Nudges and Incentives to Enhance the Opioid Treatment Workforce
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 73
- 试验地点
- 2
- 主要终点
- Number of Recruited Providers That Contact Staff for Information About Enrolling in the Study
研究概览
简要总结
This project seeks to examine a critical barrier to optimizing the health care workforce for the treatment of opioid use disorders. Without a dramatic increase in the number of primary care providers trained and comfortable with the many nuances of prescribing medication-assisted treatment (MAT), the staggering increases in opioid overdose deaths will continue to skyrocket. However, Drug Addiction Treatment Act (DATA) 2000 waiver training alone is not enough to facilitate prescribing for patients who desperately need services; an estimated 40% of physicians with waivers do not initiate MAT prescriptions. To address this problem, North Carolina developed a learning collaborative framework to promote MAT training. Learning collaboratives have been shown to be an efficacious approach to increase utilization of MAT, but engagement among providers in North Carolina has been low. To date, the need to encourage provider collaborative participation at scale has not been addressed. This is the critical problem focused on in this proposal.
The death rate from accidental opioid overdoses continues to climb at an alarming rate, with overdose deaths in 2016 almost five times the number from 1999. The daily death rate from opioid overdoses in the U.S. alone is now estimated at 115, so every day that evidence-based treatment is not available leads to more preventable deaths. North Carolina is one of the states with both an opioid overdose death rate greater than the national average (11.9 vs 10.4 deaths per 100,000, age-adjusted) and a rate of increase in opioid overdose deaths greater than the national average (19% vs. 16%). North Carolina is also one of four states with an Agency for Healthcare Research and Quality (AHRQ) funded Extension for Community Healthcare Outcomes (ECHO) MAT learning collaborative available to primary care practices, but engagement among providers is low. While the main barriers to engagement are incompletely understood, recent evidence from provider interviews conducted by the study team in December 2017 and January 2018 suggest that one substantial barrier is the time required for weekly ECHO clinics.
详细描述
This study is designed to assess how to effectively recruit and enroll primary care providers into participation into an ECHO MAT learning collaborative. For study participants that enroll in the learning collaborative, the study team will track participation over 6 months.
The study is designed to be implemented in two phases. Phase 1 is the recruitment phase. Providers will be randomized to receive recruitment letters and emails from 1 of 4 conditions. Randomization for this phase will occur at the practice level, as determined by provider address.
Participants that contact the study team and enroll in the study will begin Phase 2 of the study. In Phase 2 of the study participants will be randomly assigned to rewards for participation in ECHO MAT learning collaborative. Their participation in the learning collaborative will be tracked. Phase 2 of the study is a pilot.
Recruitment:
Primary care providers will receive recruitment letters, and may receive emails and phone calls based on the recruitment condition they are assigned to.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Factorial
- 主要目的
- Health Services Research
- 盲法
- None
盲法说明
Participants are unaware of other study arms.
入排标准
- 年龄范围
- 18 Years 至 99 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Licensed Primary Care Provider (Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Physician Assistant (PA), Nurse Practitioner (NP))
- •Currently practice in North Carolina
- •For Nurse practitioners, the following specialties were included:
- •Addiction Psychiatry
- •Addiction/Chemical Dependency
- •Adolescent Medicine
- •Emergency Medicine
- •Family Practice
- •Family Practice, Geriatric
- •General Practice
- •General Preventive Medicine
- •Geriatrics
- •Gerontology
- •Gynecology
- •Infectious Disease
- •Internal Medicine
- •Internal Medicine/Immunology Diagnostic
- •Internal Medicine/Pulmonary Dis. & Crit
- •Medicine/Pediatrics
- •Medicine/Psychiatry
- •Obstetrics
- •Obstetrics and Gynecology/Critical Care
- •Obstetrics/Gynecology
- •Other Specialty
- •Pain Management (phys med)
- •Pain Medicine
- •Pediatrics
- •Psychiatry
- •Psychiatry, Child
- •Psychiatry/Geriatric
- •Public Health
- •Unspecified
- •Hospitalist
- •For MD/DOs practitioners that were considered primary by the medical board care were included except those specializing in sports, addiction, alcohol, and surgery
- •For PAs practitioners were included that are considered primary care by the medical board
排除标准
- •Another member of the same practice is already enrolled in the study (one provider per practice in Phase 2)
- •Active participation in University of North Carolina at Chapel Hill (UNC) ECHO Collaborative at beginning of study
结局指标
主要结局
Number of Recruited Providers That Contact Staff for Information About Enrolling in the Study
时间窗: From start of recruitment to end of data collection for last participant, up to 1.5 years
Phase 1 recruitment interventions will be compared based on the number of recruited providers that reach out to study staff via email, phone, or any other method.
Mean Number of UNC ECHO Clinic Sessions a Participant Attends
时间窗: From enrollment to 6 months afterwards, enrollment to 9 months afterwards.
Phase 2 study interventions will be compared based on the number of UNC ECHO clinic sessions that a participant attends. Subsequent to COVID-19, the number of ECHO clinic sessions was decreased and the assessment period was extended by 3 additional months for those who had not completed the Follow up period as of 3/9/2020.
次要结局
- Number of Participants That Receive a DATA 2000 Waiver(From enrollment to 6 months afterwards, enrollment to 9 months afterwards.)
- Number of Recruited Providers That Complete Enrollment in the Phase 2 Study(From start of recruitment to enrollment fulfillment, up to 1 year)
- Total Amount of Time a Participant Attends a UNC ECHO Clinic Session(From enrollment to 6 months afterwards, enrollment to 9 months afterwards.)
- Number of Participants That Begin Prescribing MAT Paid by Medicaid Within One Year of Phase 2 Start(One year)