Nudges and Incentives to Enhance the Opioid Treatment Workforce

NCT03834025 | Completed Results

• 2 other identifiers: 18-2236R21DA047286
• Study Type: interventional
• Target: 73
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Opioid Abuse (Disorder)

Keywords

Opioid Abuse Disorder

Outcome Measures

Primary Outcomes (2)

• Number of Recruited Providers That Contact Staff for Information About Enrolling in the Study

  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.

  From start of recruitment to end of data collection for last participant, up to 1.5 years

• Mean Number of UNC ECHO Clinic Sessions a Participant Attends

  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.

  From enrollment to 6 months afterwards, enrollment to 9 months afterwards.

Secondary Outcomes (4)

• 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 Receive a DATA 2000 Waiver

  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

Study Arms (12)

Phase 1 Condition 1, Phase 2 Condition 1

EXPERIMENTAL

Providers assigned to this condition will be sent recruitment materials that are 'recruitment as usual' (Phase 1 Condition 1). These materials will not include prosocial messaging and will not include an additional mention of financial support available for participation. If they enroll, in Phase 2 of the study these participants will be in condition 1.

Behavioral: Phase 1 Condition 1; Behavioral: Phase 2 Condition 1

Phase 1 Condition 1, Phase 2 Condition 2

EXPERIMENTAL

Providers assigned to this condition will be sent recruitment materials that are 'recruitment as usual' (Phase 1 Condition 1). These materials will not include prosocial messaging and will not include an additional mention of financial support available for participation. If they enroll, in Phase 2 of the study these participants will be in condition 2.

Behavioral: Phase 1 Condition 1; Behavioral: Phase 2 Condition 2

Phase 1 Condition 1, Phase 2 Condition 3

EXPERIMENTAL

Providers assigned to this condition will be sent recruitment materials that are 'recruitment as usual' (Phase 1 Condition 1). These materials will not include prosocial messaging and will not include an additional mention of financial support available for participation. If they enroll, in Phase 2 of the study these participants will be in condition 3.

Behavioral: Phase 1 Condition 1; Behavioral: Phase 2 Condition 3

Phase 1 Condition 2, Phase 2 Condition 1

EXPERIMENTAL

Providers assigned to this condition will be sent recruitment materials that include additional mention of financial support available for participation, but will not include prosocial messaging (Phase 1 Condition 2). If they enroll, in Phase 2 of the study these participants will be in condition 1.

Behavioral: Phase 1 Condition 2; Behavioral: Phase 2 Condition 1

Phase 1 Condition 2, Phase 2 Condition 2

EXPERIMENTAL

Providers assigned to this condition will be sent recruitment materials that include additional mention of financial support available for participation, but will not include prosocial messaging (Phase 1 Condition 2). If they enroll, in Phase 2 of the study these participants will be in condition 2.

Behavioral: Phase 1 Condition 2; Behavioral: Phase 2 Condition 2

Phase 1 Condition 2, Phase 2 Condition 3

EXPERIMENTAL

Providers assigned to this condition will be sent recruitment materials that include additional mention of financial support available for participation, but will not include prosocial messaging (Phase 1 Condition 2). If they enroll, in Phase 2 of the study these participants will be in condition 3.

Behavioral: Phase 1 Condition 2; Behavioral: Phase 2 Condition 3

Phase 1 Condition 3, Phase 2 Condition 1

EXPERIMENTAL

Providers assigned to this condition will be sent recruitment materials that include prosocial messaging, but do not include an additional mention of financial support available for participation (Phase 1 Condition 3). If they enroll, in Phase 2 of the study these participants will be in condition 1.

Behavioral: Phase 1 Condition 3; Behavioral: Phase 2 Condition 1

Phase 1 Condition 3, Phase 2 Condition 2

EXPERIMENTAL

Providers assigned to this condition will be sent recruitment materials that include prosocial messaging, but do not include an additional mention of financial support available for participation (Phase 1 Condition 3). If they enroll, in Phase 2 of the study these participants will be in condition 2.

Behavioral: Phase 1 Condition 3; Behavioral: Phase 2 Condition 2

Phase 1 Condition 3, Phase 2 Condition 3

EXPERIMENTAL

Providers assigned to this condition will be sent recruitment materials that include prosocial messaging, but do not include an additional mention of financial support available for participation (Phase 1 Condition 3). If they enroll, in Phase 2 of the study these participants will be in condition 3.

Behavioral: Phase 1 Condition 3; Behavioral: Phase 2 Condition 3

Phase 1 Condition 4, Phase 2 Condition 1

EXPERIMENTAL

Providers assigned to this condition will be sent recruitment materials that include prosocial messaging and an additional mention of financial support available for participation (Phase 1 Condition 4). If they enroll, in Phase 2 of the study these participants will be in condition 1.

Behavioral: Phase 1 Condition 4; Behavioral: Phase 2 Condition 1

Phase 1 Condition 4, Phase 2 Condition 2

EXPERIMENTAL

Providers assigned to this condition will be sent recruitment materials that include prosocial messaging and an additional mention of financial support available for participation (Phase 1 Condition 4). If they enroll, in Phase 2 of the study these participants will be in condition 2.

