Association of a Multimodal Educational Intervention for Primary Care Physicians With Prescriptions of Buprenorphine for Opioid Use Disorders

Clark, Brinton; Kai, Mari; Dix, Ryan; White, Jonathan; Rozenfeld, Yelena; Levy, Sheldon; Engstrom, Kathleen

doi:10.1001/jamanetworkopen.2019.13818

Cited by 9 publications

(9 citation statements)

References 9 publications

(19 reference statements)

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“…Three interventions measured the impact of AD on knowledge of opioid prescribing, the prescription monitoring programme (PMP) and opioid use disorder (OUD) treatment. 18 , 26 , 29 Kattan et al used verbal pre–postintervention provider surveys to assess knowledge related to opioid treatment of non-cancer pain. 26 The authors found that after the AD intervention, there were statistically significant increases in correct responses ( p <0.01) for each of the three survey questions.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, a study by Clark et al initially assessed provider knowledge, beliefs and barriers to the buprenorphine prescribing process. 29 The top concerns of physicians were challenges around the treatment of OUD patients, limited outpatient counselling options for substance use, the time needed to manage OUD patients and insufficient personal knowledge about prescribing buprenorphine. After the multifaceted intervention with AD, there was an increase in buprenorphine prescribers and patients receiving OUD treatment.…”

Section: Resultsmentioning

confidence: 99%

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Academic detailing interventions for opioid-related outcomes: a scoping review

Kulbokas¹,

Hanson²,

Smart³

et al. 2021

DIC

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Background Academic detailing (AD) is a tailored, interactive educational outreach intervention that may improve patient outcomes. Insight into the design of AD interventions and the extent to which they are effective can help inform future AD-based programmes. The objective of this scoping review was to characterize opioid-focused AD interventions and describe their findings. Methods A scoping review focused on AD interventions for opioids was conducted in PubMed, EMBASE and CINAHL databases through July 1, 2021. Studies were eligible for inclusion if written in English, included interactive opioid-focused educational interventions, and were conducted either in person, virtually or via telephone. Four independent reviewers reviewed titles and abstracts. Data extraction from full-text publications was completed using a standardized form. Results Of 6086 articles initially identified, 22 articles met the inclusion criteria and 20 unique interventions were identified. The AD intervention was either delivered one-on-one ( n =16) or in a small, interactive group setting ( n =4). AD interventions varied in design. Effectiveness was evaluated in terms of opioid and naloxone prescribing rates, provider knowledge gaps, provider adherence to guidelines, and intervention feasibility. Sixteen (80%) interventions resulted in statistically significant improvement in one or more outcomes. Conclusion Generally, opioid-related AD was effective and programmes were primarily conducted one-on-one between pharmacists and primary care providers for 16–30 minutes. A variety of metrics and outcomes were used to assess the success/effectiveness of AD interventions, which is an important consideration in future studies as no single metric captures the effectiveness of an educational outreach-based intervention for pain management.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Academic detailing interventions for opioid-related outcomes: a scoping review

Kulbokas¹,

Hanson²,

Smart³

et al. 2021

DIC

View full text Add to dashboard Cite

show abstract

“…Shown here is the proportion of nonwaivered respondents who perceived buprenorphine to be not at all beneficial, not that beneficial, somewhat beneficial, or very beneficial for their patient populations, and the proportion of providers who expressed no interest, slight interest, moderate interest, and high interest in buprenorphine prescribing. PCPs in the past, 22,23 but they have not traditionally focused on the benefits of buprenorphine therapy for providers' specific patient populations. Interventions that highlight the impact of buprenorphine treatment on providers' patient panels may increase the efficacy of preexisting educational programs and decrease the discrepancy between patients' needs for buprenorphine and providers' ability to prescribe.…”

Section: Discussionmentioning

confidence: 99%

Impact of Policy Change on Access to Medication for Opioid Use Disorder in Primary Care

