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Research ArticleOriginal Research

Barriers to Primary Care Physicians Prescribing Buprenorphine

Eliza Hutchinson, Mary Catlin, C. Holly A. Andrilla, Laura-Mae Baldwin and Roger A. Rosenblatt
The Annals of Family Medicine March 2014, 12 (2) 128-133; DOI: https://doi.org/10.1370/afm.1595
Eliza Hutchinson
University of Washington, Department of Family Medicine, Research Section, Seattle, Washington
BA
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Mary Catlin
University of Washington, Department of Family Medicine, Research Section, Seattle, Washington
BSN, MPH
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C. Holly A. Andrilla
University of Washington, Department of Family Medicine, Research Section, Seattle, Washington
MS
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Laura-Mae Baldwin
University of Washington, Department of Family Medicine, Research Section, Seattle, Washington
MD, MPH
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Roger A. Rosenblatt
University of Washington, Department of Family Medicine, Research Section, Seattle, Washington
MD, MPH, MFR
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  • For correspondence: rosenb@uw.edu
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    Figure 1

    Barriers to prescribing buprenorphine by prescribing and nonprescribing physicians.

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    Table 1

    Physician and Practice Characteristics by Buprenorphine Prescribing Status

    CharacteristicDoes Not Prescribe Buprenorphine (n = 56) No. (%)Prescribes Buprenorphine (n = 22) No. (%)All Physician Respondents (N = 78) No. (%)P Value
    Physician characteristics
    Sexns
     Male35 (62)12 (55)47 (60)
     Female21 (38)10 (45)31 (40)
    Age, y
     Mean53.847.752.1.04
     <35 6 (11) 3 (14) 9 (12)
     35–5421 (38)11 (50)32 (41)
     >5429 (52) 8 (36)37 (47)
    Licensens
     Doctor of medicine53 (95)18 (89)71 (91)
     Doctor of osteopathy 3 (5) 4 (18) 7 (9)
    Practice characteristics
    County classificationns
     Urban40 (71)14 (64)54 (69)
     Rural16 (28) 8 (36)24 (31)
    Practice typens
     Safety net (RHC, CHC, tribal/IHS)14 (25) 8 (36)22 (28)
     Hospital-sponsored clinic10 (18) 5 (23)15 (19)
     Private practice15 (27) 8 (3623 (29)
     Other17 (30) 1 (5)18 (23)
    Single vs multispecialtyns
     Single specialty (family or internal medicine)34 (61)17 (77)51 (65)
     Multispecialty21 (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.

    • View popup
    Table 2

    Buprenorphine Prescribing Status by Specialty, Practice Size, and Partner Waiver Status

    CharacteristicDoes Not Prescribe Buprenorphine (n = 56) No. (%)Prescribes Buprenorphine (n = 22) No. (%)All Physician Respondents (N = 78) No. (%)P Valuea
    Physician specialty.05
    Family medicine42 (75)21 (95)63 (81)
    Other14 (25) 1 (5)15 (19)
    Number of physicians
    Mean practice size13.9 9.012.4ns
     1 (solo) 7 (12) 3 (14)10 (13)
     2–921 (38)13 (59)34 (44)
     10–4921 (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 NAb37 (66) 7 (32)44 (56)
     Any19 (34)15 (68)34 (44)
     Meana 0.8 1.8 1.1.04
     027 (48) 6 (27)33 (42)
     111 (20) 7 (32)18 (23)
     2–5 6 (11) 6 (27)12 (15)
     >5 2 (4) 2 (9) 4 (5)
     Responded unknown or NA10 (18) 1 (5)11 (14)
    • NA = not applicable; ns = not significant.

    • ↵a Computed using Fisher’s exact text.

    • ↵b Three cases excluded because they reported number of physicians in the multiclinic system rather than for 1 clinic.

    • View popup
    Table 3

    Experience and Satisfaction With Buprenorphine Reported by Prescribing Physicians

    VariablePrescribes Buprenorphine (n = 22) No. (%)
    Patients ever treated with buprenorphine
     Mean10.1
     1–311 (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 panel21 (95)
     Patients of other physicians in clinic17 (89)a
     Referrals from other physicians or agencies16 (73)
     Patients from the community not in the practice14 (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.

Additional Files

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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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The Annals of Family Medicine: 12 (2)
The Annals of Family Medicine: 12 (2)
Vol. 12, Issue 2
March/April 2014
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Barriers to Primary Care Physicians Prescribing Buprenorphine
Eliza Hutchinson, Mary Catlin, C. Holly A. Andrilla, Laura-Mae Baldwin, Roger A. Rosenblatt
The Annals of Family Medicine Mar 2014, 12 (2) 128-133; DOI: 10.1370/afm.1595

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Barriers to Primary Care Physicians Prescribing Buprenorphine
Eliza Hutchinson, Mary Catlin, C. Holly A. Andrilla, Laura-Mae Baldwin, Roger A. Rosenblatt
The Annals of Family Medicine Mar 2014, 12 (2) 128-133; DOI: 10.1370/afm.1595
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  • Evaluation of a Program Designed to Support Implementation of Prescribing Medication for Treatment of Opioid Use Disorder in Primary Care Practices
  • Barriers and Facilitators to Using a Clinical Decision Support Tool for Opioid Use Disorder in Primary Care
  • Barriers and facilitators for family physicians prescribing opioid agonist therapy in Saskatchewan
  • Increasing Access to Medications for Opioid Use Disorder in Primary Care: Removing the Training Requirement May Not Be Enough
  • Clinician Perceptions About a Decision Support System to Identify and Manage Opioid Use Disorder
  • Use of a Benchmark Tracking Assessment to Support Expansion of Buprenorphine for Treatment of Opioid Use Disorder in Primary Care
  • The Concurrent Initiation of Medications Is Associated with Discontinuation of Buprenorphine Treatment for Opioid Use Disorder
  • The Impact on Future Prescribing Patterns of Opioid Use Disorder (OUD) Education and Waiver Provision During Residency
  • Financing Buprenorphine Treatment in Primary Care: A Microsimulation Model
  • The Value of Treating Opioid Use Disorder in Family Medicine: From the Patient Perspective
  • A Change Management Case Study for Safe Opioid Prescribing and Opioid Use Disorder Treatment
  • Barriers and facilitators to buprenorphine use for opioid agonist treatment: protocol for a scoping review
  • Buprenorphine Provision by Early Career Family Physicians
  • Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder
  • Now is the Time to Address Substance Use Disorders in Primary Care
  • Growth In Buprenorphine Waivers For Physicians Increased Potential Access To Opioid Agonist Treatment, 2002-11
  • Geographic and Specialty Distribution of US Physicians Trained to Treat Opioid Use Disorder
  • In This Issue: Building Blocks for Improving Practice
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Subjects

  • Domains of illness & health:
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    • Mental health
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Keywords

  • buprenorphine
  • opiate substitution treatment
  • rural health
  • primary health care
  • opiate addiction

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