Article Figures & Data
Figures
- Figure 1
Barriers to prescribing buprenorphine by prescribing and nonprescribing physicians.
Tables
Characteristic Does Not Prescribe Buprenorphine (n = 56) No. (%) Prescribes Buprenorphine (n = 22) No. (%) All Physician Respondents (N = 78) No. (%) P Value Physician characteristics Sex ns Male 35 (62) 12 (55) 47 (60) Female 21 (38) 10 (45) 31 (40) Age, y Mean 53.8 47.7 52.1 .04 <35 6 (11) 3 (14) 9 (12) 35–54 21 (38) 11 (50) 32 (41) >54 29 (52) 8 (36) 37 (47) License ns Doctor of medicine 53 (95) 18 (89) 71 (91) Doctor of osteopathy 3 (5) 4 (18) 7 (9) Practice characteristics County classification ns Urban 40 (71) 14 (64) 54 (69) Rural 16 (28) 8 (36) 24 (31) Practice type ns Safety net (RHC, CHC, tribal/IHS) 14 (25) 8 (36) 22 (28) Hospital-sponsored clinic 10 (18) 5 (23) 15 (19) Private practice 15 (27) 8 (36 23 (29) Other 17 (30) 1 (5) 18 (23) Single vs multispecialty ns Single specialty (family or internal medicine) 34 (61) 17 (77) 51 (65) Multispecialty 21 (38) 5 (23) 26 (33) -
CHC = community health clinic; ns = nonsignificant; RHC = rural health clinic; tribal/IHS = tribally owned and operated clinic or an Indian Health Service clinic.
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- Table 2
Buprenorphine Prescribing Status by Specialty, Practice Size, and Partner Waiver Status
Characteristic Does Not Prescribe Buprenorphine (n = 56) No. (%) Prescribes Buprenorphine (n = 22) No. (%) All Physician Respondents (N = 78) No. (%) P Valuea Physician specialty .05 Family medicine 42 (75) 21 (95) 63 (81) Other 14 (25) 1 (5) 15 (19) Number of physicians Mean practice size 13.9 9.0 12.4 ns 1 (solo) 7 (12) 3 (14) 10 (13) 2–9 21 (38) 13 (59) 34 (44) 10–49 21 (38) 6 (27) 27 (35) >49 6 (11) 0 (0) 6 (8) Missing 1 (2) 0 (0) 1 (1) Other physicians in trainee’s practice Number known to have waivers .006 0, unknown, or NAb 37 (66) 7 (32) 44 (56) Any 19 (34) 15 (68) 34 (44) Meana 0.8 1.8 1.1 .04 0 27 (48) 6 (27) 33 (42) 1 11 (20) 7 (32) 18 (23) 2–5 6 (11) 6 (27) 12 (15) >5 2 (4) 2 (9) 4 (5) Responded unknown or NA 10 (18) 1 (5) 11 (14) Variable Prescribes Buprenorphine (n = 22) No. (%) Patients ever treated with buprenorphine Mean 10.1 1–3 11 (50) 4–10 6 (27) >10 4 (18) Unknown 1 (5) Has name on public list of prescribing physicians 9 (41) Clinical opinion of buprenorphine’s effectiveness for treating opioid addiction Mean score 4.3 Dissatisfied (1–3) 3 (14) Satisfied (4–5) 18 (82) Missing 1 (5) Types of patients physician is willing to accept for treatment Patients already on personal panel 21 (95) Patients of other physicians in clinic 17 (89)a Referrals from other physicians or agencies 16 (73) Patients from the community not in the practice 14 (64) Patients from other communities not already in the practice 8 (36) Has participated in telemedicine sessions offering addiction, pain, and psychiatry specialists 8 (36) -
↵a Of 19 physicians, 3 prescribers were solo practitioners.
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The Article in Brief
Barriers to Primary Care Physicians Prescribing Buprenorphine
Roger A. Rosenblatt , and colleagues
Background Buprenorphine-naloxone is a highly effective outpatient treatment for opioid addiction, yet few physicians offer it. In an earlier project, 120 physicians were trained to prescribe buprenorphine. This study determined what proportion of the trainees began prescribing it and identified barriers to incorporating this approach into outpatient practice
What This Study Found Of the 78 physicians interviewed, 22 (28%) reported prescribing buprenorphine, though almost all reported positive attitudes toward the treatment. Commonly-cited barriers included a lack of mental health and psychosocial support, time constraints, and a lack of specialty, institutional and partner support.
Implications
- Interventions before and after training could help increase the number of physicians who offer buprenorphine for treatment of addiction.
- Targeting physicians in clinics that agree in advance to institute services, coupled with technical assistance after training is completed, could help more physicians become active providers of buprenorphine.
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