Krupp

Hung

LaChapelle

et al. 2023

Southern Medical Journal

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Objectives:The opioid overdose epidemic is escalating. Increasing access to medications for opioid use disorder in primary care is crucial. The impact of the US Department of Health and Human Services' policy change removing the buprenorphine waiver training requirement on primary care buprenorphine prescribing remains unclear. We aimed to investigate the impact of the policy change on primary care providers' likelihood of applying for a waiver and the current attitudes, practices, and barriers to buprenorphine prescribing in primary care.Methods: We used a cross-sectional survey with embedded educational resources disseminated to primary care providers in a southern US academic health system. We used descriptive statistics to aggregate survey data, logistic regression models to evaluate whether buprenorphine interest and familiarity correlate with clinical characteristics, and a χ 2 test to evaluate the effect of the educational intervention on screening.Results: Of the 54 respondents, 70.4% reported seeing patients with opioid use disorder, but only 11.1% had a waiver to prescribe buprenorphine. Few nonwaivered providers were interested in prescribing, but perceiving buprenorphine to be beneficial to the patient population was associated with interest (adjusted odds ratio 34.7, P < 0.001). Two-thirds of nonwaivered respondents reported the policy change having no impact on their decision to obtain a waiver; however, among interested providers, it increased their likelihood of obtaining a waiver. Barriers to buprenorphine prescribing included lack of clinical experience, clinical capacity, and referral resources. Screening for opioid use disorder did not increase significantly after the survey.Conclusions: Although most primary care providers reported seeing patients with opioid use disorder, interest in prescribing buprenorphine was low and structural barriers remained the dominant obstacles. Providers with a preexisting interest in buprenorphine prescribing reported that removing the training requirement was helpful.

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“…Our findings suggested that PCPs lack a full understanding of unnecessary drugs and ignore their non-health related impacts, such as wasting medical resources. Education is an important priority to help PCPs prescribe wisely [ 31 ]. A systematic review implied that the prescribing behaviors of PCPs could be successfully changed through academic detailing [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Primary care physician responses to requests by older adults for unnecessary drugs: a qualitative study

Liang

et al. 2022

BMC Prim. Care

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Background Unnecessary drug use can cause avoidable harm to older adults and is particularly common in primary care, but how primary care physicians (PCPs) respond to older adult requests for unnecessary drugs has not been well studied. This study is to explore PCPs’ responses to requests for unnecessary drugs from older adults, and their influencing factors and potential solutions. Methods This qualitative study was conducted through semi-structured, in-depth interviews from January 4 to September 30, 2020 using a grounded theory methodology. A purposive sample of PCPs affiliated with community healthcare centers in Zhejiang Province and Guangdong Province, China were recruited. The face-to-face interviews were audio-recorded, transcribed verbatim, and independently coded by two investigators. Themes surrounding PCPs’ responses to requests for unnecessary drugs, their influencing factors and potential solutions were analysed using a constant comparative approach. Results Of the 23 participants involved in this study, 12 (52%) were women and the mean age was 35 years. PCPs frequently declined older adults’ requests for unnecessary drugs through dissuasion, and occasionally rebuffed patients or referred them to another practitioner. PCPs may fulfill requests due to physician acquiescence, patient pressure, or inadequate supervision and support. Participants recommended four potential solutions to improve the quality of prescribing, including developing professional communication skills, enhancing pharmacist-physician collaboration, improving electronic prescription systems, and strengthening prescription management. Conclusions PCPs typically deny requests by older adults for unnecessary drugs according to three main patterns, and guidance is necessary to reduce the potential for adverse consequences. Factors contributing to request fulfillment by PCPs require attention, and the potential solutions recommended by participants deserve consideration to improve the service quality of prescribing for older adults in primary care practices.

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Association of a Multimodal Educational Intervention for Primary Care Physicians With Prescriptions of Buprenorphine for Opioid Use Disorders

Abstract: This quality improvement study examines the association of a multimodal educational intervention for primary care physicians (PCPs) with prescriptions of buprenorphine for treatment of patients with opioid use disorder.

Cited by 9 publications

References 9 publications

Academic detailing interventions for opioid-related outcomes: a scoping review

Academic detailing interventions for opioid-related outcomes: a scoping review

Impact of Policy Change on Access to Medication for Opioid Use Disorder in Primary Care

Primary care physician responses to requests by older adults for unnecessary drugs: a qualitative study

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