Family Medicine Physicians Research Articles

Antibiotic prescription patterns in patients with suspected urinary tract infections in Ecuador.

Urinary tract infections (UTI) are among the most common cause to prescribe antibiotics in primary care. Diagnosis is based on the presence of clinical symptoms in combination with the results of laboratory tests. Antibiotic therapy is the primary approach to the treatment of UTIs; however, some studies indicate that therapeutics in UTIs may be suboptimal, potentially leading to therapeutic failure and increased bacterial resistance. This study aimed to analyze the antibiotic prescription patterns in adult patients with suspected UTIs and to evaluate the appropriateness of the antibiotic prescription. This is a cross-sectional study of patients treated in outpatient centers and in a second-level hospital of the Ministry of Public Health (MOPH) in a city in Ecuador during 2019. The International Classification of Disease Tenth Revision (ICD-10) was used for the selection of the acute UTI cases. The patients included in this study were those treated by family, emergency, and internal medicine physicians. We included a total of 507 patients in the analysis and 502 were prescribed antibiotics at first contact, constituting an immediate antibiotic prescription rate of 99.01%. Appropriate criteria for antibiotic prescription were met in 284 patients, representing an appropriate prescription rate of 56.02%. Less than 10% of patients with UTI had a urine culture. The most frequently prescribed antibiotics were alternative antibiotics (also known as second-line antibiotics), such as ciprofloxacin (50.39%) and cephalexin (23.55%). Factors associated with inappropriate antibiotic prescribing for UTIs were physician age over forty years, OR: 2.87 (95% CI, 1.65-5.12) p<0.0001, medical care by a general practitioner, OR: 1.89 (95% CI, 1.20-2.99) p = 0.006, not using point-of-care testing, OR: 1.96 (95% CI, 1.23-3.15) p = 0.005, and care at the first level of health, OR: 15.72 (95% CI, 8.57-30.88) p<0.0001. The results of our study indicate an appropriate prescription rate of 56.02%. Recommended antibiotics such as nitrofurantoin and fosfomycin for UTIs are underutilized. The odds for inappropriate antibiotic prescription were 15.72 times higher at the first level of care compared to the second. Effective strategies are needed to improve the diagnosis and treatment of UTIs.

Prescribing by Physician Associates and Nurse Practitioners in Older Adults Is Outpacing Traditional Prescribers: Implications for Practice in American Medicine.

Prescribing is a significant activity undertaken by physicians, physician associates/assistants (PAs), and nurse practitioners (NPs). We analyzed prescribing data to understand better the growing presence of PAs and NPs in older adults. A trend in frequently prescribed medications was compared with other physicians. All prescriptions in Medicare Part D were grouped into broad categories of drugs and linked to each type of provider. The analysis spanned 9 years (2013-2021). The results revealed that all five providers similarly prescribed the top three main drug classes (antacids, antihypertensives, and statins). In addition, there was a decline in the number of unique prescribers and prescriptions for all three types of physicians (family medicine, internal medicine, and general practice physicians). Concurrently, the number and share of prescriptions for NPs and PAs increased yearly. The findings are consistent with data that PAs and NPs are backfilling physician shortages in treating older adults.

Being Patient

In this narrative medicine essay, a family medicine physician’s experience while undergoing a breast biopsy inspires her to build trust with her patients by listening and counseling more.

A qualitative study of primary care clinician’s approach to ending cervical cancer screening in older women in the United States

The United States Preventive Services Task Force (USPSTF) recommends that cervical cancer screening end in average-risk patients with a cervix at 65 years of age if adequate screening measures have been met, defined as having 1) at least three normal consecutive cytology (Pap) tests, or 2) two normal cytology tests and/or two negative high-risk human papillomavirus tests between ages 55–65; the last test should be performed within the prior 5 years. Up to 60 % of all women aged 65 years and older who are ending screening do not meet the criteria for adequate screening. The objective of this study was to understand the process and approach that healthcare clinicians use to determine eligibility to end cervical cancer screening. In 2021 we conducted semi-structured interviews in San Francisco, CA with twelve healthcare clinicians: two family medicine physicians, three general internal medicine physicians, two obstetrician/gynecologists and five nurse practitioners. Thematic analysis, using inductive and deductive coding, was utilized. Three major themes emerged: following guidelines, relying on self-reported data regarding prior screening, and considering sexual activity as a factor in the decision to end screening. All interviewees endorsed following the USPSTF guidelines and they utilized self-report to determine eligibility to end screening. Clinicians’ approach was dependent in part on their judgement about the reliability of the patient to convey their screening history. Sexual activity of the patient was considered when making clinical recommendations. Shared decision-making was often utilized. Clinicians voiced a strong reliance on self-reported screening history to end cervical cancer screening.

