Primary Care of Opioid use Disorder: The End of “the French Model”?

2020 ◽  
Vol 26 (6) ◽  
pp. 346-354 ◽  
Author(s):  
Julie Dupouy ◽  
Sandy Maumus-Robert ◽  
Yohann Mansiaux ◽  
Antoine Pariente ◽  
Maryse Lapeyre-Mestre
Keyword(s):  
Primary Care ◽  
Private Practice ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
Access To Treatment ◽  
Cross Sectional ◽  
Number Of Patients ◽  
French Model

<b><i>Background:</i></b> In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a ‘French model’ facilitating access to treatment based on the involvement of GPs in buprenorphine prescription. <b><i>Objectives:</i></b> Our study aimed to assess whether the involvement of primary care in OUD management has changed lately. <b><i>Materials and Methods:</i></b> Using data from the French National Health Insurance database, we conducted a yearly repeated cross-sectional study (2009–2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP. <b><i>Results:</i></b> Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (<i>n</i> = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 ± 27.1 patients in 2009 to 16.0 ± 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period. <b><i>Conclusions:</i></b> Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.

Facilitators and barriers to utilization of medications for opioid use disorder in primary care in South Carolina

2020 ◽  
Vol 56 (1) ◽  
pp. 14-39
Author(s):  
Sarah M Oros ◽  
Lillian M Christon ◽  
Kelly S Barth ◽  
Carole R Berini ◽  
Bennie L Padgett ◽  
...  
Keyword(s):  
Primary Care ◽  
South Carolina ◽  
Focus Group ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
Focus Group Interviews ◽  
Facilitators And Barriers ◽  
Group Interviews

Objective Utilization of medications for opioid use disorder (MOUD) has not been widely adopted by primary care providers. This study sought to identify interprofessional barriers and facilitators for use of MOUD (specifically naltrexone and buprenorphine) among current and future primary care providers in a southeastern academic center in South Carolina. Method Faculty, residents, and students within family medicine, internal medicine, and a physician assistant program participated in focus group interviews, and completed a brief survey. Survey data were analyzed quantitatively, and focus group transcripts were analyzed using a deductive qualitative content analysis, based upon the theory of planned behavior. Results Seven groups ( N = 46) completed focus group interviews and surveys. Survey results indicated that general attitudes towards MOUD were positive and did not differ significantly among groups. Subjective norms around prescribing and controllability (i.e., beliefs about whether prescribing was up to them) differed between specialties and between level of training groups. Focus group themes highlighted attitudes about MOUD (e.g., “opens the flood gates” to patients with addiction) and perceived facilitators and barriers of using MOUD in primary care settings. Participants felt that although MOUD in primary care would improve access and reduce stigma for patients, prescribing requires improved provider education and an integrated system of care. Conclusions The results of this study provide an argument for tailoring education to specifically address the barriers primary care prescribers perceive. Results promote the utilization of active, hands-on learning approaches, to ultimately promote uptake of MOUD prescribing in the primary care setting in South Carolina.

scholarly journals Validation Study of a Predictive Algorithm to Evaluate Opioid Use Disorder in a Primary Care Setting

2017 ◽  
Vol 4 ◽  
pp. 233339281771741
Author(s):  
Maneesh Sharma ◽  
Chee Lee ◽  
Svetlana Kantorovich ◽  
Maria Tedtaotao ◽  
Gregory A. Smith ◽  
...  
Keyword(s):  
Primary Care ◽  
Validation Study ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Public Health Issue ◽  
Care Providers ◽  
Opioid Use ◽  
Predictive Algorithm ◽  
Primary Care Patients ◽  
Treatment Changes

Background: Opioid abuse in chronic pain patients is a major public health issue. Primary care providers are frequently the first to prescribe opioids to patients suffering from pain, yet do not always have the time or resources to adequately evaluate the risk of opioid use disorder (OUD). Purpose: This study seeks to determine the predictability of aberrant behavior to opioids using a comprehensive scoring algorithm (“profile”) incorporating phenotypic and, more uniquely, genotypic risk factors. Methods and Results: In a validation study with 452 participants diagnosed with OUD and 1237 controls, the algorithm successfully categorized patients at high and moderate risk of OUD with 91.8% sensitivity. Regardless of changes in the prevalence of OUD, sensitivity of the algorithm remained >90%. Conclusion: The algorithm correctly stratifies primary care patients into low-, moderate-, and high-risk categories to appropriately identify patients in need for additional guidance, monitoring, or treatment changes.

scholarly journals A pilot study of the functionality and clinician acceptance of a clinical decision support tool to improve primary care of opioid use disorder

