Despite efforts to curb opioid use disorder (OUD), the epidemic continues to be a major national crisis. Methadone, buprenorphine, and naltrexone are standard of care FDA-approved treatments for OUD, but access to these medication-assisted treatments (MAT) is limited. “In recent years, initiatives have been launched to expand use of medications for opioid use disorder (MOUD) in primary care settings,” says Andrew L. Sussman, PhD, MCRP.
The process of acquiring requisite skills to deliver MAT occurs in two phases. In phase 1 core competency development, which can include the full Drug Addiction Treatment Act (DATA) waiver training, or for 30 or fewer active patients, any form of training that providers deem necessary. In phase 2, providers transition to active prescribing, in which continued support is necessary to expand patient volume and maximize access. “Research shows that many providers do not complete training and licensure steps,” Dr. Sussman says. “Others may complete their training and licensure, but do not continue to active prescribing or, alternatively, begin prescribing and then falter.”
Implementing & Evaluating a Benchmark Tracking Assessment
For a study published in the Journal of the American Board of Family Medicine, Dr. Sussman, Julie Griffin Salvador, PhD, and colleagues developed a systematic benchmark tracking assessment (BTA) process to expand buprenorphine treatment for OUD in rural primary care settings. They examined the impact of provider participation in an online intervention to support the expansion of buprenorphine treatment for OUD. “We developed a BTA to evaluate where providers ‘get stuck’ along the training-to-prescribing continuum,” says Dr. Sussman. “This enabled us to intervene more rapidly with the necessary support.”
For the intervention, 41 providers were contacted by phone every 3 months for up to 2 years to track their advancement along five identified key benchmark areas. The Extensions for Community Healthcare Outcomes (ECHO) model was used to deliver training and support to providers. Weekly ECHO sessions were held for 12-week cycles and included in-depth education on buprenorphine and OUD. External support was provided outside of ECHO sessions by request or was offered to providers who were not progressing along buprenorphine implementation steps.
BTA Gives a Better Understanding of Barriers to MAT Expansion
“Our study found that the BTA process was a feasible approach to help clinicians identify challenges along the training-to-prescription continuum and facilitate targeted support to address barriers,” Dr. Salvador says. “The assessment questions are brief and focused, and providers generally appreciated the rapid responses when encountering barriers. This ‘check in’ process serves as a useful reminder and allows clinicians to refocus.”
The study revealed different groupings of barriers for clinicians who missed benchmarks and those who never missed them (Table). In the case of missing benchmarks, time constraints for completing DATA waiver training requirements were a key factor. “Clinicians who missed benchmarks often experienced challenges earlier in the training and licensure phase because of time constraints with completing these steps,” Dr. Salvador says. “Clinicians who never missed benchmarks and had started to prescribe had specific questions about patient management. These findings suggest that a tailored approach to supporting clinicians is most helpful to ensure progression to MOUD prescribing.”
Continued Efforts Needed to Give Providers Additional Support
The BTA provides a simple strategy to help build the workforce in clinics, agencies, and healthcare systems to care for patients with OUD using buprenorphine, according to Dr. Salvador. “Providing training in buprenorphine MOUD may not be sufficient to help many providers actually initiate prescribing as well as address barriers that impede progress,” he says. “The BTA is a quick—5 minutes—and easy process of checking in at each step, identifying barriers, and helping to resolve them,” she adds. “Providers can then progress to prescribing and expanding access to MOUD.”
The study team concurred that additional research is needed to compare successful startups of buprenorphine between clinicians who use the BTA for support and providers who are only given training with no follow up. “This could determine the effectiveness of the BTA in a randomized controlled study,” Dr. Salvador says. “In the meantime, the BTA has the potential to be widely adopted to support providers administer buprenorphine treatment for OUD.”
