JMIR Publications

ABSTRACT

Background:

Substance use and overdose deaths make up a substantial portion of injury-related deaths in the United States, with the state of Ohio leading the nation in rates of diagnosed substance use disorders. Ohio’s growing epidemic has indicated a need to improve substance use disorder care in a primary care setting through the engagement of multidisciplinary providers and the utilization of a comprehensive approach to care.

Objective:

The purpose of this study was to assess the ability of Weitzman ECHO: Comprehensive Substance Use Disorder Care (CSUDC ECHO) to both address and meet seven series learning objectives and address multiple substances by analyzing: 1) the frequency of exposure to the learning objective topics and substance types during case discussions and 2) participants’ change in knowledge, self-efficacy, attitudes, and skills related to the treatment of substance use disorders pre-to-post series.

Methods:

We employed a mixed methods approach utilizing a conceptual content analysis based on series learning objectives and substance types and a paired samples t-test of participants’ self-reported learner outcomes. The content analysis gauged the frequency and dose of learning objective themes and illicit and non-illicit substances mentioned in participant case presentations and discussions, and the paired samples t-test was utilized to compare participants’ knowledge, self-efficacy, attitudes, and skills associated with series learning objectives and medication management of illicit and non-illicit substances from pre- to post-series.

Results:

The results of the content analysis indicated that three learning objective themes — team-based care, harm reduction, and social determinants of health — resulted in the highest frequencies and dose appearing in 100% (n=22) of case presentations and discussions. Alcohol resulted as the highest frequency and dose among the illicit and non-illicit substances appearing in 81.36% (n=18) of case presentations and discussions. The results of the paired samples t-test indicated statistically significant increases in knowledge domain statements related to polysubstance use (P=.02), understanding the approach other disciplines use in SUD care (P=.02), and medication management strategies for nicotine use disorder (P=.03) and opioid use disorder (P=.003). Statistically significant increases were observed for two self-efficacy domain statements regarding medication management for nicotine use disorder (P=.002) and alcohol use disorder (P=.02). One statistically significant increase in the skill domain was observed regarding using the Stages of Change Theory in patient interventions (P=.03).

Conclusions:

These findings indicate that the ECHO program’s content aligned with its stated learning objectives; met its learning objectives for the four themes where significant improvements were measured; and met its intent to address multiple substances in case presentations and discussions. These results demonstrate that Project ECHO is a potential tool to effectively educate multidisciplinary providers in a comprehensive approach to substance use disorder care.