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Rebecca C. Rossom ◽  
JoAnn M. Sperl-Hillen ◽  
Patrick J. O’Connor ◽  
A. Lauren Crain ◽  
Laurel Nightingale ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
Convenience Sample ◽  
Increased Risk

Abstract Objective Most Americans with opioid use disorder (OUD) do not receive indicated medical care. A clinical decision support (CDS) tool for primary care providers (PCPs) could address this treatment gap. Our primary objective was to build OUD-CDS tool and demonstrate its functionality and accuracy. Secondary objectives were to achieve high use and approval rates and improve PCP confidence in diagnosing and treating OUD. Methods A convenience sample of 55 PCPs participated. Buprenorphine-waivered PCPs (n = 8) were assigned to the intervention. Non-waivered PCPs (n = 47) were randomized to intervention (n = 24) or control (n = 23). Intervention PCPs received access to the OUD-CDS, which alerted them to patients at potentially increased risk for OUD or overdose and guided diagnosis and treatment. Control PCPs provided care as usual. Results The OUD-CDS was functional and accurate following extensive multi-phased testing. PCPs used the OUD-CDS in 5% of encounters with at-risk patients, far less than the goal of 60%. OUD screening confidence increased for all intervention PCPs and OUD diagnosis increased for non-waivered intervention PCPs. Most PCPs (65%) would recommend the OUD-CDS and found it helpful with screening for OUD and discussing and prescribing OUD medications. Discussion PCPs generally liked the OUD-CDS, but use rates were low, suggesting the need to modify CDS design, implementation strategies and integration with existing primary care workflows. Conclusion The OUD-CDS tool was functional and accurate, but PCP use rates were low. Despite low use, the OUD-CDS improved confidence in OUD screening, diagnosis and use of buprenorphine. NIH Trial registration NCT03559179. Date of registration: 06/18/2018. URL: https://clinicaltrials.gov/ct2/show/NCT03559179

scholarly journals Multilevel Risk Factors for Hospital Readmission Among Patients With Opioid Use Disorder in Selected US States: Role of Socioeconomic Characteristics of Patients and Their Community

2020 ◽  
Vol 7 ◽  
pp. 233339282090424
Author(s):  
Jayasree Basu
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
Discharge Data ◽  
American Hospital ◽  
Us States ◽  
Socioeconomic Characteristics

Research Objective: Using a multilevel framework, the study examines the association of socioeconomic characteristics of the individual and the community with all-cause 30-day readmission risks for patients hospitalized with a principal diagnosis of opioid use disorder (OUD). Study Design: The study uses hospital discharge data of adult (18+) patients in 5 US states for 2014 from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, linked to community and hospital characteristics using data from Health Resources and Services Administration and American Hospital Association, respectively. A multilevel logistic regression model is applied on data pooled over 5 states adjusting for patient, hospital, and community characteristics. Principal Findings: Higher primary care access, as measured by density of primary care providers, is associated with reduced readmission risks among patients with OUD. Medicare is associated with the highest readmission risk (odds ratio [OR] = 2.0, P < .01) compared to private coverage, while Medicaid coverage is also associated with elevated risk (OR = 1.71, P < .01). Being self-pay or covered by other payers carried a similar risk to private coverage. Urban patients had higher readmission rates than rural patients. Conclusions: Patients’ risk of readmission following hospitalization for OUD varies according to availability of primary care providers, expected payer, and geographic location. Understanding which patients are most at risk may allow policy makers to design interventions to prevent readmissions and improve patient outcomes. Future studies may wish to focus on understanding when a decreased readmission rate represents better patient outcomes and when it represents difficulty accessing health care.

scholarly journals What are the impacts when primary care providers diminish stigma for patients with opioid use disorder in British Columbia?

2020 ◽  
Author(s):  
◽  
Mary MacLellan
Keyword(s):  
Primary Care ◽  
Health Care ◽  
British Columbia ◽  
Literature Review ◽  
Access To Health Care ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Care Providers ◽  
Opioid Use

Stigma is a complex phenomenon with a myriad of detrimental health and social impacts that are not fully studied or understood. Persistent stigma exists towards individuals who have opioid use disorder (OUD) in British Columbia. OUD is a chronic, relapsing, clinical condition that has been identified as one of the most challenging substance use disorders. For those affected, they must also endure the consequences of stigma that promote barriers to health care, health and social inequalities, diminished quality of life as well as increased morbidity and mortality. The current unremitting opioid overdose crisis in British Columbia further emphasizes the importance of eradicating stigma towards individuals who use opioids and/or suffer from OUD, as untreated OUD is fueling this multifaceted public health emergency. For these reasons, an integrative literature review has been conducted to identify how primary care providers in British Columbia can address the intersecting stigmas for individuals suffering OUD. The results are discussed within the context of primary health care in British Columbia. Whittemore and Knafl’s approach to the integrative literature review was utilized in this study to review eleven pertinent articles. The findings suggest that stigma occurs on varying levels for individuals with OUD that serve to reinforce each other and manifest as discrimination, mistrust, social distancing, minimized advocacy, unequal access to health care and suboptimal health care. Further, the findings indicated that the role of primary care providers may be instrumental in eradicating stigma in a timely manner. Recommendations for primary care providers to dismantle the stigma associated with OUD are discussed, and specific strategies for the primary care setting are presented.

