TY - JOUR
KW - Buprenorphine/therapeutic use
KW - Delivery of Health Care
KW - Harm Reduction
KW - Humans
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/drug therapy
KW - Low threshold
KW - buprenorphine
KW - co-located
KW - integrated care
KW - qualitative
KW - Stakeholders
AU - S. N. Kapadia
AU - J. L. Griffin
AU - J. Waldman
AU - N. R. Ziebarth
AU - B. R. Schackman
AU - C. N. Behrends
A1 - 
AB - BACKGROUND: To respond to the U.S. opioid crisis, new models of healthcare delivery for opioid use disorder treatment are essential. We used a qualitative approach to describe the implementation of a low-threshold buprenorphine treatment program in an independent, community-based medical practice in Ithaca, NY. METHODS: We conducted 17 semi-structured interviews with program staff, leadership, and external stakeholders. Then we analyzed these data using content analysis. We used purposeful sampling aiming for variation in job title for program staff, and in organizational affiliation for external stakeholders. RESULTS: We found that opening an independent medical practice allowed for low-threshold buprenorphine treatment with less regulatory oversight, but state-certification was ultimately required to ensure financial sustainability. Relying on health insurance reimbursement alone led to funding shortfalls and additional funding sources were also required. The practice's ability to build relationships with licensed substance use treatment programs, community organizations, the legal system, and government agencies in the region differed depending on how much these entities supported a harm reduction philosophy compared to abstinence-based treatment. Finally, expanding the practice to a second location in a different region, co-located with a syringe service program, required adapting to a new cultural and political environment. CONCLUSION: The results from this study provide insight about the challenges that independent medical practices might face in delivering low-threshold buprenorphine treatment. They support policy efforts to address the financial burdens associated with providing low-threshold buprenorphine therapy and inform the external relationships that other providers would need to consider when delivering novel treatment models.
AD - Department of Medicine, Weill Cornell Medicine, New York, New York, USA.; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA.; Department of Medicine, Weill Cornell Medicine, New York, New York, USA.; REACH Medical, Ithaca, New York, USA.; REACH Medical, Ithaca, New York, USA.; Department of Policy Analysis and Management, Cornell University, Ithaca, New York, USA.; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA.; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA.
BT - Substance use & misuse
C5 - Education & Workforce; Opioids & Substance Use
CP - 2
DO - 10.1080/10826084.2021.2012484
IS - 2
JF - Substance use & misuse
LA - eng
M1 - Journal Article
N2 - BACKGROUND: To respond to the U.S. opioid crisis, new models of healthcare delivery for opioid use disorder treatment are essential. We used a qualitative approach to describe the implementation of a low-threshold buprenorphine treatment program in an independent, community-based medical practice in Ithaca, NY. METHODS: We conducted 17 semi-structured interviews with program staff, leadership, and external stakeholders. Then we analyzed these data using content analysis. We used purposeful sampling aiming for variation in job title for program staff, and in organizational affiliation for external stakeholders. RESULTS: We found that opening an independent medical practice allowed for low-threshold buprenorphine treatment with less regulatory oversight, but state-certification was ultimately required to ensure financial sustainability. Relying on health insurance reimbursement alone led to funding shortfalls and additional funding sources were also required. The practice's ability to build relationships with licensed substance use treatment programs, community organizations, the legal system, and government agencies in the region differed depending on how much these entities supported a harm reduction philosophy compared to abstinence-based treatment. Finally, expanding the practice to a second location in a different region, co-located with a syringe service program, required adapting to a new cultural and political environment. CONCLUSION: The results from this study provide insight about the challenges that independent medical practices might face in delivering low-threshold buprenorphine treatment. They support policy efforts to address the financial burdens associated with providing low-threshold buprenorphine therapy and inform the external relationships that other providers would need to consider when delivering novel treatment models.
PY - 2022
SN - 1532-2491; 1082-6084; 1082-6084
SP - 308
EP - 315
EP - 
T1 - The Experience of Implementing a Low-Threshold Buprenorphine Treatment Program in a Non-Urban Medical Practice
T2 - Substance use & misuse
TI - The Experience of Implementing a Low-Threshold Buprenorphine Treatment Program in a Non-Urban Medical Practice
U1 - Education & Workforce; Opioids & Substance Use
U2 - 34889691
U3 - 10.1080/10826084.2021.2012484
VL - 57
VO - 1532-2491; 1082-6084; 1082-6084
Y1 - 2022
ER -