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Adams ZW, Smoker MP, Marriott BR, Mermelstein SP, Ojo O, Aalsma MC, Hulvershorn LA. A Statewide Consultation Helpline for Rapid Linkage to Services for Youths With Opioid Use Disorder and Other Substance Use. Psychiatr Serv 2024:appips20230289. [PMID: 38835252 DOI: 10.1176/appi.ps.20230289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVE The authors examined the initial implementation of the Indiana Adolescent Addiction Access (AAA) program, modeled on the widely disseminated Child Psychiatry Access Program framework. The AAA program developed a statewide consultation helpline to connect health care providers with adolescent addiction specialists. METHODS The AAA line was staffed by a coordinator, who fielded initial questions, and on-call clinical specialists (social workers, nurse practitioners, psychiatrists, and psychologists), who were paged to complete telephone consultations and provide care recommendations. When necessary, AAA providers offered urgent clinical assessments and initiated treatment. Descriptive analyses were performed for key variables over the first 21 months of AAA operations. RESULTS From July 2021 to March 2023, a total of 125 consultations were completed. Most callers were health care providers (71%) or parents (27%). Calls pertained to youths ages 10-18 years (mean±SD age=16.4±1.3; 62% of callers were male, 84% White, and 11% Black), with concerns around cannabis (63%), opioids (38%), and other substances. About 26% of calls related to an overdose, and 41% of cases were rated as severe. Recommendations included starting new medications (17%) or outpatient therapy (86%), and 17% of consultations resulted in urgent evaluations. CONCLUSIONS The Indiana AAA program helps overcome key barriers to adolescent substance use treatment. Increasing the capacity to initiate medication for opioid use disorder and other treatment rapidly through consultation and direct care is a promising, scalable approach for preventing overdose deaths among youths.
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Affiliation(s)
- Zachary W Adams
- Adolescent Behavioral Health Research Program (Adams, Smoker, Marriott, Mermelstein, Aalsma, Hulvershorn), Department of Psychiatry (Adams, Smoker, Marriott, Mermelstein, Ojo, Hulvershorn), and Department of Pediatrics (Aalsma), Indiana University School of Medicine, Indianapolis
| | - Michael P Smoker
- Adolescent Behavioral Health Research Program (Adams, Smoker, Marriott, Mermelstein, Aalsma, Hulvershorn), Department of Psychiatry (Adams, Smoker, Marriott, Mermelstein, Ojo, Hulvershorn), and Department of Pediatrics (Aalsma), Indiana University School of Medicine, Indianapolis
| | - Brigid R Marriott
- Adolescent Behavioral Health Research Program (Adams, Smoker, Marriott, Mermelstein, Aalsma, Hulvershorn), Department of Psychiatry (Adams, Smoker, Marriott, Mermelstein, Ojo, Hulvershorn), and Department of Pediatrics (Aalsma), Indiana University School of Medicine, Indianapolis
| | - Sharon P Mermelstein
- Adolescent Behavioral Health Research Program (Adams, Smoker, Marriott, Mermelstein, Aalsma, Hulvershorn), Department of Psychiatry (Adams, Smoker, Marriott, Mermelstein, Ojo, Hulvershorn), and Department of Pediatrics (Aalsma), Indiana University School of Medicine, Indianapolis
| | - Olawale Ojo
- Adolescent Behavioral Health Research Program (Adams, Smoker, Marriott, Mermelstein, Aalsma, Hulvershorn), Department of Psychiatry (Adams, Smoker, Marriott, Mermelstein, Ojo, Hulvershorn), and Department of Pediatrics (Aalsma), Indiana University School of Medicine, Indianapolis
| | - Matthew C Aalsma
- Adolescent Behavioral Health Research Program (Adams, Smoker, Marriott, Mermelstein, Aalsma, Hulvershorn), Department of Psychiatry (Adams, Smoker, Marriott, Mermelstein, Ojo, Hulvershorn), and Department of Pediatrics (Aalsma), Indiana University School of Medicine, Indianapolis
| | - Leslie A Hulvershorn
- Adolescent Behavioral Health Research Program (Adams, Smoker, Marriott, Mermelstein, Aalsma, Hulvershorn), Department of Psychiatry (Adams, Smoker, Marriott, Mermelstein, Ojo, Hulvershorn), and Department of Pediatrics (Aalsma), Indiana University School of Medicine, Indianapolis
