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Implementation of a collaborative care management program with buprenorphine in primary care: a comparison between
Joji Suzuki1, Michele L Matthews2, David Brick3
1Instructor in Psychiatry, Harvard Medical School, Boston, Massachusetts; Division of Addiction Psychiatry, Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.
Objective:
To implement a collaborative care management program with buprenorphine in a primary care clinic.
Design:
Prospective observational study.
Setting:
A busy urban academic primary care clinic affiliated with a tertiary care hospital.
Participants:
Opioid-dependent patients or patients with chronic pain using opioids nonmedically were recruited for the study. A total of 45 participants enrolled.
Interventions:
Patients were treated with buprenorphine and managed by a supervising psychiatrist, pharmacist care manager, and health coaches. The care manager conducted buprenorphine inductions and all follow-up visits. Health coaches offered telephonic support. The psychiatrist supervised both the care manager and health coaches.
Main Outcome Measures:
Primary outcomes were treatment retention at 6 months, and change in the proportion of aberrant toxicology results and opioid craving scores from baseline to 6 months. After data collection, clinical outcomes were compared between opioid-dependent patients and patients with chronic pain using opioids nonmedically. Overall, 55.0 percent of participants (25/45) remained in treatment at 6 months. Primary care physicians (PCPs)' attitudes about opioid dependence treatment were surveyed at baseline and at 18 months.
Results:
Forty-three patients (95.6 percent) accepted treatment and 25 (55.0 percent) remained in treatment at 6 months. The proportion of aberrant urine toxicology results decreased significantly from baseline to 6 months (p < 0.01). Craving scores significantly decreased from baseline to 6 months (p < 0.01). Opioid-dependent patients, as opposed to patients with chronic pain using opioids nonmedically, were significantly more likely to complete 6 months of treatment (p < 0.05). PCPs' confidence in treating opioid dependence in primary care increased significantly from baseline to 18 months postimplementation (p < 0.01).
Conclusion:
Collaborative care management for opioid dependence with buprenorphine may be feasible in a primary care clinic. More research is needed to understand the role of buprenorphine in managing patients with chronic pain using opioids nonmedically.
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