{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T18:24:55Z","timestamp":1790187895514,"version":"4.1.0"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"content-version":"vor","delay-in-days":134,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Previous evaluations of the pain care-related Extension for Community Healthcare Outcomes (ECHO) telementoring programmes found that long-term programmes (16\u201352\u2009weeks) 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\u2009894 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\u20134.1) 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: \u22120.6 percentage points; non-opioid pharmacologic: 1.1 percentage points). Incremental changes across three domains of Moore\u2019s 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.<\/jats:p>","DOI":"10.1093\/her\/cyaf019","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T11:13:54Z","timestamp":1747307634000},"source":"Crossref","is-referenced-by-count":2,"title":["A short-duration telementoring pain management programme for Medicaid: impact on clinician outcomes"],"prefix":"10.1093","volume":"40","author":[{"given":"Sarah A","family":"Friedman","sequence":"first","affiliation":[{"name":"Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada , 1664 North Virginia Street, Reno, NV 89557,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Lewandowski","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Nevada , 1664 North Virginia Street, Reno, NV 89557,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis G","family":"Patterson","sequence":"additional","affiliation":[{"name":"Nevada Advanced Pain Specialists , 5587 Longley lane, Reno 89511,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Snyder","sequence":"additional","affiliation":[{"name":"Project ECHO Nevada, Office of Statewide Initiatives, School of Medicine, University of Nevada , 604 West Moana Lane, Reno, NV 89509,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dotun","family":"Sangoleye","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada , 1664 North Virginia Street, Reno, NV 89557,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Troy C","family":"Jorgensen","sequence":"additional","affiliation":[{"name":"Project ECHO Nevada, Office of Statewide Initiatives, School of Medicine, University of Nevada , 604 West Moana Lane, Reno, NV 89509,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Militante","sequence":"additional","affiliation":[{"name":"Project ECHO Nevada, Office of Statewide Initiatives, School of Medicine, University of Nevada , 604 West Moana Lane, Reno, NV 89509,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mordechai S","family":"Lavi","sequence":"additional","affiliation":[{"name":"Project ECHO Nevada, Office of Statewide Initiatives, School of Medicine, University of Nevada , 604 West Moana Lane, Reno, NV 89509,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"2025070910324443800_R1","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1146\/annurev-publhealth-031914-122957","article-title":"The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction","volume":"36","author":"Kolodny","year":"2015","journal-title":"Annu Rev Public Health"},{"key":"2025070910324443800_R2","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1176\/appi.ajp.2015.15020262","article-title":"Prescription opioid misuse, abuse, and treatment in the United States: an update","volume":"173","author":"Brady","year":"2016","journal-title":"Am J Psychiatry"},{"key":"2025070910324443800_R3","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.15585\/mmwr.mm655051e1","article-title":"Increases in drug and opioid-involved overdose deaths - United States, 2010\u20132015","volume":"65","author":"Rudd","year":"2016","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025070910324443800_R4","first-page":"511","article-title":"Increase in drug overdose deaths involving fentanyl-Rhode Island, January 2012-March 2014","volume":"19","author":"Mercado","year":"2018","journal-title":"Pain Med Malden Mass"},{"key":"2025070910324443800_R5","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.2147\/JPR.S136478","article-title":"Provider confidence in opioid prescribing and chronic pain management: results of the Opioid Therapy Provider Survey","volume":"10","author":"Pearson","year":"2017","journal-title":"J Pain Res"},{"key":"2025070910324443800_R6","doi-asserted-by":"publisher","first-page":"e135","DOI":"10.37765\/ajmc.2020.42841","article-title":"Healthcare professionals\u2019 perceptions of challenges to chronic pain management","volume":"26","author":"Polacek","year":"2020","journal-title":"Am J Manag Care"},{"key":"2025070910324443800_R7","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.13563","article-title":"Estimated Rates of Incident and Persistent Chronic Pain Among US Adults, 2019-2020","volume":"6","author":"Nahin","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2025070910324443800_R8","doi-asserted-by":"publisher","first-page":"E593","DOI":"10.36076\/ppj.2018.6.E593","article-title":"Evaluation of primary care physician chronic pain management practice patterns","volume":"21","author":"Provenzano","year":"2018","journal-title":"Pain Phys"},{"key":"2025070910324443800_R9","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1093\/jnci\/djaa110","article-title":"Temporal trends in opioid prescribing patterns among oncologists in the medicare