Article Figures & Data
Tables
- Table 1.
Topics Covered by the Addiction Medicine Consultant to Assist Primary Care Practices
Develop and refine clinical policies on MOUD How to responding to positive urine drug screenings Determine when it is appropriate to refer patients to other treatment facilities Incorporate telehealth into induction workflows, especially in rural areas Treat and support MOUD patients who use substances or relapse multiple times Educate primary care practice staff on harm reduction strategies, buprenorphine, and urine drug screening How to approach the topic of MOUD with patients on chronic opioid treatment How to respond to widespread presence of fentanyl or methamphetamine Plan for induction in cases where fentanyl is present Support the roles of nurses, care coordinators, and behavioral health clinicians in MOUD treatment (ie, when to initiate contact with patients, how often to reach out, and how best to support MOUD patients) Understand license regulations related to buprenorphine prescribing MOUD = medications for opioid use disorder.
- Table 2.
Descriptive Statistics for Practice Characteristics and Outcome Measures (N = 15)
Practice characteristics Statistics No. of practices Organization type, % Hospital or health system owned 20.0 3 FQHC 26.7 4 Clinician-owned solo or group practice 46.7 7 Other 6.7 1 Practice specialty, % Family medicine only 73.3 11 Family medicine in combination with other specialtiesa 13.3 2 Internal medicine only 6.7 1 Othera 6.7 1 Number of clinicians, % 1 33.3 5 2 40.0 6 3 + 26.7 4 Rural location, % 60.0 9 Outcome measures Total number of practice facilitator interactions per practice, mean (SD) range 33.3 (14.3) 12-60 15 Remote (virtual or conference call) meetings 9.7 (3.4) 2-14 In-person meetings 1.1 (2.5) 0-7 E-mails 21.9 (13.3) 3-47 Telephone calls 0.5 (1.2) 0-4 Number of active buprenorphine prescriptions, mean (SD) range 15 0 months 2.1 (7.7) 0-30 6 months 4.9 (9.8) 0-37 13 months 11.3 (11.2) 0-44 Core aim 1 completion, % (range)b 15 0 months 40.0 (4.8-71.4) 6 months 79.7 (52.4-100.0) 13 months 93.0 (76.2-100.0) Core aim 2 completion, % (range)b 15 0 months 22.7 (0.0-40.0) 6 months 56.9 (26.7-93.3) 13 months 83.6 (66.7-100.0) Core aim 3 completion, % (range)b 15 0 months 28.3 (0.0-66.7) 6 months 57.2 (33.3-100.0) 13 months 93.3 (75.0-100.0) Baseline Final Milestones Mean SD Mean SD Core aim 1: Build your team 1.1: Leadership in this clinic is committed to providing MOUD and communicates consistently its aims within meetings, case conferences, e-mails, internal communications, and celebrations of success. 1.9 0.6 3.1 0.7 1.2: Practice identifies champions (ie, RN, clinician, MA, etc) responsible for practice change related to MOUD. Practice has dedicated resources (protected time, EHR, functionality, etc) to meet and engage in practice change. 2.4 1.0 3.3 0.7 1.3: Eligible clinicians have obtained their DEA X-waiver allowing them to prescribe buprenorphine for treatment of OUD. 3.2 1.1 3.6 0.9 1.4: Clinicians and staff have received training in the last 2 years on patient-centered, empathic communication emphasizing patient safety, destigmatization, and harm reduction. 1.6 0.7 2.8 0.9 1.5: Comprehensive policies regarding MOUD that reflect evidence-based guidelines exist, have been recently updated, and have been discussed with all clinicians and staff. 2.1 1.0 2.7 0.7 1.6: Formal signed patient agreements regarding MOUD exist, align with current policies, and are consistently used with all patients on MOUD. 1.9 1.1 2.9 0.9 1.7: Practice uses a registry or other system to proactively track & monitor patients prescribed MOUD to ensure their safety. 2.3 1.0 2.9 0.8 Core aim 2: Engage and support patients 2.1: Care plan documentation templates align with current policies and are consistently used for people on MOUD. 1.5 0.5 2.1 0.7 2.2: Practice communicates to its patients about the benefits of MOUD through flyers, posters, and other appropriate outreach. 1.1 0.3 1.7 0.7 2.3: Practice consistently uses screening tools and other workflows to identify opioid misuse, diversion, and addiction. 2.3 1.0 3.0 0.7 2.4: Workflows exist and are used to provide prompt access to patients for MOUD inductions and routine maintenance appointments. Practice prescribes MOUD for at least 10 new patients since the start of the project. 1.9 0.9 2.4 0.7 2.5: Harm reduction strategies are identified, implemented and tracked as a part of the routine care for patients with OUD. 1.5 0.5 2.1 0.5 Core aim 3: Connect with recovery support services 3.1: Practice communicates with at least 3 local professional organizations about the availability of MOUD services in the clinic. 1.7 0.7 2.2 0.8 3.2: Policies and workflows are implemented to identify people who may benefit from higher levels of care for their OUD or other mental and behavioral health needs. Hand offs to appropriate specialists and treatment facilities are coordinated and tracked. 1.8 0.7 2.3 0.7 3.3: Patients are provided information about community resources for recovery services, including in-person or virtual. 1.8 0.8 2.3 0.7 3.4: Practice defines and implements workflows to assess social needs of those on MOUD (housing, transportation, food insecurity, etc) and to refer patients to appropriate resources to address identified needs. 2.1 0.9 2.5 0.7 DEA = Drug Enforcement Administration; EHR = electronic health record; MA = medical assistant; MOUD = medications for opioid use disorder; OUD = opioid use disorder; RN = registered nurse.
