Peer Prescriber Support Strategies to Increase Buprenorphine Prescribing in Primary Care

Opioid use disorder continues to cause significant morbidity and mortality in the United States. Buprenorphine is a highly effective treatment option, but is not easily accessible due in part to an insufficient prescriber workforce. Primary care professionals (PCPs) have the potential to greatly improve access to buprenorphine, but they report significant barriers such as inadequate addiction training. This study aimed to characterize the value of different peer prescriber support training models for PCPs practicing in urban and rural clinics in Ohio.

We interviewed 26 purposively sampled PCPs as part of a clinical trial planning grant to develop and pilot a buprenorphine prescribing support program. PCPs provided feedback on the training module and additional training needs during semi-structured interviews. Interviews were coded using an inductive approach, informed by grounded theory.

PCPs expressed a need for support from other buprenorphine prescribers and on-the-job shadowing and consultation opportunities to confidently prescribe buprenorphine. Interactions with colleagues who did not support or prescribe medications for opioid use disorder (MOUD) were similarly influential, reducing PCPs' interest in prescribing buprenorphine. Internal mentorship opportunities, like starting with managing a few stable patients in collaboration with current prescribers, improved PCPs' comfort with MOUD, but were more available in urban than rural clinics. Structured external mentorship, including real-time consultation options, was also beneficial, especially for rural PCPs.

Support from buprenorphine prescribers, both peer PCPs and external experts, may be a useful strategy for overcoming reluctance to prescribe buprenorphine in primary care. On-site peer mentors may be more readily available to urban providers. More research is needed to understand effective strategies for fostering rural peer prescriber mentorship networks, especially in the absence of on-site mentors. Future research should test innovative strategies for bolstering rural and urban addiction mentorship networks.