population","volume":"113","author":"Jairam","year":"2021","journal-title":"J Natl Cancer Inst"},{"key":"2025070910324443800_R10","doi-asserted-by":"publisher","first-page":"E546","DOI":"10.1503\/cmaj.109-5748","article-title":"Opioid prescriptions down but some patients fear doctors now too strict","volume":"191","author":"Owens","year":"2019","journal-title":"CMAJ Can Med Assoc J"},{"key":"2025070910324443800_R11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2024.105649","article-title":"Barriers, facilitators, and recommendations to increase the use of a clinical decision support tool for managing chronic pain in primary care","volume":"192","author":"Cuadros","year":"2024","journal-title":"Int J Med Inf"},{"key":"2025070910324443800_R12","author":"Hubs & Programs"},{"key":"2025070910324443800_R13","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1007\/s11606-018-4710-5","article-title":"Army and navy ECHO pain telementoring improves clinician opioid prescribing for military patients: an observational cohort study","volume":"34","author":"Katzman","year":"2019","journal-title":"J Gen Intern Med"},{"key":"2025070910324443800_R14","article-title":"Total Medicaid MCOs","volume-title":"KFF"},{"key":"2025070910324443800_R15","doi-asserted-by":"publisher","first-page":"5","DOI":"10.3109\/15360280903544877","article-title":"Costs of opioid abuse and misuse determined from a Medicaid database","volume":"24","author":"McAdam-Marx","year":"2010","journal-title":"J Pain Palliat Care Pharmacother"},{"key":"2025070910324443800_R16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10826084.2017.1416407","article-title":"High-risk prescribing to medicaid enrollees receiving opioid analgesics: individual- and county-level factors","volume":"53","author":"Heins","year":"2018","journal-title":"Subst Use Misuse"},{"key":"2025070910324443800_R17","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1353\/hpu.2015.0009","article-title":"Prescription practices involving opioid analgesics among Americans with Medicaid, 2010","volume":"26","author":"Mack","year":"2015","journal-title":"J Health Care Poor Underserved"},{"key":"2025070910324443800_R18","first-page":"1882","article-title":"Improving pain care with project ECHO in community health centers","volume":"18","author":"Anderson","year":"2017","journal-title":"Pain Med Off J Am Acad Pain Med"},{"key":"2025070910324443800_R19","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1093\/pm\/pnx122","article-title":"SCAN-ECHO for pain management: implementing a regional telementoring training for primary care providers","volume":"19","author":"Ball","year":"2018","journal-title":"Pain Med"},{"key":"2025070910324443800_R20","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1177\/1357633X18782090","article-title":"Evaluation of an innovative tele-education intervention in chronic pain management for primary care clinicians practicing in underserved areas","volume":"25","author":"Furlan","year":"2019","journal-title":"J Telemed Telecare"},{"key":"2025070910324443800_R21","doi-asserted-by":"publisher","first-page":"461","DOI":"10.4103\/psychiatry.IndianJPsychiatry_211_18","article-title":"Innovative telementoring for addiction management for remote primary care physicians: a feasibility study","volume":"60","author":"Sagi","year":"2018","journal-title":"Indian J Psychiatry"},{"key":"2025070910324443800_R22","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1016\/j.ajp.2018.07.010","article-title":"Effectiveness of NIMHANS ECHO blended tele-mentoring model on integrated mental health and addiction for counsellors in rural and underserved districts of Chhattisgarh, India","volume":"36","author":"Mehrotra","year":"2018","journal-title":"Asian J Psychiatry"},{"key":"2025070910324443800_R23","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9010014","article-title":"Changes in opioid prescribing behaviors among family physicians who participated in a weekly tele-mentoring program","volume":"9","author":"D\u00edaz","year":"2020","journal-title":"J Clin Med"},{"key":"2025070910324443800_R24","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/s40501-020-00199-8","article-title":"Project ECHO and opioid education: a systematic review","volume":"7","author":"Holmes","year":"2020","journal-title":"Curr Treat Options Psychiatry"},{"key":"2025070910324443800_R25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/chp.20001","article-title":"Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities","volume":"29","author":"Moore","year":"2009","journal-title":"J Contin Educ Health Prof"},{"key":"2025070910324443800_R26","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1002\/chp.21210","article-title":"Innovative telementoring for pain management: project ECHO pain","volume":"34","author":"Katzman","year":"2014","journal-title":"J Contin Educ Health Prof"},{"key":"2025070910324443800_R27","first-page":"886","article-title":"Opioid analgesics in Georgia Medicaid: trends in potential inappropriate prescribing practices by demographic characteristics, 2009-2014","volume":"24","author":"Jayawardhana","year":"2018","journal-title":"J Manag Care Spec Pharm"},{"key":"2025070910324443800_R28","doi-asserted-by":"publisher","first-page":"2199","DOI":"10.1056\/NEJMoa1009370","article-title":"Outcomes of treatment for Hepatitis C virus infection by primary care providers","volume":"364","author":"Arora","year":"2011","journal-title":"N