TY - JOUR
T1 - A qualitative study of the adoption of buprenorphine for opioid addiction treatment
AU - Green, Carla A.
AU - McCarty, Dennis
AU - Mertens, Jennifer
AU - Lynch, Frances L.
AU - Hilde, Anadam
AU - Firemark, Alison
AU - Weisner, Constance M.
AU - Pating, David
AU - Anderson, Bradley M.
N1 - Funding Information:
An award from the National Institute on Drug Abuse (R01 DA016341) supported data collection and analysis. We appreciate and thank the clinicians who gave us their precious time to participate in interviews. Thanks also go to the interviewers who traveled to meet those clinicians at the times and places that made those interviews possible: Sue Leung, Ph.D.; Alison Firemark M.A.; Cynthia Perry-Baker, B.S.; Christine Lou, Ph.D.; and Melanie Jackson, B.S. Ms. Firemark and Dr. Leung helped with coding and theme extraction. We thank project managers Agatha Hinman, Shannon Janoff, Leah Wolfe, and later, Alison Firemark.
PY - 2014/3
Y1 - 2014/3
N2 - Qualified physicians may prescribe buprenorphine to treat opioid dependence, but medication use remains controversial. We examined adoption of buprenorphine in two not-for-profit integrated health plans, over time, completing 101 semi-structured interviews with clinicians and clinician-administrators from primary and specialty care. Transcripts were reviewed, coded, and analyzed. A strong leader championing the new treatment was critical for adoption in both health plans. Once clinicians began using buprenorphine, patients' and other clinicians' experiences affected decisions more than did the champion. With experience, protocols developed to manage unsuccessful patients and changed to support maintenance rather than detoxification. Diffusion outside addiction and mental health settings was nonexistent; primary care clinicians cited scope-of-practice issues and referred patients to specialty care. With greater diffusion came questions about long-term use and safety. Recognizing how implementation processes develop may suggest where, when, and how to best expend resources to increase adoption of such treatments.
AB - Qualified physicians may prescribe buprenorphine to treat opioid dependence, but medication use remains controversial. We examined adoption of buprenorphine in two not-for-profit integrated health plans, over time, completing 101 semi-structured interviews with clinicians and clinician-administrators from primary and specialty care. Transcripts were reviewed, coded, and analyzed. A strong leader championing the new treatment was critical for adoption in both health plans. Once clinicians began using buprenorphine, patients' and other clinicians' experiences affected decisions more than did the champion. With experience, protocols developed to manage unsuccessful patients and changed to support maintenance rather than detoxification. Diffusion outside addiction and mental health settings was nonexistent; primary care clinicians cited scope-of-practice issues and referred patients to specialty care. With greater diffusion came questions about long-term use and safety. Recognizing how implementation processes develop may suggest where, when, and how to best expend resources to increase adoption of such treatments.
KW - Buprenorphine
KW - Diffusion of technology
KW - Implementation research
KW - Medication adoption
KW - Opioid addiction
KW - Qualitative research
UR - http://www.scopus.com/inward/record.url?scp=84892482605&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84892482605&partnerID=8YFLogxK
U2 - 10.1016/j.jsat.2013.09.002
DO - 10.1016/j.jsat.2013.09.002
M3 - Article
C2 - 24268947
AN - SCOPUS:84892482605
SN - 0740-5472
VL - 46
SP - 390
EP - 401
JO - Journal of Substance Abuse Treatment
JF - Journal of Substance Abuse Treatment
IS - 3
ER -