Description of Physician Champion Efforts to Expand Buprenorphine Treatment in Primary Care and Explore a Quality Implementation Measure of Success: Buprenorphine as a Percentage of All Opioids Prescribed.

Abstract

This study describes the impact of a single physician champion's implementation efforts to increase buprenorphine treatment for opioid use disorder (OUD) in primary care and a "proof-of-concept" new quality electronic health record outcome indicative of success. Five primary care clinics at one academic medical center participated in this retrospective program evaluation conducted from October 2021 to December 2023. A physician champion led all implementation strategies for buprenorphine prescribing, including "en bloc" group engagement and training of physicians at clinic A; a limited set of implementation resources was later shared with clinic B. Clinics C-E served as controls. Electronic health record outcome measures from each clinic included (1) percent of clinicians prescribing buprenorphine, (2) number of buprenorphine prescriptions, (3) number of full opioid agonist prescriptions, and (4) percentage buprenorphine (PB) prescriptions defined as the number of buprenorphine prescriptions divided by the sum of the total number of buprenorphine and full mu-opioid agonist prescriptions. During the 2-year period at clinic A, all clinicians prescribed buprenorphine; there was a decrease in full agonist prescribing, and PB increased from 0% to 30.8%. PB increased also at Clinic B. Buprenorphine prescribing did not increase, full agonist prescribing was stable, and PB remained <10% at control clinics. These results show that a single physician can help other clinicians initiate and sustain buprenorphine prescribing. The PB metric, which includes full agonist prescribing along with buprenorphine, may be a particularly important quality metric for tracking implementation progress and quality improvement.