title: Optimizing psychosocial support during office-based buprenorphine treatment in primary care: Patients' experiences and preferences.
abstract: BACKGROUND
  Buprenorphine maintenance treatment is effective and has been successfully integrated into human immunodeficiency virus (HIV) and primary care settings. However, one key barrier to providers prescribing buprenorphine is their perception that they are unable to provide adequate counseling or psychosocial support to patients with opioid addiction. This qualitative study investigated supportive elements of office-based buprenorphine treatment that patients perceived to be most valuable.
  
  
  METHODS
  The authors conducted five focus groups with 33 buprenorphine treatment-experienced participants. Focus groups were audio-recorded and transcribed. Iterative readings of transcripts and grounded theory analysis revealed common themes.
  
  
  RESULTS
  Overall, participants perceived that buprenorphine treatment helped them to achieve their treatment goals and valued the flexibility, accessibility, and privacy of treatment. Participants identified interpersonal and structural elements of buprenorphine treatment that provided psychosocial support. Participants desired good physician-patient relationships, but also valued care delivery models that were patient-centered, created a safe place for self-disclosure, and utilized coordinated team-based care.
  
  
  CONCLUSIONS
  Participants derived psychosocial support from their prescribing physician, but were also open to collaborative or team-based models of care, as long as they were voluntary and confidential. Buprenorphine-prescribing physicians without access to referral options for psychosocial counseling could focus on maintaining nonjudgmental attitudes and shared decision-making during patient encounters. Adding structure and psychosocial support to buprenorphine treatment through coordinated team-based care also seems to have great promise.
authors.affiliation: a Albert Einstein College of Medicine , Bronx , New York , USA.|b Department of Medicine, Montefiore Medical Center , Bronx , New York , USA.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Fox
authors.affiliation: a Albert Einstein College of Medicine , Bronx , New York , USA.
authors.forename: Mariya
authors.initials: M
authors.lastname: Masyukova
authors.affiliation: a Albert Einstein College of Medicine , Bronx , New York , USA.|b Department of Medicine, Montefiore Medical Center , Bronx , New York , USA.
authors.forename: Chinazo O
authors.initials: CO
authors.lastname: Cunningham
mesh_terms: D002047:Buprenorphine / Q000627:therapeutic use*; D017144:Focus Groups; D006801:Humans; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009819:Office Visits; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D057240:Patient Preference; D011320:Primary Health Care; D036301:Qualitative Research; D012944:Social Support
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine
keywords: Buprenorphine; opiate addiction; psychosocial support