Opioid overdoses currently claim the lives of 115 Americans per day. This epidemic is alarming, not just in its effects on the lives of individuals and families, but also on the light it has shined on the disturbing lack of treatment options in many areas. A number of effective treatments are available for opioid use disorder, but many require special training beyond a professional degree. In addition, the complex comorbidities and life circumstances faced by those with an opioid use disorder can deter many providers from investing the time needed to learn how to diagnose and treat individuals needing these services. To date, of North Carolina's 8087 primary care physicians, 4669 nurse practitioners, and 4237 physician assistants, only 785 (<5%) have undergone the waiver training required to provide medication assisted treatment (MAT) for opioid use disorder, a miniscule number of North Carolina's primary care workforce. Many waiver-trained providers are not yet prescribing, due in part to the lack of on-going education or support, so the effective rate of treatment provision is substantially lower than 5%. Further, only one-fifth of NC's zip codes have a waiver-trained provider. ECHO is an evidence-supported hub-and-spoke model of professional development that uses video conferencing technology to bring experts into even the most rural areas to support primary care providers. ECHO for MAT is program in NC that uses the ECHO model to develop a provider workforce that is equipped to provide MAT to those in need of treatment, preventing further accidental deaths from overdose. ECHO for MAT sessions last two hours and the curriculum takes six months to complete. The time commitment required to develop MAT proficiency can prove to be a barrier to its take up since provider time participating in ECHO may represent lost revenue from not seeing patients. This challenge can especially prohibit participation from small and rural practices, often where treatment is most needed. This research project will conduct a pilot study to examine the extent to which informational nudges incorporating specific information from a provider's community into recruitment materials (Aim 1) and financial incentives (Aim 2) affect participation in ECHO MAT by primary care providers. Through these estimates, this study will contribute much-needed information on the incentives that can be used to create a behavioral health workforce that is ready to meet the challenges of the opioid epidemic.

Public Health Relevance

In this research project, we will examine the best ways to encourage providers to participate in a workforce development program to increase the availability of treatment for opioid use disorders in primary care. We will use two sets of incentives to encourage participation: financial (by paying one of three amounts for hourly participation) and informational (by providing customized information on the opioid crisis in the provider's area). We will monitor both of these efforts on outcomes related to participation in the workforce training program.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZDA1)
Program Officer
Duffy, Sarah Q
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University of North Carolina Chapel Hill
Public Health & Prev Medicine
Schools of Public Health
Chapel Hill
United States
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