The 24/7 Addiction Medicine Clinician Support Line was developed by the BCCSU alongside the British Columbia Ministry of Mental Health and Addictions and the Ministry of Health. Feedback from over 2,500 clinicians who participated in educational workshops held by the BCCSU was influential in the initiative’s development. Regardless of professional training or clinical setting, providers were keen to provide addictions care but desired additional support in clinical decision-making. Funding from the British Columbia provincial government supported the implementation and evaluation of this initiative. Initially, the BCCSU was supported with $500,000 Canadian dollars which was sufficient to run the service from 2020 to 2023. Due to its success, an additional budget to support the long-term continuation was granted by the province following the implementation and evaluation phase.

In order to operationalize a provincial provider consultation line, the BCCSU leveraged an existing provincial network of opioid agonist prescribers and addiction medicine specialists. After establishing clinical leadership for the service, approximately thirty physicians from across the province were recruited and trained to staff the line. Providers were selected based on their training in addiction medicine, past work experience, and current practice in order to ensure that they possessed an appropriately comprehensive level of expertise. The 24/7 addiction medicine consultation service was launched on June 16, 2020, with consultation services geared toward screening, assessment, treatment planning, and ongoing management for substance use and substance use disorders. The BCCSU worked in partnership with regional health authorities, the First Nations Health Authority, and clinician groups such as the BC Divisions of Family Practice and the Midwives Association of British Columbia to promote and raise awareness about the service. Information about the service was incorporated into all of the BCCSU’s professional training and educational curricula. The service’s outreach strategy involved a provincial Ministry of Health news release, the dissemination of service information to BC pharmacies and health authorities via fax and mail, and a promotional social media campaign.

Providers staffing the line received the patient’s personal health number and basic identification purposes to enable documentation of the consultation as a clinical encounter within a secure electronic medical record. However, patient-identifying information was not collected as part of the evaluation and quality control arm of the program, in an effort to protect patient and provider anonymity. Evaluation metrics for the consultation line involved basic provider demographic details and anonymized survey data from providers who called in to the line (see Methods: Data Collection below).

This study is a prospective, observational program evaluation of the 24/7 Addiction Medicine Clinician Support Line. We utilized a results framework in order to develop the study’s evaluation criteria with input from a multidisciplinary team of addictions experts, government health officials, and stakeholders in the province of British Columbia. The results framework has been applied to virtual health interventions in previous evaluation studies, and connects overall program objective(s) to intermediate results that are evaluated with clearly-defined performance measures [12]. With the primary goal of increasing accessibility to high-quality addictions care in British Columbia, the results focused on utilization patterns, clinical impact, and provider satisfaction (Fig. 1).

Illustrative results framework for the 24/7 addiction consult line

Given that this research was conducted as a clinical program evaluation, ethical approval was not required as per Articles 2.3 and 2.5 of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS-2) [13]. No identifiable patient or provider information was collected for research purposes and no data were linked.

Any healthcare provider who called the 24/7 Addiction Medicine Clinician Support Line during the study period was included. The term ‘healthcare provider’ includes primary care physicians, specialist physicians, nurse practitioners, registered nurses, registered psychiatric nurses, pharmacists, and licensed midwives. Support line encounters that took place from the program’s inception in June 2020 until the completion of the study pilot phase in April 2022 were included.

Data were collected from two primary sources: (1) healthcare provider demographic information collected by the support line staff at each encounter and (2) optional surveys conducted through total population sampling of providers after the consultation took place. Overall frequency and timing of calls to the 24/7 Addiction Medicine Clinician Support Line were monitored throughout the study period. Clinicians consented to the collection of demographic and clinical information for research purposes, including healthcare profession, clinical setting, geographic location, and consultation type (by drug class). Data on the type of substance use focused on during the consultation was collected for the first 700 encounters to gain a sense of providers’ needs when seeking addictions expertise. Geographic region was categorized by health authority; the province’s health administration is divided into seven health authorities that direct regional care in British Columbia. Callers had the option to provide partial consent to the collection of certain demographic variables only (i.e. healthcare profession but not geographic location), or to opt out of data collection entirely. Following the encounter, providers were sent an optional survey over text message that asked questions about their satisfaction with the consultation and any modifications to patient care following the encounter (Supplement Table 1). A comprehensive list of study outcome measures is detailed in Fig. 1. All data were anonymized and de-identified from individual encounters and stored in an encrypted and password-protected document. No patient data was stored.

Categorical data are presented as numerical values and percentages. Given the descriptive nature of the evaluation no statistical analyses were performed. All cases of missing data are reported.