Buprenorphine/Naloxone for the Treatment of Opioid Use Disorder: Analysis and Mitigation of Perceived Prescribing Barriers in Primary Care
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Authors
Haines, Maricruz
Kipngeno, Miriam
Munoz, Benjamin
True, Corey
Issue Date
2024-12-16
Type
Thesis
Language
en_US
Keywords
Drugs--Buprenorphine , Drugs--Naloxone , Opioid Use Disorder , Substance Abuse--Treatment
Alternative Title
Abstract
Background/Objectives:
The opioid epidemic is an ongoing health crisis in the United States (US). Opioid-related death rates increased by 15% from 2020 to 2021 with more than 75% of drug overdose deaths contributing to the use of an opioid. Medication-assisted treatment (MAT) with buprenorphine is an effective treatment for opioid-use disorder (OUD) that is able to be prescribed by any primary care provider with a DEA license. Despite its availability, buprenorphine/naloxone is underutilized in the primary care setting and the cause for this is multifactorial. The purpose of this project was to identify perceived barriers to prescribing buprenorphine for MAT of OUD and to attempt to reduce these barriers by increasing the knowledge, confidence, and comfort level of primary care providers (PCPs) in treating patients with OUD. The primary goal was to increase provider willingness to prescribe buprenorphine for patients with OUD.
Methods:
The project was conducted at a rural family practice clinic in southwest Kansas. A pre- and post-test study design was used to evaluate knowledge, comfort, preferences, and perceived barriers of two physicians and three nurse practitioners regarding the prescription of buprenorphine for MAT in the primary care setting. These PCPs were surveyed before and after the development and implementation of interventions tailored to identified prescribing barriers. A focus group interview was also conducted among PCPs for qualitative analysis of prescribing barriers. Interventions included an evidence-based buprenorphine home induction prescribing protocol, a patient education handout, and a first-week patient dose log. Provider willingness to prescribe buprenorphine was measured in the number of PCPs who planned to initiate MAT in the next six months or 30 days.
Results:
The barriers to buprenorphine prescription most prevalent on the pre-survey (n=5) included provider comfort level, lack of time, lack of existing policies/procedures, lack of desire to treat OUD, and lack of on-site lab. Focus group discussion further revealed that the PCPs feel participating in MAT with buprenorphine is a positive endeavor, but that rural primary care practice was so time intensive as to allow little room to add treatment of OUD into their schedule, making referral for MAT a more common practice. The providers also stated they would feel more comfortable if a formal prescribing protocol were in place to help guide treatment. Other concerns include a lack of peer support/provider coverage and the overall difficulty/complexity of patients with OUD. Post-intervention surveys (n=4) showed improved provider confidence, attitude, and interest in initiating MAT; however, despite the implementation of developed deliverables, the number of providers who intended to prescribe buprenorphine in the next six months remained unchanged (1), and no providers indicated that they planned on prescribing buprenorphine in the next 30 days.
Implications:
Implementation of the interventions increased provider knowledge and confidence, but no significant changes in prescribing practices occurred within the scope of this project. While time and provider availability to discuss interventions in depth was certainly a limitation of the project, increasing utilization of buprenorphine in primary care may require more dissemination and more systemic change beyond the mitigation of individual prescribing barriers.
Description
Practice Inquiry DNP Project III
Citation
Publisher
Washburn University