Ensuring continuous buprenorphine access: A multicomponent quality improvement initiative in a university-affiliated...

Patients with opioid use disorder encounter challenges obtaining buprenorphine (BUP) at pharmacies, increasing their risk of treatment nonadherence and illicit drug use.

The purpose of this quality improvement (QI) initiative was to implement and evaluate a multicomponent intervention to ensure continuous BUP access.

Using a quasi-experimental study design, the initiative was developed and a convenience sample was recruited from an outpatient BUP treatment program and a pharmacy affiliated with the West Virginia University health system between November 20, 2023, to and November 29, 2024. The QI intervention consisted of education, use of pharmacy-integrated electronic medical record (EMR), BUP delivery, and adherence support and/or assistance with BUP dispensing. Participants selected the intervention or wait-list control group based on their choice of pharmacy. The intervention was offered to the intervention group over a 3-month period. Proportion of days covered was the primary outcome measure for continuous BUP access. Clinical data were extracted from participants'' EMR and electronic satisfaction surveys were administered to all participants following the intervention.

Study participants included 56 patients prescribed sublingual BUP, 14 pharmacy staff, and 19 clinic staff. Nine patient participants (16.07%) received medication delivery, and 8 patient participants (14.28%) received medication adherence support and/or assistance with BUP dispensing. There was no significant difference in the mean proportion of days covered (PDC) for BUP between the intervention (97.31%) and control group (94.90%) (p = 0.32). Compared to the control group, the intervention group had lower retention rates (76.92% vs. 97.37%, p = 0.02) and was more likely to report satisfactory waiting time to receive BUP (X² = 4.85; 100% vs. 64.50%, p = 0.028).

The intervention was successfully implemented and highly rated; however, it did not significantly increase the PDC of BUP. Challenges with BUP dispensing persist and future research addressing these multilevel barriers is urgently needed.