Aline Lott, Anissa N Danner, Carol A Malte, Hope A Salameh, Diana Bachowski, Adam J Gordon, Hildi J Hagedorn, Madeline C Frost, Emily C Williams, Andrew J Saxon, Ryan S Trim, Eric J Hawkins
{"title":"在退伍军人卫生管理初级保健中实施丁丙诺啡治疗阿片类药物使用障碍:定性分析。","authors":"Aline Lott, Anissa N Danner, Carol A Malte, Hope A Salameh, Diana Bachowski, Adam J Gordon, Hildi J Hagedorn, Madeline C Frost, Emily C Williams, Andrew J Saxon, Ryan S Trim, Eric J Hawkins","doi":"10.1186/s13722-025-00568-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Medications for opioid use disorder are evidence-based, guideline-recommended treatments. While buprenorphine can be prescribed in nonspecialized office-based settings, it is underutilized. Using a multifaceted implementation initiative, the Veterans Health Administration (VHA) sought to expand access to buprenorphine in nonspecialized office-based settings, including primary care clinics. The purpose of this qualitative evaluation was to assess and describe primary care clinicians' perspectives on delivering buprenorphine care during the first year of the initiative.</p><p><strong>Methods: </strong>Using a snowball sampling approach, individualized emails were sent to primary care clinicians participating in a VHA initiative (n = 43) inviting them to be interviewed. Individual semi-structured interviews were conducted September 2019 through January 2020, and were audio-recorded, transcribed, and analyzed using thematic analysis. The Consolidated Framework for Implementation Research (CFIR), a meta-theoretical framework of five domains associated with successful adoption of interventions, was used to organize findings.</p><p><strong>Results: </strong>Of 43 clinicians invited, 19 responded and were interviewed (44.2%). Findings represented two CFIR domains: Inner Setting and Characteristics of Individuals. For Inner Setting, three themes were identified as influencing implementation during the first year of the initiative. Clinicians reported a shared receptivity to implement buprenorphine, organizational support from pharmacy services and leadership, as well as cohesive relationships among implementation team members and collaboration with outside clinics. Noted barriers included fit within primary care workflows and lack of staff, time and access to onsite laboratory services and buprenorphine. For Characteristics of Individuals, two themes were identified that may facilitate clinicians' willingness to provide buprenorphine care. Namely, clinicians reported positive attitudes about and experiences delivering opioid use disorder care and a willingness to learn/do something new.</p><p><strong>Conclusions: </strong>While implementation strategies should be tailored to individual clinic needs, prioritizing factors identified in this evaluation may support successful implementation of buprenorphine delivery in primary care.</p>","PeriodicalId":54223,"journal":{"name":"Addiction Science & Clinical Practice","volume":"20 1","pages":"38"},"PeriodicalIF":3.2000,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042572/pdf/","citationCount":"0","resultStr":"{\"title\":\"Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysis.\",\"authors\":\"Aline Lott, Anissa N Danner, Carol A Malte, Hope A Salameh, Diana Bachowski, Adam J Gordon, Hildi J Hagedorn, Madeline C Frost, Emily C Williams, Andrew J Saxon, Ryan S Trim, Eric J Hawkins\",\"doi\":\"10.1186/s13722-025-00568-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Medications for opioid use disorder are evidence-based, guideline-recommended treatments. While buprenorphine can be prescribed in nonspecialized office-based settings, it is underutilized. Using a multifaceted implementation initiative, the Veterans Health Administration (VHA) sought to expand access to buprenorphine in nonspecialized office-based settings, including primary care clinics. The purpose of this qualitative evaluation was to assess and describe primary care clinicians' perspectives on delivering buprenorphine care during the first year of the initiative.</p><p><strong>Methods: </strong>Using a snowball sampling approach, individualized emails were sent to primary care clinicians participating in a VHA initiative (n = 43) inviting them to be interviewed. Individual semi-structured interviews were conducted September 2019 through January 2020, and were audio-recorded, transcribed, and analyzed using thematic analysis. The Consolidated Framework for Implementation Research (CFIR), a meta-theoretical framework of five domains associated with successful adoption of interventions, was used to organize findings.</p><p><strong>Results: </strong>Of 43 clinicians invited, 19 responded and were interviewed (44.2%). Findings represented two CFIR domains: Inner Setting and Characteristics of Individuals. For Inner Setting, three themes were identified as influencing implementation during the first year of the initiative. Clinicians reported a shared receptivity to implement buprenorphine, organizational support from pharmacy services and leadership, as well as cohesive relationships among implementation team members and collaboration with outside clinics. Noted barriers included fit within primary care workflows and lack of staff, time and access to onsite laboratory services and buprenorphine. For Characteristics of Individuals, two themes were identified that may facilitate clinicians' willingness to provide buprenorphine care. Namely, clinicians reported positive attitudes about and experiences delivering opioid use disorder care and a willingness to learn/do something new.</p><p><strong>Conclusions: </strong>While implementation strategies should be tailored to individual clinic needs, prioritizing factors identified in this evaluation may support successful implementation of buprenorphine delivery in primary care.</p>\",\"PeriodicalId\":54223,\"journal\":{\"name\":\"Addiction Science & Clinical Practice\",\"volume\":\"20 1\",\"pages\":\"38\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-04-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042572/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Addiction Science & Clinical Practice\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13722-025-00568-9\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"SUBSTANCE ABUSE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Addiction Science & Clinical Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13722-025-00568-9","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SUBSTANCE ABUSE","Score":null,"Total":0}
Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysis.