Oh Susannah

In this narrative medicine essay, a family medicine physician whose daughter was born with a 50% chance of having the Huntingtin gene embraces the joy of the present over the fear of the future.

Cardiovascular complications in the context of COVID-19: arrhythmias

The COVID-19 pandemic has become a global crisis of unprecedented level for all mankind. The whole process of studying the disease (etiopathogenesis, diagnosis, treatment, prevention, prognosis) was not easy, because COVID-19 is a relatively new nosology that the world has never encountered. Cardiovascular complications in COVID-19 play an important role in the prognosis of morbidity and mortality. As the COVID-19 pandemic spreads, more and more patients with cardiac arrhythmias, arterial hypertension and other cardiovascular complications appear. This may be due to the impact of the SARS-CoV-2 virus on the respiratory, cardiovascular and other systems, as well as the development of inflammation. During the COVID-19 pandemic, there were more patients with arrhythmias. According to some data, the risk of arrhythmias in COVID-19 in hospitalized patients varies from 7.57% to 17.97%. The main causes of arrhythmia in the context of COVID-19 are hypoxia (acute respiratory distress syndrome, pulmonary embolism, the effect of SARS-CoV-2 on chemoreceptors), myocarditis (direct and indirect effects of SARS-CoV-2 on the myocardium), electrolyte imbalance, autonomic dysfunction, cardiotoxic drugs used in COVID-19. There can often be several reasons, and it is quite difficult to figure out which one has become the main one for each patient. This review focuses on the potential mechanisms for the development of cardiac arrhythmias in patients with COVID-19. Cardiologists, therapists and family medicine physicians should be aware of cardiovascular complications in the management of patients with COVID-19, and the prophylactic medical examination of the population.

Infusing intellectual and Developmental disability training into Medical School curriculum: a Pilot intervention

ABSTRACT Purpose Despite the rising prevalence of developmental disabilities (DD) in the US, there remains insufficient training for healthcare professionals to care for this medically underserved population – particularly adults. The National Inclusive Curriculum for Health Education (NICHE) aims to improve attitudes and knowledge towards people with intellectual and developmental disabilities (PWIDD); herein we describe one such intervention. Method The intervention integrated didactic, panel presentation and clinical skills components into a 2nd year medical school curriculum. The didactic session, covering health and assessment of PWIDDs, history of IDD, stigma, etc., was co-taught by a developmental pediatrician, family medicine physician and social worker. A panel of 3 adult self-advocates (SAs) with DD and a parent of a child with DD spoke about their lived experiences. One week later, students practiced taking clinical histories of SAs within small group settings with adult PWIDDs, facilitated by medical school faculty. Students completed the NICHE Knowledge(49 items) and Attitudes (60 items) surveys. The evaluation analyzed pre/post intervention differences in a) knowledge and attitude scores overall and b) by student age, gender, intended medical specialty, and prior experiences with PWIDDs. Open-ended comments were analyzed with content analysis. Results Overall Knowledge scores increased from pre-to posttest (n = 85; 65[19] vs. 73[17], p = 0.00), while Attitudes score improved (i.e., decreased) (n = 88; 0.55 [.06] vs. 0.53 [0.06]); p = 0.00). Higher pretest knowledge was found among female identified students (vs. others; p = 0.01) and those knowing > = 5 PWIDD (vs < 5; p = 0.02). Students characterize their IDD training and experience prior to intervention as ‘lacking’ and described the sessions as effective. Conclusions A brief (4 hours total) intervention was associated with modest but significant improved knowledge and attitudes towards PWIDDs. Replication and sustainability of this and other NICHE interventions are needed to fill gaps in PWIDDs’ health care.

