Building Capacity for Medications for Opioid Use Disorder in a Large Urban Primary Care Practice: Addressing Provider Bias and Preparedness

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An estimated 1.6 million people in the United States have opioid use disorder (OUD). In 2019, there were 49,860 opioid overdose deaths. Yet, there is woefully inadequate access to treatment with medication for opioid use disorder (MOUD). Integrating buprenorphine, one of the medications available for MOUD, in primary care increases access and retention in treatment, and reduces overdose deaths. This project aimed to increase access to MOUD by increasing provider preparedness, interest, and intent to prescribe MOUD in an urban academic primary care network in Philadelphia, PA. This project used the Define, Measure, Analyze, Improve, and Control methodology and took place from July 2020 until June 2021. Four interventions were implemented: clinical infrastructure for team-based MOUD care including a physician, medical assistant, and nurse; a physician champion available for consultations; provider education; and recommendation for additional provider training. Provider preparedness, interest, and intent were measured via survey. Access to MOUD was measured by the number of providers who prescribe buprenorphine and the number of patients receiving MOUD in the practice. Provider preparedness to diagnose OUD and discuss medication options increased to at least 85%. Provider preparedness to initiate and monitor buprenorphine therapy increased to at least 60%. Provider interest and intent to prescribe buprenorphine did not increase from a baseline of approximately 55%. The number of providers who prescribe buprenorphine increased from two to six. The number of patients receiving MOUD increased from two to 13. Implementation of a team-based clinical infrastructure, physician champion, and provider education effectively increased provider preparedness but that alone was insufficient to motivate the majority of providers to prescribe buprenorphine. However, the increase in the number of providers prescribing buprenorphine and patients receiving buprenorphine indicates a promising start. Strengthening stakeholder engagement with data reporting and stronger support systems may further increase access to MOUD.



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