Opioid ECHO: Rapid Scaling of ECHO to Address the Opioid Epidemic

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Introduction: In the United States, over 2 million adults were addicted to opioids in 2016 (1), and 63% of all accidental deaths attributed to drug overdoses were caused by opioids (2).
Incorporating team-based opioid use disorder (OUD) treatment into the primary care setting could improve access to effective care. Here, we describe how we paired the ECHO model™ with a shared services approach to increase the workforce capacity to address the growing demand for OUD treatment (3, 4).

Methods: Opioid ECHO is a 2-year, 5-hub, national ECHO program that supports primary care teams addressing this growing epidemic. Using virtual teleECHO™ sessions, healthcare providers from primary care sites connect with hub faculty for a short presentation on a topic relivant to treating OUD, followed by case-based learning. A shared curriculum is used by the five hubs, and centralized recruitment and evaluation support is provided by the ECHO Institute™. In addition to the teleECHO sessions, participants are supported through a Virtual Learning Community (VLC), in which participants interact with the Opioid ECHO community of learners and specialists to further discuss issues such as stigmatizing language and OUD treatment resources. We are using surveys and a pre/post evaluation design to understand the utility of case-based learning for Opioid ECHO, and whether participation improves participants’ confidence and attitudes toward treating OUD.

Results: Within the first year of the program, 327 multidisciplinary healthcare providers across the United States and Puerto Rico have participated in Opioid ECHO, including MDs, NPs, PAs, RNs, and counselors. Ninety-three percent of presenters reported that the case discussion changed their care plan for their patient, and 86% of participants reported that the discussion of cases presented by other participants changed some aspect of the way they care for their own patients. Participation in Opioid ECHO significantly improved participant confidence in treating OUD. There was no significant change in participant attitudes toward OUD, which may reflect that attitudes were already positive prior to participation. As we continue to collect more data from this ongoing program, we will evaluate how different covariates (i.e. program exposure, hub, state overdose rate) effect participant confidence and attitudes toward treating OUD in the primary care setting.

Conclusion: Opioid ECHO is a new model that rapidly expands the capacity to train and support primary care teams to treat OUD. Here, we show that participation in Opioid ECHO changes provider confidence to treat OUD, and case discussions result in changes in patient care plans. This approach rapidly scales the ECHO model to support primary care teams at the frontlines of the opioid epidemic.