The Implementation Climate for Integrating Buprenorphine Prescribing into Rural Primary Care

Area of Science:

• Implementation Science
• Rural Health
• Addiction Medicine

Background:

• Rural communities experience high rates of opioid use disorder (OUD) but face limited access to evidence-based medications for opioid use disorder (MOUD).
• Primary care settings in rural areas are critical for expanding MOUD access due to specialist shortages.

Purpose of the Study:

• To investigate factors within the implementation climate that either facilitate or impede the adoption of buprenorphine prescribing in rural primary care settings.

Main Methods:

• A qualitative study employing in-depth interviews with primary care physicians, nurse practitioners (NPs), and physician associates (PAs) in rural Ohio.
• Interviews explored perspectives on buprenorphine prescribing and its implementation in rural primary care.
• Analysis utilized a deductive, framework-based approach using the Consolidated Framework for Implementation Research (CFIR) inner setting factors.

Main Results:

• Three key implementation climate constructs emerged: relative priority of OUD treatment, compatibility of prescribing protocols with rural primary care workflows, and tension for change regarding current access shortages.
• Participants held diverse views on whether the current rural primary care implementation climate adequately supports buprenorphine prescribing.

Conclusions:

• Tailoring implementation strategies to address the specific nuances of the implementation climate is essential for successfully integrating buprenorphine prescribing into rural primary care.
• Enhancing buprenorphine access in rural areas necessitates a focus on optimizing the conditions for its adoption within primary care.