Opioid use disorder (OUD) is undertreated even though there are effective medications for OUD (MOUD) (e.g., buprenorphine, naltrexone). A recent study evaluated the challenges and experiences faced by multidisciplinary primary care (PC) teams during the process of integrating MOUD into their practice. Twelve geographically distinct PC teams initiated or expanded MOUD using practice facilitation, a multifaceted, evidence-based implementation strategy, which provides ongoing coaching and technical support. Researchers conducted a mixed-methods formative evaluation using qualitative ethnographic field notes and structured surveys of PC teams, which included prescribing clinicians, nonprescribing behavioral health care managers, and consulting psychiatrists. Four main themes emerged from the data:

1. Limitations of rapid access within administrative structures: Administrative limitations hindered responsiveness to OUD patients. Limited capacity, inflexible scheduling, and closed panels made it hard to accommodate new OUD patients


2. Challenges with patient engagement: Fewer OUD patients were identified than anticipated, partly due to stigma. Engaging patients in MOUD was difficult, leading to delays in treatment.


3. Training and support for prescribing clinicians: Clinicians expressed low confidence in identifying and discussing MOUD with patients. There was a need for more guidance on how to have conversations about OUD, especially for clinicians who lacked experience in this area.


4. Variable attitudes within PC teams: Clinicians acknowledged the importance of MOUD in PC settings but had conflicting attitudes due to workload concerns. They recognized the challenge of expanding care while managing barriers.

The study highlights the need for addressing barriers that make PC teams feel burdened by MOUD implementation. These barriers include limitations in scheduling flexibility, challenges in patient engagement, and the need for improved training and support for clinicians. To successfully implement MOUD in PC, efforts are required at both the organizational and system levels to provide incentives, flexibility, and adequate resources to support PC teams in delivering effective OUD treatment.

Reference:

Austin EJ et al. JAMA Netw Open 2023;6(8):e2328627. Abstract.