Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysis
Abstract 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) s...
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BMC
2025-04-01
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| Series: | Addiction Science & Clinical Practice |
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| Online Access: | https://doi.org/10.1186/s13722-025-00568-9 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Aline Lott |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-7e1764da33564fa28d948fe4604487e4 |
| institution | Kabale University |
| issn | 1940-0640 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Addiction Science & Clinical Practice |
| spelling | doaj-art-7e1764da33564fa28d948fe4604487e42025-08-20T03:52:24ZengBMCAddiction Science & Clinical Practice1940-06402025-04-0120111010.1186/s13722-025-00568-9Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysisAline Lott0Anissa N. Danner1Carol A. Malte2Hope A. Salameh3Diana Bachowski4Adam J. Gordon5Hildi J. Hagedorn6Madeline C. Frost7Emily C. Williams8Andrew J. Saxon9Ryan S. Trim10Eric J. Hawkins11Health Systems Research (HSR) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care SystemHealth Systems Research (HSR) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care SystemHealth Systems Research (HSR) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care SystemCenter for Care Delivery & Outcomes Research, Health Services Research & Development, Minneapolis VA Health Care SystemCenter of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care SystemInformatics, Decision-Enhancement, and Analytic Sciences Center, Health Systems Research, VA Salt Lake City Health Care SystemCenter of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care SystemHealth Systems Research (HSR) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care SystemHealth Systems Research (HSR) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care SystemHealth Systems Research (HSR) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care SystemCenter of Excellence in Substance Addiction Treatment and Education, Corporal Michael J. Crescenz Philadelphia VA Medical CenterHealth Systems Research (HSR) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care SystemAbstract 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.https://doi.org/10.1186/s13722-025-00568-9BuprenorphineOpioid use disorderOUD carePrimary care |
| spellingShingle | 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 Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysis Addiction Science & Clinical Practice Buprenorphine Opioid use disorder OUD care Primary care |
| title | Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysis |
| title_full | Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysis |
| title_fullStr | Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysis |
| title_full_unstemmed | Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysis |
| title_short | Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysis |
| title_sort | implementing buprenorphine for opioid use disorder in veterans health administration primary care a qualitative analysis |
| topic | Buprenorphine Opioid use disorder OUD care Primary care |
| url | https://doi.org/10.1186/s13722-025-00568-9 |
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