Background: Medications for opioid use disorder are evidence-based, guideline-recommended treatments. While buprenorphine can be prescribed in nonspecialized office-based settings, it is underutilized. Using a multifaceted implementation initiative, the Veterans Health Administration (VHA) sought to expand access to buprenorphine in nonspecialized office-based settings, including primary care clinics. The purpose of this qualitative evaluation was to assess and describe primary care clinicians' perspectives on delivering buprenorphine care during the first year of the initiative.
Methods: Using a snowball sampling approach, individualized emails were sent to primary care clinicians participating in a VHA initiative (n = 43) inviting them to be interviewed. Individual semi-structured interviews were conducted September 2019 through January 2020, and were audio-recorded, transcribed, and analyzed using thematic analysis. The Consolidated Framework for Implementation Research (CFIR), a meta-theoretical framework of five domains associated with successful adoption of interventions, was used to organize findings.
Results: Of 43 clinicians invited, 19 responded and were interviewed (44.2%). Findings represented two CFIR domains: Inner Setting and Characteristics of Individuals. For Inner Setting, three themes were identified as influencing implementation during the first year of the initiative. Clinicians reported a shared receptivity to implement buprenorphine, organizational support from pharmacy services and leadership, as well as cohesive relationships among implementation team members and collaboration with outside clinics. Noted barriers included fit within primary care workflows and lack of staff, time and access to onsite laboratory services and buprenorphine. For Characteristics of Individuals, two themes were identified that may facilitate clinicians' willingness to provide buprenorphine care. Namely, clinicians reported positive attitudes about and experiences delivering opioid use disorder care and a willingness to learn/do something new.
Conclusions: While implementation strategies should be tailored to individual clinic needs, prioritizing factors identified in this evaluation may support successful implementation of buprenorphine delivery in primary care.
期刊介绍:
Addiction Science & Clinical Practice provides a forum for clinically relevant research and perspectives that contribute to improving the quality of care for people with unhealthy alcohol, tobacco, or other drug use and addictive behaviours across a spectrum of clinical settings.
Addiction Science & Clinical Practice accepts articles of clinical relevance related to the prevention and treatment of unhealthy alcohol, tobacco, and other drug use across the spectrum of clinical settings. Topics of interest address issues related to the following: the spectrum of unhealthy use of alcohol, tobacco, and other drugs among the range of affected persons (e.g., not limited by age, race/ethnicity, gender, or sexual orientation); the array of clinical prevention and treatment practices (from health messages, to identification and early intervention, to more extensive interventions including counseling and pharmacotherapy and other management strategies); and identification and management of medical, psychiatric, social, and other health consequences of substance use.
Addiction Science & Clinical Practice is particularly interested in articles that address how to improve the quality of care for people with unhealthy substance use and related conditions as described in the (US) Institute of Medicine report, Improving the Quality of Healthcare for Mental Health and Substance Use Conditions (Washington, DC: National Academies Press, 2006). Such articles address the quality of care and of health services. Although the journal also welcomes submissions that address these conditions in addiction speciality-treatment settings, the journal is particularly interested in including articles that address unhealthy use outside these settings, including experience with novel models of care and outcomes, and outcomes of research-practice collaborations.
Although Addiction Science & Clinical Practice is generally not an outlet for basic science research, we will accept basic science research manuscripts that have clearly described potential clinical relevance and are accessible to audiences outside a narrow laboratory research field.