Increasing Primary Care Utilization of Medication-Assisted Treatment (MAT) for Opioid Use Disorder.


Journal

Journal of the American Board of Family Medicine : JABFM
ISSN: 1558-7118
Titre abrégé: J Am Board Fam Med
Pays: United States
ID NLM: 101256526

Informations de publication

Date de publication:
03 04 2023
Historique:
received: 15 08 2022
revised: 21 11 2022
accepted: 05 12 2022
medline: 6 4 2023
pubmed: 23 3 2023
entrez: 22 3 2023
Statut: ppublish

Résumé

With increasing prevalence of opioid use disorders (OUDs) there is an urgent need for OUD trained front line primary care providers (PCPs) who can help improve patient adherence to addiction treatment. Unfortunately, most physicians have had limited training for treating patients with addiction, leaving clinicians under prepared. To address this need, we created a Medication-Assisted Treatment (MAT) training program specifically designed for PCPs. A 4-hour PCP focused buprenorphine office-based implementation training was designed to supplement the 8-hour SAMHSA DATA 2000 waiver training. The intent of the supplemental training is to increase PCP likelihood of implementing MAT through practical evidenced-based implementation, addressing barriers reported by waivered PCPs. We developed and validated a new pre- and postsurvey instrument that assesses changes in participants knowledge, skills, and attitudes. Data were entered into REDCap, and composite scales were created and analyzed to determine pre-post differences. A total of 183 participants completed pre-post evaluations. Pre-post comparisons indicated substantial improvement in learner levels of confidence in implementing MAT care processes and in their interactions with MAT patients (df = 4, F = 203.518, P < .001). Participants described themselves as more comfortable identifying patients who would benefit from MAT (t = 15.04, P < .001), more competent in implementing MAT (t = 21.27, P < .001) and more willing (t = 15.56, P < .001) to implement MAT after training. Evidence suggests that a new MAT training program that supplements the SAMHSA waiver training increases confidence and willingness to implement MAT among PCPs. Efforts to replicate this success to allow for further generalization and policy recommendations are warranted.

Sections du résumé

BACKGROUND
With increasing prevalence of opioid use disorders (OUDs) there is an urgent need for OUD trained front line primary care providers (PCPs) who can help improve patient adherence to addiction treatment. Unfortunately, most physicians have had limited training for treating patients with addiction, leaving clinicians under prepared. To address this need, we created a Medication-Assisted Treatment (MAT) training program specifically designed for PCPs.
INTERVENTION
A 4-hour PCP focused buprenorphine office-based implementation training was designed to supplement the 8-hour SAMHSA DATA 2000 waiver training. The intent of the supplemental training is to increase PCP likelihood of implementing MAT through practical evidenced-based implementation, addressing barriers reported by waivered PCPs.
METHODS
We developed and validated a new pre- and postsurvey instrument that assesses changes in participants knowledge, skills, and attitudes. Data were entered into REDCap, and composite scales were created and analyzed to determine pre-post differences.
RESULTS
A total of 183 participants completed pre-post evaluations. Pre-post comparisons indicated substantial improvement in learner levels of confidence in implementing MAT care processes and in their interactions with MAT patients (df = 4, F = 203.518, P < .001). Participants described themselves as more comfortable identifying patients who would benefit from MAT (t = 15.04, P < .001), more competent in implementing MAT (t = 21.27, P < .001) and more willing (t = 15.56, P < .001) to implement MAT after training.
CONCLUSION
Evidence suggests that a new MAT training program that supplements the SAMHSA waiver training increases confidence and willingness to implement MAT among PCPs. Efforts to replicate this success to allow for further generalization and policy recommendations are warranted.

Identifiants

pubmed: 36948541
pii: jabfm.2022.220281R2
doi: 10.3122/jabfm.2022.220281R2
doi:

Substances chimiques

Buprenorphine 40D3SCR4GZ

Types de publication

Journal Article Research Support, U.S. Gov't, P.H.S.

Langues

eng

Sous-ensembles de citation

IM

Pagination

251-266

Informations de copyright

© Copyright by the American Board of Family Medicine.

Déclaration de conflit d'intérêts

Conflict of interest: None.

Auteurs

Stacey L Gardner-Buckshaw (SL)

From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB). sgardnerbuckshaw@neomed.edu.

Adam T Perzynski (AT)

From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB).

Russell Spieth (R)

From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB).

Poojajeet Khaira (P)

From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB).

Chris Delos Reyes (C)

From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB).

Laura Novak (L)

From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB).

Denise Kropp (D)

From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB).

Aleece Caron (A)

From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB).

John M Boltri (JM)

From the Department of Family and Community Medicine, Northeast Ohio Medical University (SGB); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University, Cleveland, OH (ATP); Adult Behavioral Health, The Centers, Cleveland, OH (RS); Department of Psychiatry, The MetroHealth System, Cleveland, OH (PK); Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH (CDR); Summa Health, Barberton Family Medicine Residency Program, Cleveland, OH (LN); Department of Family and Community Medicine, Northeast Ohio Medical University, Rootstown, OH (DK); Center for Health Care Research and Policy within The MetroHealth System, Case Western Reserve University (AC); Department of Family and Community Medicine, Northeast Ohio Medical University (JMB).

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