FRI123 Development And Impact Of A Best Practice Alert For Primary Aldosteronism Screening

Abstract Disclosure: S. Charoensri: None. L. Bashaw: None. C. Dehmlow: None. T. Ellies: None. A.F. Turcu: None. Background: Primary aldosteronism (PA) is a common cause of secondary hypertension, affecting up to 25% of patients with treatment-resistant hypertension. PA amplifies the risk of cardiovascular morbidity and mortality above that of equivalent primary hypertension. Despite this, &amp;lt;3% of candidates for PA screening are ever evaluated, including in academic centers with facile access to all required resources for PA subtyping and treatment. Clinical decision support tools, such as best practice alerts (BPA), can leverage electronic medical records technology to support health care delivery improvement efforts. Intervention and Measurements: In collaboration with institutional Informational Technology services, we developed an algorithm that identifies PA screening candidates as adult patients with hypertension and one of the following criteria: ≥ 4 current antihypertensive medications; age &amp;lt; 35 years; hypokalemia (defined by potassium supplements or low serum potassium in the past year); or adrenal mass on problem list. The algorithm excluded patients who had both plasma aldosterone and renin measurements within the past 5 years. A non-disruptive BPA to suggest PA screening was constructed and set to trigger in patients meeting inclusion and exclusion criteria when evaluated in outpatient setting by clinicians who treat hypertension, including Internists, Family Practitioners, Cardiologists, Nephrologists, and Endocrinologists. An order set for PA screening and a link to results interpretation guidance were also embedded within the BPA. The BPA was first piloted between Aug-Sept 2021, and then launched on October 1st, 2021. We assessed the number of unique patients identified by the BPA between Oct 1st, 2021- Dec 14th, 2022, stratified by PA screening indications; attitude towards the BPA; and number of patients who received PA screening orders. Results: In total, the BPA identified 14,443 unique candidates for PA screening, including: 6944 patients with treatment-resistant hypertension; 6583 patients with hypertension and hypokalemia; 1527 patients with hypertension &amp;lt;35 years; and 444 with hypertension and an adrenal mass. During the same time frame, 3614 (25%) patients received orders for plasma aldosterone and renin. Patients tested were on average 57 +/-17 years old, 2000 (55.3%) were women, 2573 (71.2%) were White, 712 (19.7%) Black, and 105 (2.9%) Asian. Of new orders, 1364 (37.7%) were placed by Internists, 685 (18.9%) by Family Medicine physicians, 559 (15.5%) by Endocrinologists, 235 (6.5%) by Cardiologists, and 50 (1.4%) by Nephrologists. Family Practitioners and Internists placed most orders via the embedded BPA order set (66.6% and 46.3%, respectively), while Endocrinologists placed 98.6% of the orders outside of the BPA order set. Conclusions: Non-disruptive BPAs enhance the rates of PA screening, particularly among Internists and Family Practitioners. Presentation: Friday, June 16, 2023

THU607 Improving Screening For Primary Aldosteronism Among People With Apparent Treatment Resistant Hypertension

Abstract Disclosure: K. Zekarias: None. K. Tessier: None. J. Kohlenberg: None. Introduction: The screening rate for primary aldosteronism (PA) is low among people with resistant hypertension. People with PA experience significantly more cardiovascular complications than those with primary hypertension and an equivalent degree of blood pressure control1. Therefore, identification of people with PA for early-directed therapy is crucial. Objective: We aimed to improve the screening rate for PA among people with apparent treatment resistant hypertension (aTRH), defined as blood pressure &amp;gt;140/90 despite the concurrent use of three antihypertensive drug classes or any person with hypertension on &amp;gt;4 antihypertensive medications. Methods: Using an electronic medical record (EMR) best practice alert (BPA), we implemented a quality improvement (QI) program from 9/17/2022-3/16/2023. We included adults ≥18 years of age with aTRH, who were identified using ICD codes, the last three blood pressure measurements and the antihypertensive medication list. During office visits with nephrologists, cardiologists, endocrinologists, family medicine physicians, and internists, a BPA notified providers if the person with aTRH had not been previously screened for PA with plasma aldosterone and plasma renin activity. The alert defined aTRH, suggested that screening be performed regardless of active medications, and contained an order set for plasma aldosterone, plasma renin activity, and plasma potassium. Furthermore, the BPA suggested referral to an endocrinologist if the patient fulfilled criteria for positive case detection for PA, defined as plasma renin activity &amp;lt; 1 ng/mL/hour and plasma aldosterone concentration (PAC) &amp;gt; 10 ng/dL or the plasma aldosterone to renin ratio (ARR) &amp;gt; 30 with PAC &amp;gt; 10. We compared the PA screening rate after the implementation of the BPA to the PA screening rate over the 1 year prior to the BPA implementation (9/16/2021-9/16/2022). Results: Plasma aldosterone lab orders were placed for 3.4% (179/5,261) of people with aTRH post-BPA implementation compared to 1.9% (211/10,944) pre-BPA implementation (p&amp;lt;0.01). Positive case detection for PA occurred in 25% (38/152) of people screened post -BPA implementation compared to 27% (47/173) pre-BPA implementation (p=0.66). People with aTRH who were younger (p&amp;lt;0.01) were more likely to be screened for PA pre-BPA implementation and this did not change post-implementation. Conclusion: Implementation of a QI program employing a BPA with an embedded order set in the EMR improved the screening rate for PA among adults with aTRH. Reference 1. Monticone S, D'Ascenzo F, Moretti C, Williams TA, Veglio F, Gaita F, Mulatero P. Cardiovascular events and target organ damage in primary aldosteronism compared with essential hypertension: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2018 Jan; 6 (1):41-50. Presentation: Thursday, June 15, 2023