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Schuler MS, Dick AW, Gordon AJ, Saloner B, Kerber R, Stein BD. Growing importance of high-volume buprenorphine prescribers in OUD treatment: 2009-2018. Drug Alcohol Depend 2024; 259:111290. [PMID: 38678682 DOI: 10.1016/j.drugalcdep.2024.111290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND We examined the number and characteristics of high-volume buprenorphine prescribers and the nature of their buprenorphine prescribing from 2009 to 2018. METHODS In this observational cohort study, IQVIA Real World retail pharmacy claims data were used to characterize trends in high-volume buprenorphine prescribers (clinicians with a mean of 30 or more active patients in every month that they were an active prescriber) during 2009-2018. Very high-volume prescribing (mean of 100+ patients per month) was also examined. RESULTS Overall, 94,491 clinicians prescribed buprenorphine dispensed during 2009-2018. The proportion of active prescribers meeting high-volume criteria increased from 7.4 % in 2009 to 16.7 % in 2018. High-volume prescribers accounted for 80 % of dispensed buprenorphine prescriptions during 2009-2018; very high-volume prescribers accounted for 26 %. Adult primary care physicians consistently comprised the majority of high-volume prescribers. Addiction specialists were much more likely to be high-volume prescribers compared to other specialties, including psychiatrists and pain specialists. By 2018, the proportion of prescriptions from high-volume prescribers paid by Medicaid had doubled to 40 %, accompanied by a decline in both self-pay and commercial insurance. High-volume prescribers were overwhelmingly concentrated in urban counties with the highest fatal overdose rates. In 2018, the highest density of high-volume prescribers was in New England and the mid-Atlantic region. CONCLUSIONS Growth in high-volume prescribers outpaced the overall growth in buprenorphine prescribers across 2009-2018. High-volume prescribers play an increasingly central role in providing medication for OUD in the U.S., yet results indicate key regional variation in the availability of high-volume buprenorphine prescribers.
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Affiliation(s)
- Megan S Schuler
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202, USA.
| | - Andrew W Dick
- RAND Corporation, 20 Park Plaza #920, Boston, MA 022, USA
| | - Adam J Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA; Department of Internal Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Rose Kerber
- RAND Corporation, 20 Park Plaza #920, Boston, MA 022, USA
| | - Bradley D Stein
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, USA
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Heerema MR, Ventura AS, Blakemore SC, Montoya ID, Gobel DE, Kiang MV, LaBelle CT, Bazzi AR. Evaluation of the New England Office Based Addiction Treatment ECHO: A Tool for Strengthening the Addiction Workforce. Subst Abus 2023; 44:164-176. [PMID: 37287240 PMCID: PMC10688578 DOI: 10.1177/08897077231179601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Reducing substance-related morbidity requires an educated and well-supported workforce. The New England Office Based Addiction Treatment Extension for Community Healthcare Outcomes (NE OBAT ECHO) began in 2019 to support community-based addiction care teams through virtual mentoring and case-based learning. We sought to characterize the program's impact on the knowledge and attitudes of NE OBAT ECHO participants. METHODS We conducted an 18-month prospective evaluation of the NE OBAT ECHO. Participants registered for 1 of 2 successive ECHO clinics. Each 5-month clinic included ten 1.5-hour sessions involving brief didactic lectures and de-identified patient case presentations. Participants completed surveys at Month-0, -6, -12, and -18 to assess attitudes about working with patients who use drugs and evidence based practices (EBPs), stigma toward people who use drugs, and addiction treatment knowledge. We compared outcomes using 2 approaches: (i) between-groups, which involved comparing the first intervention group to the delayed intervention (comparison) group, and (ii) within-groups, which involved comparing outcomes at different time points for all participants. In the within-group approach, each participant acted as their own control. RESULTS Seventy-six health professionals participated in the NE OBAT ECHO, representing various roles in addiction care teams. Approximately half (47% [36/76]) practiced primary care, internal, or family medicine. The first intervention group reported improved job satisfaction and openness toward EBPs compared to the delayed intervention group. Within-group analyses revealed that ECHO participation was associated with increased positive perceptions of role adequacy, support, legitimacy, and satisfaction 6 months following program completion. No changes were identified in willingness to adopt EBPs or treatment knowledge. Stigma toward people who use drugs was persistent in both groups across time points. CONCLUSIONS NE OBAT ECHO may have improved participants' confidence and satisfaction providing addiction care. ECHO is likely an effective educational tool for expanding the capacity of the addiction workforce.
