Integrating Buprenorphine Treatment Into Family Medicine Resident Clinic

Abstract

Background and Objectives: Medication-assisted treatment (MAT) for opioid use disorder with buprenorphine in primary care is effective and patient-accessible yet remains underutilized, including among residency training programs. One concern in residency programs is that MAT patients must be seen at least monthly and will overwhelm residents’ clinic schedules and dilute their clinical experience. Our family medicine residency initiated an MAT program integrated into residents’ continuity clinic schedules. After 2 years we assessed the chronic medical comorbidities we were managing in our MAT population.Methods: We performed a retrospective review of all active patients receiving MAT. We collected basic demographic data and whether we were the patient’s primary care provider (PCP) or were only providing MAT. For the patients for whom we were the PCP we recorded the chronic comorbidities that required medical management.Results: One hundred fifty-seven active patients were 52% male and 48% female. The mean age was 38 years (SD=10) with a range of 22 to 77 years, with nine patients over age 60 years (6%). One hundred three patients used us as their PCP (66%). For these patients the mean number of chronic comorbidities was 2.3; only 10 patients reported no comorbidities. Psychiatric comorbidities were the most common with 69% of patients with a mood disorder, although nonpsychiatric comorbidities still averaged 1.5 per patient.Conclusions: MAT integrated into family medicine resident continuity clinics provides a broad and substantial primary care clinical experience for residents.

Novel Performance Rating Instruments for Gynecological Procedures in Primary Care: A Pilot Study

“…18,19 Opportunities to learn and practice procedural skills in the workplace are limited for several reasons: a short family medicine training program, work-hour limitations, and the large number of procedures on the training expectations list. 20,21 To address similar challenges in medical and surgical specialties, simulation has taken on increased importance in training [22][23][24] by allowing for direct observation and provision of immediate and actionable feedback in a psychologically safe environment. 25 Both low-and high-fidelity simulations have been shown to be valuable educational tools that enhance procedural skill acquisition, retention, confidence, and desire to perform a procedure.…”

Improving Chronic Pain Management in a Family Medicine Residency

“…7 Despite the need for early training to improve the number of physicians prescribing MAT, most residencies do not offer the training as part of their program, citing lack of faculty prescribers, competing priorities, and lack of ancillary support (counseling/social work). 8,9 In recent years, residencies have started implementing changes to address these concerns, however more work is needed to overcome the care deficits in this area. 9,10 The University of Kansas School of Medicine-Wichita (KUSM-W) Family Medicine Residency Program at Ascension Via Christi (VCFM) sought to implement policy and curriculum changes to help address deficiencies in our care of patients with chronic pain on opioids as well as OUD.…”

“…8,9 In recent years, residencies have started implementing changes to address these concerns, however more work is needed to overcome the care deficits in this area. 9,10 The University of Kansas School of Medicine-Wichita (KUSM-W) Family Medicine Residency Program at Ascension Via Christi (VCFM) sought to implement policy and curriculum changes to help address deficiencies in our care of patients with chronic pain on opioids as well as OUD. The primary objective was to evaluate a skill-based, CPM educational program on the comfort and ability of family physicians to prescribe opioids and utilize MAT.…”

Residency Education Redesign: The Interplay of Innovation and Standardization

“…1 Over the years, with strong leadership from residencies, FM has continued innovating in response to community needs by adopting new therapies, such as medication-assisted treatment (MAT) and transgender health care. 2,3 The COVID-19 pandemic further underscores the need for flexibility, as family physicians quickly transitioned to virtual care, prepared for inpatient surges, and led public health initiatives. 4 FM residency training requirements have expanded considerably from 4 to over 61 pages, 5 as have innovations in medical education, including graduate medical education milestones 6 and entrustable professional activities (EPAs).…”