New UNC project to create hub for connecting rural health providers with innovative techniques to combat opioid use disorders and overdose deaths
New UNC ECHO for Medication Assisted Treatment project to research barriers and enabling factors for primary care providers to offer medication assisted treatment for opioid use disorders and thereby impact opioid overdose death rates in North Carolina
[CHAPEL HILL, NC] – A new research initiative at UNC-Chapel Hill will help to increase North Carolinian’s access to best practices of specialty care through an innovative medical education model that gives rural health practitioners access to training, experts and resources not usually available to them. The first project in this new initiative will address how to treat opioid addiction and accidental overdose.
The UNC Extension for Community Healthcare Outcomes for Rural Primary Care Medication Assisted Treatment (UNC ECHO for MAT) will build capacity in North Carolina with the Project ECHO methodology through collaboration with University of New Mexico Project ECHO leaders, provide case based learning to providers, support rural practices adding a MAT service, and engage community partners to provide comprehensive care. Furthermore, the UNC ECHO for MAT will serve as a venue for Project ECHO capacity building in North Carolina.
UNC ECHO for MAT will reduce barriers to primary care providers offering medication assisted treatment (MAT) to persons with opioid use disorders and reduce deaths from accidental overdose in North Carolina by increasing knowledge about how to treat opioid addiction and expanding treatment services to underserved and rural counties. The 3-year, $2.9 million project is funded by the Agency for Healthcare Research and Quality (AHRQ).
“AHRQ has provided North Carolina with a unique opportunity to leverage the good work and knowledge of many partners working across systems in the state, from behavioral health to public health, concerned about and invested in finding solutions to this public health crisis,” said Sherri Green, PhD, MSW, LCSW, a research fellow at the Sheps Center for Health Services Research and a research assistant professor in the Department of Maternal and Child Health in the Gillings School of Global Public Health. “Through collaborative engagement and leveraging expertise, the UNC ECHO for MAT will contribute to the knowledge base about how to reduce barriers to the important role of primary care providers in MAT; and will simultaneously build both Project ECHO capacity in NC broadly and improve the clinical resources for the state to serve persons with opioid use disorders while also addressing related issues such as neonatal abstinence syndrome”.
Accidental overdose death rates from opiates in North Carolina exceed the national average and have been steadily increasing over the past 10 years. The CDC estimated the national opioid overdose death rate for 2014 to be 9.0 per 100,000. In 2014, 45 counties in North Carolina had overdose death rates over 9.0 per 100,000. According to the North Carolina Division of Public Health, 1,101 people died in 2012 from unintentional poisoning in the state, with 92% of all unintentional poisoning deaths being drug or medication related. One effective way to combat opioid addiction and thereby opioid overdoses, is Medication Assisted Treatment (MAT). There is both a shortage of MAT providers, especially in rural counties, and a need to support MAT providers through case based learning, practice supports, and a community collaborative response with treatment and other social and medical supports for patients receiving MAT.
The UNC-ECHO for MAT demonstration project will tackle these issues by seeking to better understand what prevents primary care providers from offering MAT in their practices, evaluating strategies to overcome those barriers, and working closely with providers and community and state partners to expand access initially to MAT in 22 rural and underserved counties. The project’s goal is to research and test strategies to overcome barriers to providers offering MAT and thereby reduce the risk of accidental overdose deaths through a multi-layered provider and practice engagement strategy.
In the long term, UNC ECHO will serve as a hub through which collaborative approaches to evidence based healthcare in NC will be enhanced. Clinical faculty and researchers on the team are collaborating with others to explore ways to expand the reach and longevity of the UNC ECHO effort.
Dr. Green has partnered with communities and state agencies to expand access to evidence based practice and conduct research in addiction and integrated health care for more than 25 years. The research team also includes co-investigators Marisa Domino, PhD, professor in the Department of Health Policy and Management in the Gillings School of Global Public Health and director of the Program on Mental Health and Substance Abuse Systems and Services Research at the Cecil G. Sheps Center for Health Services Research and Christopher Shea, PhD, assistant professor in the Department of Health Policy and Management with expertise in organizational behavior and health informatics. Participating faculty from the UNC School of Medicine, School of Social Work, and the Gillings School of Global Public Health, as well as community addiction medicine experts serving on the multidisciplinary UNC ECHO for MAT team, bring experience ranging from rural family practice approaches to MAT for pain management to treatment of neonatal abstinence syndrome and dual diagnosis treatment, as well as policy and systems expertise.
Some of the barriers to using MAT include lack of training for primary care physicians, concerns about a patient’s ability to follow through with treatment, workload practice resource limitations, isolation or lack of support for the practitioner, difficulties in connecting patients with community resources, and stigma associated with substance use disorders and use of MAT. The UNC ECHO team will collaborate with Local Management Entity-Managed Care Organizations for mental health and substance use disorder services (LME/MCO) staff and providers, Community Care of North Carolina, the Governors Institute, AHECs and the NC Harm Reduction Coalition to address these concerns.
The project will offer participating providers continuing medical education (CME) credits to be certified as MAT providers, physician to physician case consultation, CME through tele-trainings and tele-case conferences to help implement a MAT program, as well as practice based office staff support. The research team will track how many practitioners prescribe MAT and the effectiveness of provider level interventions to reduce barriers to providing MAT. Medicaid and BCBS claims data and a robust systematic approach to qualitative research will be used to assess both barriers and enabling supports.
“We are both honored and excited to be part of this important effort in North Carolina and are committed to collaborating with others on related efforts in NC and nationally,” Green said.
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