October 03, 2018, 10:03 am Chris Crawford – As the United States' opioid crisis continues to devastate families and communities, it's particularly concerning that some family physicians feel unprepared to treat these patients.
According to a study published in the August/September issue of Annals of Family Medicine, few early-career family physicians report being adequately trained to provide buprenorphine treatment for opioid use disorder (OUD), and even fewer say they provide it in their practices.
Researchers analyzed data from the 2016 National Family Medicine Graduate Survey of 1,979 family physicians who completed residency in 2013 and were certified by the American Board of Family Medicine.
The authors found that only 10 percent of these early-career family physicians felt adequately trained during residency to prescribe buprenorphine for OUD, and only 7 percent reported providing buprenorphine treatment in their current practice.
Corresponding study author Sebastian Tong, M.D., M.P.H., assistant professor in the Department of Family Medicine and Population Health at Virginia Commonwealth University, Richmond, told AAFP News that he was surprised the number of family physicians who said they felt prepared to provide buprenorphine was so low.
Tong explained that a study published in the July-August 2017 issue of Family Medicine that he co-authored found that only about 29 percent of family medicine residencies had any required addiction medicine curriculum.
"As such, we expected the percent of early-career family physicians (in the current study) who are adequately trained to provide buprenorphine treatment to be on the lower end, but not as low as 10 percent."
This cross-sectional study examined whether certain physician, residency and practice characteristics were associated with physicians being adequately prepared during residency to provide buprenorphine treatment and with physicians currently providing buprenorphine treatment.
The researchers used a hierarchical model that accounted for clustering within residencies to examine the association between these two outcomes and physician, residency and practice characteristics. Physician and residency characteristics were considered for both outcomes. For the current provision of buprenorphine treatment outcome, they also considered preparedness to provide buprenorphine therapy and practice characteristics but excluded residency region because of collinearity with current practice region.
Among other study findings was the fact that of family physicians who reported currently providing buprenorphine, 46 percent said they were trained to do so during residency.
Strikingly, however, more than two-thirds of those who said they were residency-trained to provide buprenorphine therapy are not doing so in practice, suggesting the presence of logistical barriers to providing this service after graduation.
In the multivariate model, family physicians who said they felt prepared to provide buprenorphine treatment were more likely to be engaged in research or practice-based research network (PBRN) activities and to have trained in the Northeast or West as compared with the South or Midwest. As for those who currently provide buprenorphine therapy, they were more likely to feel prepared to provide this treatment, to be engaged in research or PBRN activities, to work in a federally qualified health center, and to practice in the Northeast or West.
Tong said it's logical to conclude from his team's research that more training is needed at the residency level on using buprenorphine to treat patients with OUD.
"Knowing that buprenorphine training in residency is the factor most associated with current practice suggests that increasing buprenorphine training in residency could increase buprenorphine in practice," he said. "The most challenging factor would probably be recruiting or training faculty who can teach addiction medicine."
Additional barriers to providing buprenorphine treatment have been documented in other studies, Tong said.
"These include lack of behavioral health support, lack of support from colleagues in one's practice, stigma and lack of interest," he explained. "Having technical support and CME activities would help alleviate some of these barriers."
Providing buprenorphine therapy is likely the most effective tool available in primary care to treat OUD, Tong said. Yet, despite the worsening opioid epidemic across the country, family physicians still seem to be lagging in their response to helping treat those affected.
"Efforts need to be undertaken to ensure that family medicine residency graduates are better trained in providing buprenorphine so that they can respond to the growing need," Tong concluded.
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