Integrating buprenorphine treatment into office-based practice: a qualitative study.
BACKGROUND
Despite the availability and demonstrated effectiveness of office-based buprenorphine maintenance treatment (BMT), the systematic examination of physicians' attitudes towards this new medical practice has been largely neglected.


OBJECTIVE
To identify facilitators and barriers to the potential or actual implementation of BMT by office-based medical providers.


METHODS
Qualitative study using individual and group semi-structured interviews.


METHODS
Twenty-three practicing office-based physicians in New England.


METHODS
Interviews were audiotaped, transcribed, and entered into a qualitative software program. The transcripts were thematically coded using the constant comparative method by a multidisciplinary team.


RESULTS
Eighty percent of the physicians were white; 55% were women. The mean number of years since graduating medical school was 14 (SD = 10). The primary areas of clinical specialization were internal medicine (50%), infectious disease (20%), and addiction medicine (15%). Physicians identified physician, patient, and logistical factors that would either facilitate or serve as a barrier to their integration of BMT into clinical practice. Physician facilitators included promoting continuity of patient care, positive perceptions of BMT, and viewing BMT as a positive alternative to methadone maintenance. Physician barriers included competing activities, lack of interest, and lack of expertise in addiction treatment. Physicians' perceptions of patient-related barriers included concerns about confidentiality and cost, and low motivation for treatment. Perceived logistical barriers included lack of remuneration for BMT, limited ancillary support for physicians, not enough time, and a perceived low prevalence of opioid dependence in physicians' practices.


CONCLUSIONS
Addressing physicians' perceptions of facilitators and barriers to BMT is crucial to supporting the further expansion of BMT into primary care and office-based practices.
Barry
Declan T
DT
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519-1187, USA. declan.barry@yale.edu
Irwin
Kevin S
KS
Jones
Emlyn S
ES
Becker
William C
WC
Tetrault
Jeanette M
JM
Sullivan
Lynn E
LE
Hansen
Helena
H
O'Connor
Patrick G
PG
Schottenfeld
Richard S
RS
Fiellin
David A
DA
D002047:Buprenorphine / Q000627:therapeutic use*; D005194:Family Practice / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000379:methods / Q000592:standards; D008297:Male; D009819:Office Visits; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration / Q000592:standards; D036301:Qualitative Research
D002047:Buprenorphine