Development and Implementation of a Substance Use Disorder eConsult.

Abstract

To evaluate types of substance use disorder (SUD), recommended medications, and implementation of a new SUD eConsult offering asynchronous chart review and recommendations for primary care clinicians at an academic medical center. In addition, to understand contextual factors that affected program implementation, as identified by the Practical, Robust Implementation and Sustainability (PRISM) model. A retrospective analysis of SUD eConsults between December 1, 2020 and September 30, 2024 was performed, using SUD eConsult orders and electronic medical record chart review. The PRISM model was applied to understand contextual factors affecting the implementation of the eConsult program. There were 103 completed SUD eConsults. The most common reasons for eConsult were alcohol use disorder (46.6%), followed by opioid use disorder (37.9%), tobacco use disorder (4.9%), stimulant use disorder (3.9%), cannabis use disorder (1.9%), and benzodiazepine use disorder (1.0%). In total, 65.1% of eConsults recommended new prescriptions. Recommended medications were prescribed for 58.2% of patients, and 82.1% of these patients continued the medications for the study period. Utilizing the PRISM model, key factors that facilitated the SUD eConsult program include an existing eConsult infrastructure, a team of specialists available to review eConsults, a low threshold substance use disorder treatment clinic, and incentive pay for completed eConsults. Factors that hindered program implementation include competing demands within primary care, clinician hesitancy to use eConsults for SUD, stigma related to SUD, difficulty advertising, and reliance upon internal incentive pay. The SUD eConsult program extends addiction medicine expertise to and supports pharmacotherapy initiation by primary care providers.