Increasing Access to Buprenorphine for Opioid Use Disorder in Primary Care: an Assessment of Provider Incentives

• Published in: Journal of general internal medicine : JGIM 2023-07, Vol.38 (9), p.2147-2155
• Main Authors: Kelley, A. Taylor, Wilcox, Jordynn, Baylis, Jacob D., Crossnohere, Norah L., Magel, John, Jones, Audrey L., Gordon, Adam J., Bridges, John F. P.
• Format: Article
• Language: English
• Subjects: Addictions; Analgesics, Opioid - therapeutic use; Buprenorphine; Buprenorphine - therapeutic use; Compensation; Drug abuse; Drug addiction; Health care facilities; Humans; Incentives; Internal Medicine; Medicine; Medicine & Public Health; Motivation; Narcotics; Opiate Substitution Treatment; Opioid-Related Disorders - drug therapy; Opioids; Original Research; Physicians; Primary care; Primary Health Care; Professional development; Recognition; Substance use disorder; Vacations; Workload; Workloads
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-022-07975-7

Background Primary care providers (PCPs) are essential to increasing access to office-based buprenorphine medication treatment for opioid use disorder (B-MOUD). Barriers to B-MOUD prescribing are well-documented, but there is little information regarding incentives to overcome these barriers. Objective To identify optimal incentives for PCPs to promote B-MOUD prescribing and compare incentive preferences across provider and practice characteristics. Design We surveyed PCPs using best-worst scaling (BWS) to prioritize seven potential incentives for B-MOUD prescribing (monetary compensation, paid vacation, protected time, professional development, reduced workload, service recognition, clinical resources). We then used a direct elicitation approach to determine preferred incentive levels (e.g., monetary thresholds) and types (e.g., specific clinical resources). Participants Primary care physicians and advanced practice providers (APPs) at a large Department of Veterans Affairs healthcare system. Main Measures B-MOUD prescribing incentive preferences and relative preference levels using descriptive statistics and conditional logistic regression with relative importance scale transformation (coefficients sum to 100, higher coefficient=greater importance). Key Results Fifty-three PCPs responded (73% response), including 47% APPs and 36% from community-based clinics. Reduced workload (relative importance score=26.8), protected time (18.7), and clinical resources (16.8) were significantly more preferred ( P s < 0.001) than professional development (10.5), paid vacation (10.3), or service recognition (1.5). Relative importance of monetary compensation varied between physicians (12.6) and APPs (17.5) and between PCPs located at a medical center (11.4) versus community clinic (22.3). APPs were more responsive than physicians to compensation increases of $5000 and $12,000 but less responsive to $25,000; trends were similar for medical center versus community clinic PCPs. The most frequently requested clinical resource was on-demand consult access to an addiction specialist. Conclusions Interventions promoting workload reductions, protected time, and clinical resources could increase access to B-MOUD in primary care. Monetary incentives may be additionally needed to improve B-MOUD prescribing among APPs and within community clinics.