Engl J Med"},{"key":"2025070910324443800_R29","doi-asserted-by":"publisher","first-page":"345","DOI":"10.11139\/cj.28.2.345-368","article-title":"Situated learning through social networking communities: the development of joint enterprise, mutual engagement, and a shared repertoire","volume":"28","author":"Mills","year":"2011","journal-title":"CALICO J"},{"key":"2025070910324443800_R30","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-4-11","article-title":"Evolution of Wenger\u2019s concept of community of practice","volume":"4","author":"Li","year":"2009","journal-title":"Implement Sci"},{"key":"2025070910324443800_R31","doi-asserted-by":"publisher","DOI":"10.1016\/j.tsc.2020.100630","article-title":"Adaptive expertise and creative thinking: a synthetic review and implications for practice","volume":"35","author":"Gube","year":"2020","journal-title":"Think Ski Creat"},{"key":"2025070910324443800_R32","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inform"},{"key":"2025070910324443800_R33","article-title":"All Teach, All Learn","author":"iECHO"},{"key":"2025070910324443800_R34","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1016\/j.berh.2015.04.022","article-title":"Physical exercise as non-pharmacological treatment of chronic pain: why and when","volume":"29","author":"Ambrose","year":"2015","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2025070910324443800_R35","doi-asserted-by":"publisher","first-page":"2129","DOI":"10.2146\/ajhp130798","article-title":"Intranasal naloxone administration for treatment of opioid overdose","volume":"71","author":"Robinson","year":"2014","journal-title":"Am J Health Syst Pharm"},{"key":"2025070910324443800_R36","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-022-00599-4","article-title":"How do naloxone-based interventions work to reduce overdose deaths: a realist review","volume":"19","author":"Miller","year":"2022","journal-title":"Harm Reduct J"},{"key":"2025070910324443800_R37","article-title":"StataCorp 2021. Stata: Release 17. Statistical Software."},{"key":"2025070910324443800_R38","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1001\/jama.2011.370","article-title":"Association between opioid prescribing patterns and opioid overdose-related deaths","volume":"305","author":"Bohnert","year":"2011","journal-title":"JAMA"},{"key":"2025070910324443800_R39","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1111\/j.1742-1241.2007.01415.x","article-title":"Opioid-induced bowel dysfunction: prevalence, pathophysiology and burden","volume":"61","author":"Panchal","year":"2007","journal-title":"Int J Clin Pract"},{"key":"2025070910324443800_R40","doi-asserted-by":"publisher","first-page":"1664","DOI":"10.1111\/j.1532-5415.2010.03015.x","article-title":"Risk of injury associated with opioid use in older adults","volume":"58","author":"Buckeridge","year":"2010","journal-title":"J Am Geriatr Soc"},{"key":"2025070910324443800_R41","doi-asserted-by":"publisher","first-page":"388","DOI":"10.7334\/psicothema2015.110","article-title":"Guidelines based on validity criteria for the development of multiple choice items","volume":"27","author":"Moreno","year":"2015","journal-title":"Psicothema"},{"key":"2025070910324443800_R42","author":"ECHO Implementation Study"},{"key":"2025070910324443800_R43","article-title":"Project ECHO: policy pathways for sustainability","volume-title":"Center for health care strategies","author":"Howe","year":"2019"},{"key":"2025070910324443800_R44","volume-title":"Project ECHO","author":"Project ECHO website"},{"key":"2025070910324443800_R45","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-021-01832-0","article-title":"Effectiveness and experiences of the Extension for Community Healthcare Outcomes (ECHO) model in developing competencies among healthcare professionals: a mixed methods systematic review protocol","volume":"10","author":"Chicoine","year":"2021","journal-title":"Syst Rev"},{"key":"2025070910324443800_R46","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/s40596-022-01701-5","article-title":"Effectiveness of project ECHO programs in improving clinician knowledge and confidence in managing complex psychiatric patients: a waitlist-controlled study","volume":"47","author":"Bessell","year":"2023","journal-title":"Acad Psychiatry"},{"key":"2025070910324443800_R47","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1093\/her\/cyac040","article-title":"A cohort-based nutrition ECHO for community health workers","volume":"38","author":"Thomas K","year":"2023","journal-title":"Health Educ Res"}],"container-title":["Health Education Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/her\/article-pdf\/40\/3\/cyaf019\/63196783\/cyaf019.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/her\/article-pdf\/40\/3\/cyaf019\/63196783\/cyaf019.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T14:32:47Z","timestamp":1752071567000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/her\/article\/doi\/10.1093\/her\/cyaf019\/8132964"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":47,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,5,15]]}},"URL":"https:\/\/doi.org\/10.1093\/her\/cyaf019","relation":{},"ISSN":["0268-1153","1465-3648"],"issn-type":[{"value":"0268-1153","type":"print"},{"value":"1465-3648","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025]]},"published":{"date-parts":[[2025]]},"article-number":"cyaf019"}}