Brief Prescribing Support and Buprenorphine Adoption in Rural Primary Care: A Cluster Randomized Clinical Trial

Area of Science:

• Addiction Medicine
• Primary Care Research
• Implementation Science

Background:

• Buprenorphine is effective for preventing overdose but faces access barriers in rural areas.
• Rural primary care settings are crucial for expanding buprenorphine access.
• Tailored prescribing support for rural primary care professionals (PCPs) is urgently needed.

Purpose of the Study:

• To test the feasibility and preliminary effectiveness of a brief buprenorphine prescribing support program (BPSP) designed for rural PCPs.
• To evaluate the BPSP's impact on PCPs' willingness and intention to prescribe buprenorphine.
• To assess the BPSP's implementation outcomes: feasibility, acceptability, and appropriateness.

Main Methods:

• A cluster randomized pilot clinical trial involving 63 PCPs across 27 Ohio community health centers.
• Intervention group received a brief, online BPSP training; control group received guidelines.
• Outcomes included feasibility, acceptability, appropriateness, willingness to treat opioid use disorder (OUD), and likelihood of prescribing buprenorphine.

Main Results:

• PCPs rated the BPSP as highly feasible (median 4.25/5), acceptable (median 4.88/5), and appropriate (median 5.00/5).
• The BPSP significantly increased willingness to treat OUD (86% rank improvement) and intention to prescribe buprenorphine (98% rank improvement).
• Participants showed improved knowledge, confidence, reduced stigma, and increased empathy toward patients with OUD.

Conclusions:

• Brief prescribing support is a feasible, acceptable, and appropriate strategy for rural primary care.
• The BPSP effectively increased PCPs' intentions to prescribe buprenorphine.
• A larger trial is warranted to confirm these promising preliminary findings.