PURPOSE Despite the efficacy of buprenorphine-naloxone for the treatment of opioid use disorders, few physicians in Washington State use this clinical tool. To address the acute need for this service, a Rural Opioid Addiction Management Project trained 120 Washington physicians in 2010-2011 to use buprenorphine. We conducted this study to determine what proportion of those trained physicians began prescribing this treatment and identify barriers to incorporating this approach into outpatient practice. METHODSWe interviewed 92 of 120 physicians (77%), obtaining demographic information, current prescribing status, clinic characteristics, and barriers to prescribing buprenorphine. Residents and 7 physicians who were prescribing buprenorphine at the time of the course were excluded from the study. We analyzed the responses of the 78 remaining respondents.RESULTS Almost all respondents reported positive attitudes toward buprenorphine, but only 22 (28%) reported prescribing buprenorphine. Most (95%, n = 21) new prescribers were family physicians. Physicians who prescribed buprenorphine were more likely to have partners who had received a waiver to prescribe buprenorphine. A lack of institutional support was associated with not prescribing the medication (P = .04). A lack of mental health and psychosocial support was the most frequently cited barrier by both those who prescribe and who do not prescribe buprenorphine.CONCLUSION Interventions before and after training are needed to increase the number of physicians who offer buprenorphine for treatment of addiction. Targeting physicians in clinics that agree in advance to institute services, coupled with technical assistance after they have completed their training, their clinical teams, and their administrations is likely to help more physicians become active providers of this highly effective outpatient treatment. 2014;128-133. doi:10.1370/afm.1595. Ann Fam Med INTRODUCTIONI n 2000, the passage of the Drug Addiction Treatment Act enabled qualifying physicians to receive a waiver from the special registration requirement of the Controlled Substances Act to prescribe buprenorphine-naloxone for the treatment of opioid use disorders. Buprenorphinenaloxone, hereafter referred to as buprenorphine, is the only treatment available to office-based physicians that has high rates of prolonged success for the treatment of opioid addiction.1,2 Although physicians have reported a wide range of barriers that have dissuaded them from prescribing buprenorphine, [3][4][5][6][7][8][9][10][11][12][13][14][15][16] few studies specifically addressed the barriers family practice physicians encounter. McCarty et al 10 found that 6 of 17 Oregonian family physicians trained to use buprenorphine prescribe it, whereas those who do not prescribe buprenorphine cited concerns of being overwhelmed by needy patients, the cost of medication, reimbursement, being the only physician prescribing buprenorphine in the practice, and lack of administrative support. Even though Walley et al, 15 in his ...

BackgroundResearch assistants (RAs) are hired at academic centers to staff the research and quality improvement projects that advance evidence-based medical practice. Considered a transient population, these young professionals may view their positions as stepping-stones along their path to graduate programs in medicine or public health.ObjectiveTo address the needs of these future health professionals, a novel program—Program for Research Assistant Development and Achievement (PRADA)—was developed to facilitate the development of desirable professional skill sets (ie, leadership, teamwork, communication) through participation in peer-driven service and advocacy initiatives directed toward the hospital and surrounding communities. The authors hope that by reporting on the low-cost benefits of the program that other institutions might consider the utility of implementing such a program and recognize the importance of acknowledging the professional needs of the next generation of health care professionals.MethodsIn 2011, an anonymous, Web-based satisfaction survey was distributed to the program membership through a pre-established email distribution list. The survey was used to evaluate demographics, level of participation and satisfaction with the various programming, career trajectory, and whether the program's goals were being met.ResultsUpon the completion of the survey cycle, a 69.8% (125/179) response rate was achieved with the majority of respondents (94/119, 79.0%) reporting their 3-year goal to be in medical school (52/119, 43.7%) or nonmedical graduate school (42/119, 35.3%). Additionally, most respondents agreed or strongly agreed that PRADA had made them feel more a part of a research community (88/117, 75.2%), enhanced their job satisfaction (66/118, 55.9%), and provided career guidance (63/117, 53.8%). Overall, 85.6% of respondents (101/118) agreed or strongly agreed with recommending PRADA to other research assistants.ConclusionsHigh response rate and favorable outlook among respondents indicate that the program had been well received by the program's target population. The high percentage of respondents seeking short-term entry into graduate programs in health care-related fields supports the claim that many RAs may see their positions as stepping-stones and therefore could benefit from a professional development program such as the one described herein. Strong institutional support and sustainable growth and participation are other indications of early success. Further evaluation is necessary to assess the full impact of the program, particularly in areas such as job satisfaction, recruitment, retention, productivity, and career trajectory, but also in reproducibility in other institutions.