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Affiliation(s)
- Matthew R. Heerema
- General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Alicia S. Ventura
- General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Samantha C. Blakemore
- General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Ivan D. Montoya
- General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
- Division of Health Services Research and Policy, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Danna E. Gobel
- General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Mathew V. Kiang
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - Colleen T. LaBelle
- General Internal Medicine, Boston Medical Center, Boston, MA, United States of America
- Grayken Center for Addiction Medicine, Boston Medical Center, Boston, MA, United States of America
- Boston University School of Medicine, Boston, MA, United States of America
| | - Angela R. Bazzi
- Boston University School of Public Health, Boston, MA, United States of America
- Herbert Wertheim School of Public Health, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, United States of America
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Lutgen C, Callen E, Robertson E, Clay T, Filippi MK. Implementation and Evaluation of Primary Care Team Participation in Opioid Use Disorder Learning Sessions. Subst Abus 2023; 44:51-61. [PMID: 37226899 DOI: 10.1177/08897077231174675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Previous studies show that some primary care clinicians do not feel equipped to treat patients with opioid use disorder (OUD). This study addressed the gaps in confidence and knowledge of primary care physicians and other participants (i.e., participants who were not physicians) in diagnosing, treating, prescribing, and educating patients with OUD through interactive learning sessions. METHODS The American Academy of Family Physicians National Research Network held monthly OUD learning sessions from September 2021 to March 2022 with physicians and other participants (n = 31) from 7 practices. Participants took baseline (n = 31), post-session (n = 11-20), and post-intervention (n = 21) surveys. Questions focused on confidence, knowledge, among others. We used non-parametric tests to compare individual responses pre-versus-post participation as well as to compare responses between groups. RESULTS All participants experienced significant changes in confidence and knowledge for most topics covered in the series. When comparing physicians to other participants, physicians had greater increases in confidence in dosing and monitoring for diversion (P = .047), but other participants had greater increases in confidence in the majority of topic areas. Physicians also had greater increases in knowledge than other participants in dosing and monitoring for safety (P = .033) and dosing and monitoring for diversion (P = .024), whereas other participants had greater increases in knowledge in most remaining topics. Participants agreed that sessions provided practical knowledge, except for relevancy of the case study portion of the session to current practice (P = .023) and the session improved participant ability to care for patients (P = .044). CONCLUSION Through participating in interactive OUD learning sessions, knowledge and confidence increased among physicians and other participants. These changes may impact participants' decisions to diagnose, treat, prescribe, and educate patients with OUD.
