Changing minds on MOUD: impact of messages to motivate expanded access to buprenorphine in primary care settings

Vollständiger Abstract

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Abstract Background Practitioners in primary care (PCPs) face significant barriers and lack of motivation for expansion of medications for opioid use disorder (MOUD) in their service. Educational videos specifically targeted at the primary care setting and utilizing key determinants of behavior change were assessed for impact on PCP viewer’s attitudes and intention to explore MOUD. Methods A rural-setting PCP scripted the videos, describing her extensive experience treating patients using buprenorphine. Content addressed key barriers and negative perceptions of MOUD in the primary video; supplementary videos centered on clinic and societal benefits (external motivation) or personal and professional rewards (internal motivation). Cross-sectional surveys accompanied the videos on a CE platform. Participation was open to family or internal medicine (MD, DO, APRN, PA) professionals in primary care family or internal medicine in Kentucky. Surveys measured demographics, career satisfaction, and change (Post / Retrospective-Pre format) in importance of 19 barriers and 4 areas of confidence for MOUD practice. Intention to explore MOUD was the primary outcome. Educational content was rated for gain in clinical knowledge/skills and information usefulness. Feedback on specific aspects of video content and general impact was probed in open-ended questions. Results Among the 37 professional learners, concern for negative attitudes/perceptions across the practice (staff, other practitioners, patients), limited appointment time, and reimbursement of clinical visits were all reduced in importance in Post-video assessment (Fisher’s non-parametric tests; p’s ≤ 0.05). A sense that MOUD fits with ones’ calling in being a doctor was positively impacted. Likelihood to screen for OUD was increased, and participants who scored higher on career satisfaction were more likely to consider board certification as an Addiction Medicine Specialist. Conclusions Education that is conceived for and specifically responsive to the primary care environment and especially the challenges of rural practice can help overcome perceived barriers and promote consideration of MOUD service in primary care practice.