1.58 Increasing Knowledge About Adolescent Opioid Use, Screening, and Treatment Among Pediatric, Family Medicine, and Emergency Medicine Resident Physicians

1.58 Increasing Knowledge About Adolescent Opioid Use, Screening, and Treatment Among Pediatric, Family Medicine, and Emergency Medicine Resident Physicians

US Pediatric Primary Care Physician Workforce in Rural Areas, 2010 to 2020

This cross-sectional study examines the growth and distribution of the general pediatrician and family medicine physician workforce from 2010 to 2020 across the US and identifies the sociodemographic characteristics of counties lacking this workforce.

Diseño y validación del cuestionario ACPAPS para valorar la atención centrada en la persona por el médico de familia

ObjectivesDesign, construction and validation of a self-completion test that allows the Family Physician (FP) to assess the extent to which he/she integrates person-centred care (PCC) in his/her clinical practice. DesignQualitative. Questionnaire design. LocationPrimary care. ParticipantsTwo hundred and fourteen family and community medicine physicians and residents, from 62 of the 80 health centres in the autonomous community of Murcia (Spain). MethodsConstruction of a questionnaire from a bank of 873 items from a systematic review and a Delphi study. Review by PCC panel of experts (8). Cognitive pretest with 10 FP. Doctors from 62 health centres were invited to participate. With the responses we measured reliability, validity and feasibility. ResultsThe final questionnaire contains 37 items. We measured reliability through internal consistency with a Cronbach's alpha of .915. For construct validity, the appropriate Bartlett's test of sphericity and the Kaiser-Mayer-Olkin measure of .889 allowed us to carry out a factor analysis with the extraction of nine factors (Kaiser's rule) with five main factors (Scree test) whose items coincide with the dimensions proposed by the experts. To assess its feasibility we considered the response rate of 31.15%, the response time of 17minutes 23seconds and only .9% of respondents considered the questionnaire long or complex. ConclusionsThe ACPAPS questionnaire is a reliable, valid and feasible tool to assess PCC in FM, which has multiple and far-reaching applications.

Changes in Provider Perceptions and Practices Regarding Dosing Units for Oral Liquid Medications

ObjectiveA 2015 survey of primary care providers (PCPs) found that while many believed that milliliter (mL)-only dosing was safest for oral liquid medications, few would use mL alone in dosing instructions. Since 2015, many recommendations have promoted “mL-only” dosing. In 2019, a follow-up survey was conducted to assess if PCP perceptions and practices have changed. MethodsPediatricians, family medicine physicians, nurse practitioners, and internists participating in the 2015 and 2019 DocStyles cross-sectional, web-based surveys were asked about their perceptions and practices regarding dosing units for oral liquid medications. ResultsIn 2019, among 1392 respondents, the proportion of PCPs who reported they believed using mL-only is the safest dosing instruction ranged from 55.1% of internists to 80.8% of pediatricians. While fewer PCPs believed patients/caregivers prefer dosing instructions in mL-only (23.9% of nurse practitioners to 48.4% of pediatricians), more held this belief in 2019 compared to 2015; pediatricians had the greatest absolute increase (+14.4%) and family medicine physicians had the smallest increase (+1.3%). While 61.6% of pediatricians reported they would use mL-only dosing, only 36.0% of internists, 36.6% of nurse practitioners, and 42.5% of family medicine physicians reported they would do so. After controlling for age, gender, region, and specialty, 2019 PCP survey participants were more likely to report that they would use mL-only dosing compared to 2015 participants (adjusted odds ratio 1.51, 95% confidence interval 1.29–1.77). ConclusionsBroader educational efforts may be necessary to reach nonpediatricians, to encourage prescribing and communication with patients/caregivers using mL-only dosing.

