The Buprenorphine Positive Deviants: Findings from a Qualitative Study of Connecticut Health Care Practitioners Who Have Integrated Buprenorphine Prescribing in Primary Care Settings
The United States is experiencing an opioid use epidemic. The epidemic has significant public health consequences such as increased incidence of opioid use disorder (OUD) and fatal and nonfatal opioid-related overdoses. OUD is a treatable chronic disease with various treatment options. Pharmacotherapy with buprenorphine has been well researched and is one of the most effective treatment options available, however there are a limited number of health care practitioners who have the waiver to prescribe buprenorphine. Buprenorphine integration in primary care settings is effective yet underutilized. The goal of this research was to learn from Connecticut-based primary care nurse practitioners, physician assistants, and physicians about their experiences integrating and prescribing buprenorphine in their primary care practices. Potential participants were identified from a publically available list of healthcare practitioners who had the waiver to prescribe buprenorphine. Internet searches were conducted to obtain emails for these practitioners. Practitioners were emailed an invitation to complete a brief web-based survey to obtain information about their buprenorphine prescribing behaviors and demographic characteristics. Participants who indicated they were primary care providers were invited to participate in an individual, semi-structured, qualitative interview to learn more about how they integrated buprenorphine prescribing into their clinical practices. A total of 89 practitioners completed the survey, and nine completed a qualitative interview. Participants discussed their prescribing practices, factors influencing buprenorphine prescribing, and recommendations for increasing the number of buprenorphine prescribers. Analysis was conducting using the rigorous and accelerated data reduction technique. Participants discussed five ways they adapted knowledge about buprenorphine into their local context: conducting home inductions, continuing treatment with patients using alcohol or illicit drugs, individualizing treatment to suit patient needs, providing same-day treatment, and providing treatment through mobile clinics and street medicine. Participants described two key facilitators that helped them to prescribe buprenorphine: their professional experiences and perceptions of the pharmacological characteristics of buprenorphine. Participants suggested two primary strategies to increase the number of buprenorphine providers: incorporating buprenorphine information in medical education and revising federal regulations to encourage practitioners to prescribe buprenorphine. These adaptations and recommendations might be considered to increase the number of health care practitioners prescribing buprenorphine.
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