Introduction to UNC Medication Assisted Treatment (MAT) ECHO Clinic. Robyn Jordan, MD, PhD

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2 Introduction to UNC Medication Assisted Treatment (MAT) ECHO Clinic Robyn Jordan, MD, PhD

3 Conflicts UNC Extension for Community Healthcare Outcomes for Medication Assisted Treatment (UNC ECHO for MAT) is made possible by funding from the Agency for Healthcare Research and Quality (AHRQ) Grant Number: 1R18HS I have no conflicts of interest to report.

4 Objectives 1. How the NC ECHO initiative can help decrease opioid overdose deaths 2. Introduce Project ECHO for MAT 3. Convince you to join us!

5 Opioid Overdose Rates are Rising in NC

6 Overdose Rates are Higher in Rural Counties

7 MAT Availability in NC is Limited North Carolina has 61 opioid treatment programs (OTPs). 9 However, these are concentrated in only 44 counties. In addition, 30 North Carolina counties have no buprenorphine providers listed in the Buprenorphine Waiver Practitioner Locator. 28 counties have neither an OTP program nor a provider listed in the Buprenorphine Waiver Practitioner Locator.

8 MAT Works! Improve patient survival Increase retention in treatment Decrease illicit opiate use and other criminal activity among people with substance use disorders Increase patients ability to gain and maintain employment Improve birth outcomes among women who have substance use disorders and are pregnant Decrease relapse Lower risk of contracting HIV or hepatitis C

9 UNC ECHO for MAT Engagements For providers in 22 rural counties with overdose rates that exceed the national average, the grant will support: Free DATA 2000 training for primary care providers Weekly case-based learning ECHO clinic In office support for providers interested in training and strategy support for medical assistants, nurses, and office staff in their practices. One to one provider case consultation We are working on an expansion of access to the ECHO clinic, DATA training, and CME credits to providers in all 100 counties. The expansion will eventually result in additional ECHO clinics.

10 Produced By: North Carolina Rural Health Research Program, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill. 0 miles UNC ECHO for Opioid Medication Assisted Treatment

11 Introduction to Project ECHO Launched in 2003, the ECHO model makes specialized medical knowledge accessible wherever it is needed to save and improve people s lives. MISSION: Project ECHO (Extension for Community Healthcare Outcomes) is a movement to demonopolize knowledge and amplify the capacity to provide best practice care for underserved people all over the world.

12 Four Principles of the Echo Model 1. Use technology to leverage scarce resources 2. Sharing best-practices to reduce disparities 3. Case-based learning to master complexity 4. Monitor outcomes Project ECHO shares knowledge and expands treatment capacity. The result: better care for more people.

13 Tele-case Conferencing vs Tele-medicine

14 Getting Started: Website Our website will be finalized soon. On our website, you will find: Zoom Connection information Didactic presentation slides ECHO Clinic Agenda Link for CME

15 CME Credits UNC MAT ECHO will provide Free ASAM Data-2000 training for physicians and advanced practice professionals enrolled in the study CME category one credits at no cost for weekly ECHO clinics Application for CME credit has been approved by the American Academy of Family Physicians.

16 This is the Future. The NC Opioid Action Plan and the NC Proposed Design for Medicaid Managed Care emphasize provision of MAT and integration of physical and behavioral health services the Proposed Design for Medicaid Managed Care also emphasizes use of quality metrics linked to reimbursement Sooner or later, primary care practices will likely be expected to provide MAT ECHO offers an opportunity to get ahead of the curve by receiving free training and (for practice that qualify) practice support and consultation.

17 Help your patients! You are already seeing pts with opioid use disorder ECHO is flexible! Join as often as you want Drink when you are thirsty Medical Directors encourage your staff! Provide protected time to join ECHO weekly or monthly

18 Questions? For More Information

19 Joining the Study: Fill out brief online survey initially and at 6 months A few providers will do in depth interview with incentives After a few months, present patient cases Continue to attend ECHO for as long as you want! For More Information echo@unc.edu sgreen@unc.edu

20 What to Expect During Clinic ECHO clinics contain two main parts 1. Didactic Presentation minute presentation by a specialist on an issue related to the treatment of Substance Use Disorders, followed by minutes of questions/discussion 2. Case Presentations Participants present real cases (2 cases per session) to discuss with the network and receive advice from expert faculty The ECHO Model is all-teach, all-learn Community providers learn from specialists and from each other Specialists learn from community providers as best practices emerge

21 At start of clinic, all participants introduce themselves One person speaks at a time/mute yourself when not speaking Communicate clearly during clinic Direct your attention to the camera Feel free to wave, send a chat note, or otherwise indicate interest in speaking if you are having difficulty getting into the conversation Speak clearly Use the chat function: direct IT questions to UNC Tech Support Feel free to eat or drink during clinic Show kindness to fellow participants Questions are encouraged ECHO Etiquette

22 ECHO Etiquette Introduce yourself each time you speak (e.g. Sherri at UNC ) Dialing in via phone: o Please use camera if possible. It helps build relationships if we can see each other. o *6 will mute/unmute if joining by phone is necessary

23 ECHO Etiquette No Protected Health Information (PHI) This includes names, initials, birthdate (except year), address/city Use ECHO ID when referring to patient during clinic PHI may also include work history or living history, depending on the community size/population

24 How to Present a Case Fill out Case Presentation Form as completely as possible Instructions for sending your Case Presentation Form to us will be coming soon by and eventually on the website Project ECHO staff will send back ECHO ID and confirm date of case presentation ECHO ID: 5-digit number used to identify patients in clinic to avoid use of personal health information Attend clinic, and share case and questions with the network Project ECHO staff will send written/signed recommendations from Medical Director after clinic

25 Case Presentation