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Affiliation(s)
- Cory Lutgen
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
| | - Elisabeth Callen
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
| | - Elise Robertson
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
| | - Tarin Clay
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
| | - Melissa K Filippi
- American Academy of Family Physicians, National Research Network, Leawood, KS, USA
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Oliver AP, Bell LA, Agley J, Bixler K, Hulvershorn LA, Adams ZW. Examining the Efficacy of Project ECHO to Improve Clinicians' Knowledge and Preparedness to Treat Adolescent Vaping. Clin Pediatr (Phila) 2022; 61:869-878. [PMID: 35774009 PMCID: PMC10591463 DOI: 10.1177/00099228221107816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As adolescent vaping reaches epidemic rates in the United States, it is imperative that pediatric clinicians have access to medical knowledge on best practices for screening, assessing, and treating vaping-related substance use. The Teen Vaping ECHO (Extension for Community Healthcare Outcomes) program was developed to offer practical learning sessions focused on clinical management of adolescent vaping. This study describes the development, implementation, and evaluation of the program's impact on participants' knowledge, attitudes, and practices regarding treatment of adolescent vaping from registration to the end of the series. Participants were generally knowledgeable about vaping at registration and reported significant increases in comfort talking with patients about vaping, counseling patients on nicotine replacement products, and frequency of implementing best-practice screening strategies at the end of the series. This study suggests ECHO programs focused on improving clinical management of adolescent vaping may increase accessibility of evidence-based care and reduce harms associated with vaping in youth.
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Affiliation(s)
- Alexander P. Oliver
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lauren A. Bell
- Department of Pediatrics-Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jon Agley
- Department of Applied Health Science, School of Public Health Bloomington, Indiana University, Bloomington, IN, USA
| | - Kristina Bixler
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Leslie A. Hulvershorn
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Zachary W. Adams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Wood BR, Bauer K, Lechtenberg R, Buskin SE, Bush L, Capizzi J, Crutsinger-Perry B, Erly SJ, Menza TW, Reuer JR, Golden MR, Hughes JP. Direct and Indirect Effects of a Project ECHO Longitudinal Clinical Tele-Mentoring Program on Viral Suppression for Persons With HIV: A Population-Based Analysis. J Acquir Immune Defic Syndr 2022; 90:538-545. [PMID: 35499527 PMCID: PMC9283242 DOI: 10.1097/qai.0000000000003007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Project Extension for Community Health Outcomes (ECHO) aims to connect community providers to academic specialists, deliver longitudinal clinical mentorship and case consultations, plus encourage dissemination of knowledge and resources. The impact on outcomes for persons with HIV (PWH) is uncertain. SETTING PWH in Washington and Oregon outside of the Seattle and Portland metro areas, January 2011 to March 2018. METHODS Using viral load (VL) surveillance data, we assessed difference in the percentage of PWH who were virally suppressed among PWH whose providers participated versus did not participate in Project ECHO. Analyses included multiple mixed-effects regression models, adjusting for time and for patient, provider, and clinic characteristics. RESULTS Based on 65,623 VL results, Project ECHO participation was associated with an increase in the percentage of patients with VL suppression (13.7 percentage points greater; P < 0.0001), although the effect varied by estimated provider PWH patient volume. The difference was 14.7 percentage points ( P < 0.0001) among patients of providers who order <20 VL's/quarter and 2.3 and -0.6 percentage points among patients of providers who order 20-40 or >40 VL's/quarter, respectively ( P > 0.5). The magnitude of difference in VL suppression was associated with the number of sessions attended. Among patients of lower-volume providers who did not participate, VL suppression was 6.2 percentage points higher if providers worked in a clinic where another provider did participate ( P < 0.0001). CONCLUSION Project ECHO is associated with improvement in VL suppression for PWH whose providers participate or work in the same clinic system as a provider who participates, primarily because of benefits for patients of lower-volume providers.
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Affiliation(s)
- Brian R. Wood
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA
- Mountain West AIDS Education and Training Center, Seattle, WA, USA
| | - Karin Bauer
- Mountain West AIDS Education and Training Center, Seattle, WA, USA
| | | | - Susan E. Buskin
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Lea Bush
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| | - Jeff Capizzi
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| | | | | | - Timothy W. Menza
- Public Health Division, Oregon Health Authority, Portland, OR, USA
| | | | - Matthew R. Golden
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, USA
- Public Health – Seattle and King County HIV/STD Program, Seattle, WA, USA
| | - James P. Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
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