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Integrating Buprenorphine for Opioid Use Disorder into Rural, Primary Care Settings.

Jessica J Wyse1,2, Alison Eckhardt3, Summer Newell3

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This summary is machine-generated.

Expanding buprenorphine prescribing for opioid use disorder (OUD) in rural primary care requires structural changes. Successful implementation involved targeted hires, clinician engagement, and leadership support for team development and process redesign.

Keywords:
accessopioid agonistopioid use disorderruralveterans

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Area of Science:

  • Health Services Research
  • Substance Use Disorders
  • Rural Health

Background:

  • Medications for opioid use disorder (MOUD), including buprenorphine, are effective but underutilized, particularly in rural areas.
  • The US Department of Veterans Affairs (VA) aims to increase buprenorphine access in primary care for rural veterans.
  • Rural patients face significant disparities in accessing essential healthcare services, including OUD treatment.

Purpose of the Study:

  • To understand how rural VA health care systems successfully integrated buprenorphine treatment into primary care.
  • To identify facilitators and barriers to implementing buprenorphine prescribing in rural primary care settings.
  • To inform strategies for expanding OUD treatment access in underserved areas.

Main Methods:

  • Qualitative interviews were conducted with 30 clinicians, leaders, and staff in rural VA systems that increased primary care buprenorphine prescribing (2015-2020).
  • Administrative data from the VA Corporate Data Warehouse (CDW) identified relevant health care systems.
  • A mixed inductive/deductive approach was used to analyze interview data.

Main Results:

  • Implementation was often initiated by a targeted hire, followed by "champion" clinicians engaging peers and leadership.
  • Key facilitators included aligning buprenorphine prescribing with existing goals and demonstrating supportive roles.
  • Successful integration involved developing new clinical teams and redesigning processes, all supported by leadership.

Conclusions:

  • Altering primary care structures is crucial for improving buprenorphine accessibility in rural settings.
  • Strategies include targeted hiring, fostering supportive clinical teams, and redesigning workflows.
  • Leadership support is instrumental in overcoming implementation challenges for OUD treatment in primary care.