Launching an innovative educational model addressing substance use disorders and dental pain management (Project ECHO® in dentistry)

Abstract

Background: Uninformed opioid prescribing by dentists has contributed to the current opioid crisis. This report describes the development and implementation of an innovative, interactive, multidisciplinary, and participant-centric telementoring program "Pain Management and Substance Use Disorders Dental ECHO (Extension for Community Health Care Outcomes)". We disseminated information to dentists about appropriate opioid prescribing practices and engaged them with a focus on pain management and substance use disorders. The objective of this study was to assess the effectiveness of this program for self-reported: (1) change in knowledge and confidence related to clinical skills for dental pain management of patients with substance use disorders; (2) change in clinical behavior of dentists for safe opioids prescribing; and (3) change in clinic policies regarding safe opioids prescribing.Methods: An interdisciplinary panel of experts in medicine, pharmacy, social work, and dentistry designed and led the "Pain Management and Substance Use Disorders Dental ECHO" for invited dental care providers and dental students. Six cohorts each consisting of six, 1-h-long sessions were conducted via the Zoom videoconference platform in years 2020 and 2021. Each session included a didactic expert presentation, a participant-presented patient case and discussion. Each participant completed pre-and post-program surveys to assess the program's influence on participant knowledge, clinical confidence and behavior change. Results:The participants (N = 151) were dentists (n = 109), dental faculty (n = 15), dental residents (n = 6), dental hygienists/assistants (n = 13) and nurses and clinic administrators (n = 8). Self-reported perceived medication knowledge, confidence in identification, treatment and willingness to engage with substance use disorders patients, and reported compliance with Prescription Drug Monitoring Program (PDMP) checks increased significantly from before to after the sessions (p < 0.001). Overall, participants expressed high levels of satisfaction with the content and reported that the sessions provided high benefit. Conclusion:The Project ECHO model is effective in rapidly disseminating evidence-based information. Dentists viewed this model as having a high degree of benefit for the optimal management of dental pain and the recognition and treatment of substance use disorders.

Trends in dispensed prescriptions for opioids, sedatives, benzodiazepines, gabapentin, and stimulants to children by general dentists, 2012–2019

“…Future research would benefit from exploration of dental practice styles in these regions. Continuing education for dental providers may be another possible mechanism through which to address inappropriate prescribing of drugs with safety risks 38 . It is important to note that some trends, including the observed 2016 increase in sedative fills, were driven by a small number of dentists.…”

“…Continuing education for dental providers may be another possible mechanism through which to address inappropriate prescribing of drugs with safety risks. 38 It is important to note that some trends, including the observed 2016 increase in sedative fills, were driven by a small number of dentists. These findings are consistent with a recent study which found that 5% of dentists were responsible for almost half of opioid prescriptions to adults in 2019.…”