Launching a Medication-Assisted Treatment in an Outpatient Office-Based Practice

Abstract

<jats:p> Background: Opioid use and overdose are escalating in the United States. Primary care providers are in a strategic position to assess patients for medication-assisted treatment (MAT). Objectives: To describe the implementation of MAT in an integrated primary care residency clinic and assess provider comfort levels with evaluating patients for high-risk opioid use, conduct crucial conversations about MAT treatment options and referral to MAT for evaluation and treatment. Methods: As part of a Primary Care Training and Enhancement grant through Health Resources and Services Administration, we used an implementation process to allow for optimal clinic flow. The process included assessment of patient populations, identifying a provider champion, organizing multidisciplinary team, engaging a practice facilitator, designing clinic model and infrastructure, creating the electronic health record order sets along with provider and staff training. Providers responded to brief questions to evaluate comfort levels in 3 domains: identifying high-risk opioid use, conducting crucial conversations about treatment options and referral to MAT for evaluation and treatment. Discussion: Incorporating MAT within an integrated primary care clinic and residency program with waiver training for residents was a successful and innovative program. The availability of MAT provided a solution for patients that could benefit from this type of treatment. MAT presence gave providers the opportunity to refer these patients for treatment that had not previously been as accessible. Conclusion: An integrated primary care practice with an embedded MAT can be successful with an organized structure to optimize clinic flow. </jats:p>

Primary care provider confidence in addressing opioid use disorder: A concept analysis

“…Training influences PCP confidence by contributing to the experience PCPs have in addressing OUD (Harder et al, 2021; Kirk et al, 2020; Townley & Dorr, 2017; Wolk et al, 2019). Didactic sessions with case discussions (Tofighi et al, 2019), pairing PCPs with experienced OUD providers for mentoring and observation (Louie et al, 2019; Sobel et al, 2019; Tofighi et al, 2019), or team‐based learning opportunities (Zittleman et al, 2020) were all associated with increased PCP confidence in addressing OUD.…”

“…Of the 18 included studies, two were randomized control trials (Rossom et al, 2021; Zittleman et al, 2020), seven were cross‐sectional (Foti et al, 2021; Harder et al, 2021; Hawkins et al, 2021; Sell & Visconti, 2020; Sinclair et al, 2020; Wolk et al, 2019), seven were pretest–posttest (Cantone et al, 2018; Cavitt et al, 2022; Coplin, 2019; Kirk et al, 2020; Lockett et al, 2018; Pytell et al, 2019; Sobel et al, 2019; Tofighi et al, 2019), one was a narrative review (Louie et al, 2019), and one was a report from the National Academy of State Health Policy (Townley & Dorr, 2017). The defining attributes, antecedents, consequences, case scenarios, and empirical referents of PCP confidence in addressing OUD were informed by a critical analysis of the 18 included studies.…”

“…For example, a PCP may be confident referring to specialty care for OUD, yet not confident screening, conversing about, or treating OUD. Kirk et al (2020) evaluated PCP confidence in relation to three domains: identifying high‐risk opioid use, conducting crucial conversations about treatment options, and referral to medication assisted treatment for evaluation and treatment. Foti et al (2021) found that most PCPs were somewhat or very comfortable screening and diagnosing patients with OUD, yet fewer said they were somewhat or very comfortable prescribing medications for OUD (MOUD).…”

Exploring the Demographic and Professional Characteristics of Physicians and Nurse Practitioners Associated With Providing Medication-Assisted Treatment: A Retrospective Observational Study

“…The integration of medication-assisted treatment (MAT) for OUD in the primary care clinical setting is growing as a health care delivery model for increasing access to care. 11 , 12 In combination with counseling and social services, MAT has proven to be effective in supporting sustained recovery from opioid addiction. 12 Recently, legislation was passed that allowed providers to begin prescribing opioid agonist medications in their practice without the need for a waiver, pending completion of the appropriate training.…”