Key Lessons Learned in Medication-Assisted Treatment Implementation
- What the Data Show:
- The study is nearing its final year. Current data show the Extensions for Community Healthcare Outcomes (ECHO) model is helpful for starting or expanding MAT for opioid use disorder in rural primary care in New Mexico.
- Published data show that participants have overall positive experience with the ECHO-F intervention (Salvador et al, 2019; Salvador et al 2020).
- Many providers ask for and engage in additional supports to help them start or expand MAT (called “facilitation”).
- Additional Support:
- Requesting additional "facilitation" support is common among clinics participating in the intervention. This support is primarily clinical and is provided via email or telephone outside of ECHO clinic hours. In many cases additional support helps to keep them on track in starting and expanding MAT.
- Some clinics participating in the ECHO-F intervention have not succeeded in expanding MAT. For some of these clinics, ECHO sessions and additional supports are not enough to support them. Often this is because clinic leadership and/or providers have determined they cannot start MAT due to lack of clinic staff or other behavioral health supports. Therefore, do not fully engage in the facilitation support process.
- Lack of Time and Clinic Leadership Support:
- The most common barriers to joining ECHO-F are lack of time due to clinical demands and lack of clinic administrative support. Not supporting providers and staff to participate is also related to willingness to start or expand MAT services at the clinic.
- Current data (first quarter of 2021, N = 41 clinics as of April 2021) continue to show positive impacts of ECHO-F on MAT expansion.
- Twenty-eight clinics (68%) have made progress toward prescribing. Of these, 22 out of 41 clinics (53%) had providers either start prescribing for first time or add patients onto their panels.
- Seven clinics have not yet completed data collection (17%).
- Six clinics (15%) did not start MAT or withdrew; the study team continues to reach out to provide additional support and offer to reengage them.
In the News
- From Pages to Practice (a Psychiatric Services podcast) – Engagement With Project ECHO to Increase Medication-Assisted Treatment in Rural Primary Care
- The study has engaged providers and staff from 45 clinics to date in ECHO-F, with enrollment continuing through 2021.
- MAT services are expanding in New Mexico; 482 new patients have been started on MAT in the ECHO-F stud clinics.
- The 12-session curriculum developed for the ECHO-F study is innovative and can help expand MAT nationally.
- A manuscript detailing this curriculum has been published in Substance Abuse (2020).
Conferences & Publications
|North American Primary Care Research Group||November 20-24, 2020||Virtual|
|North American Primary Care Research Group||November 16-20, 2019||Toronto, ON|
|WONCA World Rural Health Conference||October 12-15, 2019||Albuquerque, NM|
|Global Implementation Conference||September 15-17, 2019||Glasgow, UK|
|National Association for Rural Mental Health||August 26-29, 2019||Albuquerque, NM|
Oral Presentation Poster
- Cole ES, DiDomenico E, Green S, Heil SK, Hilliard T, Mossburg SE, Sussman AL, Warwick J, Westfall JM, Zittleman L, Salvador JG. The who, the what, and the how: A description of strategies and lessons learned to expand access to medications for opioid use disorder in rural America. Substance Abuse. 2021 Apr 3;42(2):123-9.
- Salvador JG, Bhatt SR, Jacobsohn VC, Maley LA, Alkhafaji RS, Rishel Brakey H, Myers OB, Sussman AL. Feasibility and acceptability of an online ECHO intervention to expand access to medications for treatment of opioid use disorder, psychosocial treatments and supports. Substance Abuse. 2020 Aug 12:1-8. doi: 10.1080/08897077.2020.1806184
- Salvador J, Bhatt S, Fowler R, Ritz J, James R, Jacobsohn V, Brakey HR, Sussman AL. Engagement with Project ECHO to increase medication-assisted treatment in rural primary care. Psychiatric Services. 2019 Dec 1;70(12):1157-60. https://doi.org/10.1176/appi.ps.201900142