Outcomes of a novel office-based opioid treatment program in an internal medicine resident continuity practice

Jarratt D Pytell,Megan E Buresh,Ryan Graddy

doi:10.1186/s13722-019-0175-z

Abstract

BackgroundThe integration of opioid use disorder (OUD) care and competencies in graduate medical education training is needed. Previous research shows improvements in knowledge, attitudes, and practices after exposure to OUD care. Few studies report outcomes for patients with OUD in resident physician continuity practices.MethodsA novel internal office-based opioid treatment (OBOT) program was initiated in a resident continuity clinic. Surveys of resident and staff knowledge and attitudes of OBOT were administered at baseline and 4 months. A retrospective chart review of the 15-month OBOT clinic obtained patient characteristics and outcomes.ResultsTwelve patients with OUD were seen in the OBOT clinic. Seven patients (58%) were retained in care at the end of the study period for a range of 9–15 months. Eight patients demonstrated a good clinical response. Surveys of residents and staff at 4 months were unchanged from baseline showing persistent lack of comfort in caring for patients with OUD.ConclusionsOBOT can be successfully integrated into resident continuity practices with positive patient outcomes. Improvement in resident and staff attitudes toward OBOT were not observed and likely require direct and frequent exposure to OUD care to increase acceptance.

Highlights

The integration of opioid use disorder (OUD) care and competencies in graduate medical education training is needed
Several evidence-based treatment options exist for patients with OUD including treatment with buprenorphine in primary care settings, known as officebased opioid treatment (OBOT; [3])
The primary goal of this study is to describe the structure of the OBOT clinic, provide patient outcomes, and evaluate resident and staff attitudes toward and knowledge of OUD treatment

Summary

Introduction

The integration of opioid use disorder (OUD) care and competencies in graduate medical education training is needed. Common reasons cited by providers for not prescribing buprenorphine include lack of knowledge and experience, and negative attitudes toward patients with OUD [6,7,8]. Providers with early exposure to treating patients with OUD during training are likely to continue to offer treatment in later practice [9, 10]. Common concerns are that the patient population will change or that the clinic is not the appropriate place to treat patients with OUD. This is despite evidence showing that patients with OUD (and other substance use disorders) are prevalent in primary care clinics [15, 16]

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