A Buprenorphine Education and Training Program for Primary Care Residents: Implementation and Evaluation

Abstract

ABSTRACT. Background: Although substance use disorders are highly prevalent, resident preparation to care for patients with these disorders is frequently insufficient. With increasing rates of opioid abuse and dependence, and the availability of medication-assisted treatment, one strategy to improve resident skills is to incorporate buprenorphine treatment into training settings. Methods: In this study, esidency faculty delivered the BupEd education and training program to 71 primary care residents. BupEd included (1) a didactic session on buprenorphine, (2) an interactive motivational interviewing session, (3) monthly case conferences, and (4) supervised clinical experience providing buprenorphine treatment. To evaluate BupEd, the authors assessed (1) residents’ provision of buprenorphine treatment during residency, (2) residents’ provision of buprenorphine treatment after residency, and (3) treatment retention among patients treated by resident versus attending physicians. Results: Of 71 residents, most served as a covering or primary provider to at least 1 buprenorphine-treated patient (84.5 and 66.2%, respectively). Of 40 graduates, 27.5% obtained a buprenorphine waiver and 17.5% prescribed buprenorphine. Treatment retention was similar between patients cared for by resident PCPs versus attending PCPs (90-day retention: 63.6% [n = 35] vs. 67.9% [n = 152]; P = .55). Conclusion: These results show that BupEd is feasible, provides residents with supervised clinical experience in treating opioid-dependent patients, and can serve as a model to prepare primary care physicians to care for patients with opioid dependence.

Keywords:

• Buprenorphine
• opioid dependence
• substance abuse education

Acknowledgments

This work was presented in part at the Society of General Internal Medicine Annual Conference (Miami, Florida; April, 2009) and the Annual Conference of the Association for Medical Education and Research in Substance Abuse (Bethesda, Maryland; November 2010).

This work was supported by Health Resources and Services Administration (HRSA), Residency Training in Primary Care Grant, D58HP10330; HRSA, HIV/AIDS Bureau, Special Projects of National Significance, grant 6H97HA00247; the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center (NIH AI-51519); NIH R25DA023021; and the Robert Wood Johnson Foundation's Harold Amos Medical Faculty Development Program.The authors would like to acknowledge the PCSM residents and waivered CHCC physicians who participated in this study.