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. 2022 Jan-Feb;20(1):18-23.
doi: 10.1370/afm.2757.

Increasing Capacity for Treatment of Opioid Use Disorder in Rural Primary Care Practices

Linda Zittleman  1 , Kristen Curcija  2 , Donald E Nease Jr  2 , Mary Fisher  2 , L Miriam Dickinson  2 , John F Thomas  3   4 , Ashley Espinoza  5 , Christin Sutter  2 , Jennifer Ancona  2 , Jodi Summers Holtrop  2 , John M Westfall  2   6
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Increasing Capacity for Treatment of Opioid Use Disorder in Rural Primary Care Practices

Linda Zittleman et al. Ann Fam Med. 2022 Jan-Feb.

Abstract

Purpose: Evidence supports treatment for opioid use disorder (OUD) with buprenorphine in primary care practices (PCPs). Barriers that slow implementation of this treatment include inadequately trained staff. This study aimed to increase the number of rural PCPs providing OUD treatment with buprenorphine. This evaluation describes the impact of a practice team training on the implementation and delivery of OUD treatment with buprenorphine in PCPs of rural Colorado.

Methods: Implementing Technology and Medication Assisted Treatment Team Training in Rural Colorado (IT MATTTRs) was a multilevel implementation study that included a practice-focused intervention to improve awareness, adoption, and use of buprenorphine treatment for OUD. Participating PCP teams received the IT MATTTRs Practice Team Training and support. Practices' implementation of treatment components was assessed before and after training. Practice-reported and population-level data from the Prescription Drug Monitoring Program were obtained to describe changes in delivery of treatment after training.

Results: Forty-two practices received team training. Practices reported an average of 4.7 treatment-related components in place at baseline compared with 13.0 at 12-month follow-up (F[2,56] = 31.17, P <.001). The proportion of participating practices providing or referring patients for treatment increased from 18.8% to 74.4%. The increase in number of people with a prescription for buprenorphine was significantly greater in the study region over a 4-year period compared with the rest of the state (Wald χ2 = 15.73, P <.001).

Conclusions: The IT MATTTRs training for PCP teams in OUD treatment with buprenorphine addressed elements beyond clinician waiver training to make implementation feasible and effectively increased implementation and delivery of this treatment in rural Colorado.

Keywords: buprenorphine; education; opioid-related disorders; primary health care; rural health.

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Figures

Figure 1.
Figure 1.
Patients prescribed buprenorphine and those in treatment with buprenorphine for 6 months or more reported by IT MATTTRs study practices.
Figure 2.
Figure 2.
Patients prescribed buprenorphine by patient and provider location in the IT MATTTRs study region from 2015-2019.
See this image and copyright information in PMC

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