu;Anilla Del Fabbro;Caroline Bonham;Danielle K. Duran;Annette Crisanti;Julie G. Salvador
  • 通讯作者:
    Julie G. Salvador

Julie G. Salvador的其他文献

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{{ truncateString('Julie G. Salvador', 18)}}的其他基金

ECHO-F Model to Expand Medication Assisted Treatment in Rural Primary Care
ECHO-F 模型扩大农村初级保健的药物辅助治疗
  • 批准号:
    10221050
  • 财政年份:
    2017
  • 资助金额:
    $ 38.33万
  • 项目类别:

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