Difficulties of osteoporosis screening among family medicine physicians

Difficulties of osteoporosis screening among family medicine physicians

43060 A dermatologist, internist, and family medicine physician walk into an eczema patient visit: Comparing systemic corticosteroid prescribing patterns between dermatologists and primary care providers for AD

43060 A dermatologist, internist, and family medicine physician walk into an eczema patient visit: Comparing systemic corticosteroid prescribing patterns between dermatologists and primary care providers for AD

Barriers and Solutions for Pediatric Rheumatology Referrals in a Rural Area: Physician Survey Results From Montana State.

Currently, there are 9 states across the United States that do not have a pediatric rheumatologist, including the state of Montana. Patients in these states are often cared for by outreach clinics staffed by pediatric rheumatology (PR) providers from other states or looked after by in-state adult rheumatologists or in-state primary care providers. Using a web-based survey, we determined barriers and potential solutions to PR referrals from referring providers (including primary care providers and subspecialists) in Montana state. Eighty-five Montana referring providers responded, with 44% being pediatric physicians and 33% being family medicine physicians. Other respondents were adult rheumatologists, pediatric and family medicine advanced practice providers, orthopedic surgeons, and pediatric subspecialists. Eighty-five percent of providers had previously referred a patient to PR. Referring providers rated difficulty referring MT patients to PR as 27 (on a linear numeric scale of 0-100, with 0 being very difficult) and noted lack of access to local pediatric rheumatologist as the most significant barrier to referral. The top patient barrier as perceived by 95% of providers was travel time. Potential solutions to improve care included presence of local pediatric rheumatologist with 50 miles, development of algorithms for common PR complaints, and outreach clinics. Referring providers in Montana report difficulty in referring to PR, with lack of access and travel time being key barriers. Improving access through expanding local PR workforce and increasing access through outreach clinics may help reduce these barriers.

Training in Residency and Provision of Reproductive Health Services Among Family Medicine Physicians

Contraception and abortion services are essential health care, and family medicine (FM) physicians are an important part of the workforce providing this care. Residency could inform the reproductive health services FM physicians provide. To determine which residency training factors are associated with FM physicians' provision of reproductive health services to Medicaid beneficiaries. This cross-sectional, population-based observational study of inpatient and outpatient FM physicians who completed residency between 2008 and 2018 and treated at least 1 Medicaid beneficiary in 2019 was conducted from November 2022 to March 2023. The study used 2019 American Medical Association Masterfile and Historical Residency file, as well as the 2019 Transformed Medicaid Statistical Information System claims. Residency training in community-based or reproductive health-focused programs. The outcomes were providing the following to at least 1 Medicaid beneficiary in 2019: prescription contraception (pill, patch, and/or ring), intrauterine device (IUD) and/or contraceptive implant, and dilation and curettage (D&C). Odds of providing each outcome were measured using correlated random-effects regression models adjusted for physician, residency program, and county characteristics. In the sample of 21 904 FM physician graduates from 410 FM residency programs, 12 307 were female (56.3%). More than half prescribed contraception to Medicaid beneficiaries (13 373 physicians [61.1%]), with lower proportions providing IUD or implant (4059 physicians [18.5%]) and D&C (152 physicians [.7%]). FM physicians who graduated from a Reproductive Health Education in Family Medicine program, which fully integrates family planning into residency training, had significantly greater odds of providing prescription contraception (odds ratio [OR], 1.23; 95% CI, 1.07-1.42), IUD or implant (OR, 1.79; 95% CI, 1.28-2.48), and D&C (OR, 3.61; 95% CI, 2.02-6.44). Physicians who completed residency at a Teaching Health Center, which emphasizes community-based care, had higher odds of providing an IUD or implant (OR, 1.51; 95% CI, 1.19-1.91). In this cross-sectional study of FM physicians providing Medicaid service, characteristics of residency training including community-based care and integration of family planning training are associated with greater odds of providing reproductive health services. With growing reproductive health policy restrictions, providing adequate training in reproductive health is critical to maintaining access to care, especially for underserved populations.

Common clinical laboratory features among women with polycystic ovary syndrome and metabolic syndrome.

