Insights Into Recovery: A Qualitative Analysis of Primary Care Provider Perspectives on Treating Veterans With Opioid Use Disorder in the VA Primary Care Setting.

Abstract

Background: The Veterans Health Administration (VA) has prioritized addressing opioid use disorder (OUD) due to rising opioid overdose rates among Veterans, aiming to expand evidence-based OUD treatment in primary care. The purpose of this project was to (1) examine VA provider perspectives regarding OUD treatment in primary care, and (2) explore provider perceptions about stigma related to OUD.

Methods: From September 2021 to June 2022, we held 6 semi-structured focus groups with multidisciplinary VA primary care providers (n = 91 participants) via Microsoft Teams and in person. Each group, comprising 13 to 24 providers, engaged in interviews lasting 50 to 80 minutes. We employed qualitative interviewing techniques to collect feedback on provider perspectives concerning OUD treatment within VA primary care. Participants viewed 2 to 3 short videos from the Insights Into Recovery series. Focus group interviews were recorded, transcribed, and checked for accuracy. Directed content analysis was used to identify themes and patterns.

Results: Participants identified several barriers to treating OUD in primary care. Patient-level challenges reported by providers included establishing clinician-patient trust and differing views on OUD diagnoses. Provider-level barriers included limited experience, discomfort with treatment, and managing complex care needs. System-level obstacles involved time constraints, administrative burdens, and stigma, which affected attitudes toward OUD and opioid medication use. Facilitators of OUD care included satisfaction with patient success, training in buprenorphine prescribing, and the use of motivational interviewing (MI) techniques tailored to the patient's level of readiness.

Conclusions: Providers identified barriers to OUD care, including patient trust issues, limited provider experience, lack of support, and stigma from both patients and providers. Facilitators included enhanced training in buprenorphine prescribing and MI. To strengthen OUD care, 3 key strategies are recommended: addressing provider stigma, prioritizing OUD-specific training, and integrating MI. These initiatives could enhance OUD care in primary care settings within the VA, benefiting Veterans with chronic pain and OUD.