Increasing buprenorphine access for patients with chronic pain: A quality improvement initiative.

OBJECTIVE: Buprenorphine is effective for chronic pain and safer than full-agonist opioids; however, limited education and support regarding buprenorphine can result in under-prescribing in primary care and reduced access in specialty pain clinics. The purpose of this quality improvement initiative was to optimize and evaluate procedures for transferring patients stable on buprenorphine for chronic pain from a specialty pain clinic back to primary care.

SETTING: Eight primary care clinics within a Veterans Health Administration Healthcare System.

METHODS: A standard operating procedure for facilitated transfer of prescribing was developed following a needs assessment, and was introduced during an educational session with primary care providers, and providers completed a survey assessing attitudes about buprenorphine prescribing. Success of the initiative was measured through number of patients transferred back to primary care over the course of 18 months.

RESULTS: Survey results indicated primary care providers with previous experience prescribing buprenorphine were more likely to view buprenorphine prescribing for pain as within the scope of their practice and endorse feeling comfortable managing a buprenorphine regimen. Providers identified systemic and educational barriers to prescribing, as well as ongoing support from specialty pain care and primary care as facilitators. Metrics suggested the standard operating procedure was generally successful in transferring and retaining eligible patients in primary care.

CONCLUSION: This quality improvement initiative suggests a facilitated transfer procedure can be useful in increasing buprenorphine prescribing for pain in primary care. Future efforts to increase primary care provider comfort and address systemic barriers to buprenorphine prescribing are needed.