Note: Implementation rating scale: (1) not started = no work has started on activity at the practice; (2) just beginning = work is started and there is minor progress on the activity; (3) actively addressing = substantial work is done and activity is almost complete; and (4) completed = activity is fully and regularly implemented at the practice.
- Table 4.
Regression Models of Change Over Time in Buprenorphine Prescribing and Completion of Integrated Support for MOUD Program Aims, 2022-2023 (N = 15)
Outcome B SE P Valuea No. of active buprenorphine prescriptions Time 0 months ref ref <.001 6 months 0.84 0.21 <.001 13 months 1.67 0.19 <.001 Specialty Non–family medicine ref ref .92 Family medicine −0.12 1.21 … Organization type Clinician-owned ref ref .83 FQHC 0.28 0.98 … Hospital or health system owned 0.92 1.05 … Other −0.13 1.58 … Core aim 1 completion Time 0 months ref ref <.001 3 months 0.28 0.06 <.001 6 months 0.40 0.06 <.001 9 months 0.49 0.06 <.001 13 months 0.53 0.06 <.001 Specialty Non–family medicine ref ref .18 Family medicine −0.11 0.08 … Organization type Clinician-owned ref ref .95 FQHC 0.01 0.06 … Hospital or health system owned −0.03 0.07 … Other −0.03 0.10 … Core aim 2 completion Time 0 months ref ref <.001 3 months 0.20 0.05 <.001 6 months 0.34 0.05 <.001 9 months 0.50 0.05 <.001 13 months 0.61 0.05 <.001 Specialty Non–family medicine ref ref .99 Family medicine 0.00 0.07 … Organization type Clinician-owned ref ref .56 FQHC −0.03 0.06 … Hospital or health system owned −0.08 0.06 … Other −0.09 0.09 … Core aim 3 completion Time 0 months ref ref <.001 3 months 0.16 0.06 .013 6 months 0.29 0.06 <.001 9 months 0.59 0.06 <.001 13 months 0.65 0.06 <.001 Specialty Non–family medicine ref ref .67 Family medicine 0.03 0.07 … Organization type Clinician-owned ref ref .14 FQHC −0.12 0.06 … Hospital or health system owned 0.00 0.06 … Other 0.03 0.10 … FQHC = Federally Qualified Health Center; ref = reference group; SE = standard error.
↵a Outcomes from multiple regressions were adjusted for multiple comparisons using Bonferroni’s method; P values <.013 were considered statistically significant.
Additional Files
SUPPLEMENTAL MATERIALS IN PDF FILE BELOW
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- Hall_Supplemental_F1-2.pdf -
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- Hall_Supplemental_F1-2.pdf -
VISUAL ABSTRACT IN PDF FILE BELOW
- Hall_Visual_abstract.pdf -
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- Hall_Visual_abstract.pdf -
PLAIN-LANGUAGE SUMMARY
Original Research
Primary Care Support Program Achieves Fivefold Increase in Buprenorphine Prescribing to Treat Opioid Use Disorder
Background and Goal:Despite the removal of the X-waiver requirement, which once restricted clinicians from prescribing buprenorphine for opioid use disorder (OUD), only a small percentage of primary care clinicians currently prescribe medication for OUD (MOUD). This study evaluated a structured support program designed to help small, rural primary care clinics improve their capacity to provide this treatment.
Study Approach:Researchers worked with 15 primary care practices in Colorado over a 12-month period, from January 2022 through January 2023. The program provided clinics with monthly educational sessions, direct access to an addiction medicine specialist, and support from practice facilitators to achieve specific milestones in MOUD implementation. Financial incentives were offered based on progress toward these goals. The researchers measured changes in buprenorphine prescribing and milestone completion rates at baseline and at 12 months.
Main Results:
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The average number of active buprenorphine prescriptions per practice (calculated over the preceding three months) increased significantly from 2.1 at the start of the program (baseline) to 11.3 at 12 months (P < .001).
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Clinic completion rates for MOUD implementation milestones also showed significant improvements:
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Core Aim 1 ("Build Your Team"): Increased from 40% at the start of the program to 93% at 12 months
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Core Aim 2 ("Engage and Support Patients"): Increased from 23% to 84%
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Core Aim 3 ("Connect with Recovery Support Services"): Increased from 28% to 93%
Why It Matters:By providing structured support and resources, this program successfully increased the ability of clinics to prescribe MOUD and support patients in need, addressing critical gaps in opioid treatment access. The findings from this study highlight a potentially scalable and effective model to expand access to MOUD in rural communities, where treatment options for opioid use disorder are often limited.
Evaluation of a Program Designed to Support Implementation of Prescribing Medication for Treatment of Opioid Use Disorder in Primary Care Practices
Tristen L. Hall, PhD, MPH, et al
University of Colorado Anschutz Medical Campus, Aurora, Colorado
Visual Abstract:
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