Women with polycystic ovary syndrome (PCOS) have a high prevalence of metabolic syndrome (MS), with rates up to 33%. This is associated with long-term consequences such as cardiovascular diseases, type 2 diabetes mellitus (T2DM), cancer, sleep apnea, and psychological issues. The prevalence of MS worldwide is often associated with obesity and T2DM, yet regional variations are reported. In this study, 122 women consulting general practice and family medicine physicians were evaluated, revealing a BMI exceeding 30 kg/m2. Among MS criteria, the most common diagnoses were T2DM in 29 patients, insulin resistance (IR) in 36, arterial hypertension (AH) in 51, reduced HDL levels in 53, and elevated triglycerides in 39. Further analysis revealed 16 unique combinations of MS components in these patients, with 75% of PCOS cases exhibiting three MS components and 25% having four. Additionally, research indicated that most women with PCOS face persistent, treatment-resistant obesity, with a notably higher BMI (ρ=0.87; r=0.76). These findings highlight the multifactorial nature of PCOS and MS etiology.

Clinician views on reporting pregnant and birthing patients who use alcohol and/or drugs to child welfare

Multiple health professional associations have expressed concern with policies that require clinician reporting of pregnant people's substance use to child welfare, including that reporting negatively affects patient outcomes and the patient-provider relationship. However, research has shown that clinicians continue to report pregnant and birthing patients at high rates. This study aimed to explore clinician views on reporting pregnant and birthing patients who use alcohol or drugs during pregnancy to child welfare and whether there are patterns in the types of decisions that clinicians agree with, disagree with, or feel conflicted about. In-depth interviews were conducted with 37 hospital-based clinicians (13 obstetrics and gynecology physicians, 12 emergency medicine physicians, 10 family medicine physicians, and 2 advance practice registered nurses) in the United States. The participants discussed one or more patient cases where they or someone else on the care team had to decide whether to report that patient to child welfare related to their use of alcohol or drugs during pregnancy. Cases were categorized on the basis of whether the participant agreed, disagreed, or was conflicted by the reporting decision in that case. Patterns were explored by patient-level factors, provider specialty, and whether the participant perceived that the decision was influenced by a state or hospital policy. A total of 53 patient cases (average 2 per interview) were identified. The participants typically described cases where they agreed with the decision to report or believed there was no other option than reporting. These cases typically involved patients who used nonprescribed opioids during pregnancy, were experiencing factors (eg, unstable housing and untreated mental health disorders) in addition to substance use, and/or left the hospital against medical advice without their infant. Moreover, some participants, mostly obstetricians and gynecologists, described cases where they felt conflicted about or disagreed with the decision to report. These cases typically involved pregnant patients using cannabis and patients reported because of hospital and/or state policy. Only 1 participant described a case where they disagreed with the decision to not report. The participants agreed with most, but not all, child welfare reporting decisions. When participants disagreed or felt conflicted with reporting decisions, these feelings were almost entirely related to decisions to report, which, in some cases, were prompted by hospital or state policies. Policies may prompt reporting that exceeds what clinicians believe is appropriate.

An analysis of patterns of distribution of buprenorphine in the United States using ARCOS, Medicaid, and Medicare databases.

Opioid overdose remains a problem in the United States despite pharmacotherapies, such as buprenorphine, in the treatment of opioid use disorder. This study characterized changes in buprenorphine use. Using the Drug Enforcement Administration's ARCOS, Medicaid, and Medicare claims databases, patterns in buprenorphine usage in the United States from 2018 to 2020 were analyzed by examining percentage changes in total grams distributed and changes in grams per 100 K people in year-to-year usage based on ZIP code and state levels. For ARCOS from 2018 to 2019 and 2019 to 2020, total buprenorphine distribution in grams increased by 16.2% and 12.6%, respectively. South Dakota showed the largest statewide percentage increase in both 2018-2019 (66.1%) and 2019-2020 (36.7%). From 2018 to 2019, the ZIP codes ND-577 (156.4%) and VA-222 (-82.1%) had the largest and smallest percentage changes, respectively. From 2019 to 2020, CA-932 (250.2%) and IL-603 (-36.8%) were the largest and smallest, respectively. In both 2018-2019 and 2019-2020, PA-191 had the second highest increase in grams per 100K while OH-452 was the only ZIP code to remain in the top three largest decreases in grams per 100K in both periods. Among Medicaid patients in 2018, there was a nearly 2000-fold difference in prescriptions per 100k Medicaid enrollees between Kentucky (12 075) and Nebraska (6). Among Medicare enrollees in 2018, family medicine physicians and other primary care providers were the top buprenorphine prescribers. This study not only identified overall increases in buprenorphine availability but also pronounced state-level differences. Such geographic analysis can be used to discern which public policies and regional factors impact buprenorphine access.