Behavioral: Phase 1 Condition 4; Behavioral: Phase 2 Condition 2

Phase 1 Condition 4, Phase 2 Condition 3

EXPERIMENTAL

Providers assigned to this condition will be sent recruitment materials that include prosocial messaging and an additional mention of financial support available for participation (Phase 1 Condition 4). If they enroll, in Phase 2 of the study these participants will be in condition 3.

Behavioral: Phase 1 Condition 4; Behavioral: Phase 2 Condition 3

Interventions

Phase 1 Condition 1 BEHAVIORAL

Providers assigned to this condition will be sent recruitment materials that are 'recruitment as usual' (Phase 1 Condition 1). These materials will not include prosocial messaging and will not include an additional mention of financial support available for participation.

Phase 1 Condition 1, Phase 2 Condition 1; Phase 1 Condition 1, Phase 2 Condition 2; Phase 1 Condition 1, Phase 2 Condition 3

Phase 1 Condition 2 BEHAVIORAL

Providers assigned to this condition will be sent recruitment materials that include an additional mention of financial support available for participation, but will not include prosocial messaging (Phase 1 Condition 2).

Phase 1 Condition 2, Phase 2 Condition 1; Phase 1 Condition 2, Phase 2 Condition 2; Phase 1 Condition 2, Phase 2 Condition 3

Phase 1 Condition 3 BEHAVIORAL

Providers assigned to this condition will be sent recruitment materials that include prosocial messaging, but do not include an additional mention of financial support available for participation (Phase 1 Condition 3).

Phase 1 Condition 3, Phase 2 Condition 1; Phase 1 Condition 3, Phase 2 Condition 2; Phase 1 Condition 3, Phase 2 Condition 3

Phase 1 Condition 4 BEHAVIORAL

Providers assigned to this condition will be sent recruitment materials that include prosocial messaging and an additional mention of financial support available for participation (Phase 1 Condition 4).

Phase 1 Condition 4, Phase 2 Condition 1; Phase 1 Condition 4, Phase 2 Condition 2; Phase 1 Condition 4, Phase 2 Condition 3

Phase 2 Condition 1 BEHAVIORAL

Providers who enroll in the study and are assigned to this condition will be in this group. Other than the opportunity to participate in a learning collaborative, participants receive no compensation.

Phase 1 Condition 1, Phase 2 Condition 1; Phase 1 Condition 2, Phase 2 Condition 1; Phase 1 Condition 3, Phase 2 Condition 1; Phase 1 Condition 4, Phase 2 Condition 1

Phase 2 Condition 2 BEHAVIORAL

Providers who enroll in the study and are assigned to this condition will be in this group. In addition to the opportunity to participate in the learning collaborative, participants receive a reimbursement at 30% of the NC Medicaid rate for a patient visit.

Phase 1 Condition 1, Phase 2 Condition 2; Phase 1 Condition 2, Phase 2 Condition 2; Phase 1 Condition 3, Phase 2 Condition 2; Phase 1 Condition 4, Phase 2 Condition 2

Phase 2 Condition 3 BEHAVIORAL

Providers who enroll in the study and are assigned to this condition will be in this group. In addition to the opportunity to participate in the learning collaborative, participants receive a reimbursement at 100 percent of the NC Medicaid rate for a patient visit for their time participating in the learning collaborative.

Phase 1 Condition 1, Phase 2 Condition 3; Phase 1 Condition 2, Phase 2 Condition 3; Phase 1 Condition 3, Phase 2 Condition 3; Phase 1 Condition 4, Phase 2 Condition 3

Eligibility Criteria

• Age: 18 Years - 99 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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

You may not qualify if:

• 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

Sponsors & Collaborators

• University of North Carolina, Chapel Hill: lead
• National Institute on Drug Abuse (NIDA): collaborator

Study Sites (1)

University of North Carolina At Chapel Hill

Chapel Hill, North Carolina, 27599-7411, United States

Location

MeSH Terms

Conditions

Opioid-Related Disorders

Condition Hierarchy (Ancestors)

Narcotic-Related Disorders; Substance-Related Disorders; Chemically-Induced Disorders; Mental Disorders

Results Point of Contact

• Title: Marisa Domino, PhD
• Organization: University of North Carolina at Chapel Hill

domino@unc.edu

919-966-3891

Study Officials

• Marisa Domino, PhD

  University of North Carolina, Chapel Hill

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Participants are unaware of other study arms.
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: January 29, 2019
• First Posted: February 7, 2019
• Study Start: February 12, 2019
• Primary Completion: August 28, 2020
• Study Completion: August 28, 2020
• Last Updated: August 20, 2021
• Results First Posted: August 20, 2021

Record last verified: 2021-06

Data Sharing

• IPD Sharing: Will share
• Time Frame: 9 to 36 months following publication
• Access Criteria: We will share data, as allowed, provided the investigator who proposes to use the data has approval from an Institutional Review Board (IRB), Independent Ethics Committee (IEC), or Research Ethics Board (REB), as applicable, and executes a data use/sharing agreement with UNC.

Locations

US (1)