A short-duration telementoring pain management programme for Medicaid: impact on clinician outcomes.

Abstract

Previous evaluations of the pain care-related Extension for Community Healthcare Outcomes (ECHO) telementoring programmes found that long-term programmes (16-52 weeks) improve clinician knowledge, self-efficacy, and prescribing practices. We evaluated a 6- to 7-week Pain Management ECHO in Nevada Medicaid clinician networks. We collected pre- and post-knowledge and self-efficacy scores from 15 of 18 unique ECHO participants (83% response rate). We derived opioid prescribing outcomes from 44 894 Medicaid pharmacy claims records from 11 ECHO participants and 10 comparison clinicians. The three outcomes included any opioid (binary), non-opioid pain medication (binary), and opioid dose (continuous). Logistic regressions using difference-in-difference (DID) estimated the ECHO treatment effects. Knowledge scores (75% to 82%) and self-efficacy scores (3.4-4.1) increased after ECHO participation. After ECHO participation, opioid prescribing decreased, and non-opioid prescribing increased; changes in both outcomes were above and beyond changes in the comparison group (any opioid DID treatment effect: -0.6 percentage points; non-opioid pharmacologic: 1.1 percentage points). Incremental changes across three domains of Moore's Framework for continuing medical education provide evidence supporting a short-duration ECHO intervention in partnership with Medicaid managed care. Promulgation of this less resource-intensive approach can sustainably aid clinicians in managing pain experienced by Medicaid beneficiaries.