scholarly journals Stressors Facing Home-Based Primary Care Providers

Geriatrics ◽  
2019 ◽  
Vol 4 (1) ◽  
pp. 17 ◽  
Author(s):  
Katherine O’Brien ◽  
Sara Bradley ◽  
Vanessa Ramirez-Zohfeld ◽  
Lee Lindquist
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Cross Sectional ◽  
Home Setting ◽  
Caregiver Support ◽  
Qualitative Survey ◽  
Home Based Primary Care ◽  
Home Based

The numbers of homebound patients in the United States are increasing. Home-based primary care (HBPC) is an effective model of interdisciplinary care that has been shown to have high patient satisfaction rates and excellent clinical outcomes. However, there are few clinicians that practice HBPC and clinicians that do face additional stressors. This study sought to better understand the stressors that HBPC providers face in caring for homebound patients. This was a cross-sectional qualitative survey and analysis of HBPC providers. Responses were categorized into four themes: The patient in the home setting, caregiver support, logistics, and administrative concerns. This research is the first to analyze the stressors that providers of HBPC face in serving the needs of complex homebound patients. Awareness and attention to these issues will be important for the future sustainability of home-based primary care.

scholarly journals Barriers to and solutions for addressing insufficient professional interpreter use in primary healthcare

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Fabienne N. Jaeger ◽  
Nicole Pellaud ◽  
Bénédicte Laville ◽  
Pierre Klauser
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Primary Care Providers ◽  
Care Providers ◽  
Key Factors ◽  
Cross Sectional ◽  
Interpreter Use ◽  
Health Authorities ◽  
Professional Interpreter ◽  
Paediatric Primary Care

Abstract Background The aim of this nationwide study was to investigate barriers to adequate professional interpreter use and to describe existing initiatives and identify key factors for successful interpreter policies in primary care, using Switzerland as a case study. Methods Adult and paediatric primary care providers were invited to participate in an online cross-sectional questionnaire-based study. All accredited regional interpreter agencies were contacted first by email and, in the absence of a reply, by mail and then by phone. Local as well as the national health authorities were asked about existing policies. Results 599 primary care physicians participated. Among other reasons, physicians identified cumbersome organization (58.7%), absent financial coverage (53.7%) and lack of knowledge on how to arrange interpreter interventions (44%) as main barriers. The odds of organising professional interpreters were 6.6-times higher with full financial coverage. Some agencies confirmed difficulties providing professional interpreters for certain languages at a timely manner. Degrees of coverage of professional interpreter costs (full coverage to none) and organization varied between regions resulting in different levels of unmet needs. Conclusions Professional interpreter use can be improved through the following points: increase awareness and knowledge of primary care providers on interpreter use and organization, ensure financial coverage, as well as address organizational aspects. Examples of successful interventions exist.

Predictors and Outcomes of Burnout Among Primary Care Providers in the United States: A Systematic Review

2019 ◽  
Vol 77 (5) ◽  
pp. 387-401 ◽  
Author(s):  
Cilgy M. Abraham ◽  
Katherine Zheng ◽  
Lusine Poghosyan
Keyword(s):  
United States ◽  
Primary Care ◽  
Primary Care Providers ◽  
The United States ◽  
Organizational Level ◽  
Care Practice ◽  
Practice Environment ◽  
Care Providers ◽  
Cross Sectional ◽  
Study Designs

Primary care providers (PCPs) in the United States work in challenging environments and may be at risk for burnout. This article identifies the predictors and outcomes of burnout among PCPs in the United States. A comprehensive literature search of eight databases was conducted to identify studies investigating predictors or outcomes of PCP burnout. The Joanna Briggs Institute’s critical appraisal checklists for cross-sectional and cohort studies were used for quality appraisal. Overall, 21 studies met inclusion criteria, had sufficient quality, reported personal and/or organizational predictors of burnout, and described burnout outcomes at the patient, provider, or organizational level. Prevalence of PCP burnout ranged from 13.5% to 60%. The primary care practice environment was the most common predictor of PCP burnout. In conclusion, developing interventions to improve the practice environment may help reduce PCP burnout. Future studies using robust study designs and standardized instruments to consistently measure burnout are needed.

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