Literature Collection

BACKGROUND: Office-based opioid treatment (OBOT) is an evidence-based treatment model for opioid use disorder (OUD) offered by both addiction and general primary care providers (PCPs). Calls exist for more PCPs to offer OBOT. Few studies have been conducted on the primary care characteristics of OBOT patients. OBJECTIVE: To characterize medical conditions, medications, and treatment outcomes among patients receiving OBOT with buprenorphine for OUD, and to describe differences among patients by age and by time in care. METHODS: This study is a retrospective review of medical records on or before 4/29/2019 at an outpatient primary care clinic within a nonprofit addiction treatment setting. Inclusion criterion was all clinic patients actively enrolled in the OBOT program. Patients not prescribed buprenorphine or with no OBOT visits were excluded. RESULTS: Of 355 patients, 42.0% had another PCP. Common comorbid conditions included chronic pain and psychiatric diagnosis. Few patients had chronic viral hepatitis or HIV. Patients reported a median of 4 medications. Common medications were cardiovascular, antidepressant, and nonopioid pain agents. Older patients had a higher median number of medications. There was no significant difference in positive opioid urine toxicology (UT) based on age, chronic pain status, or psychoactive medications. Patients retained >1 year were less likely to have positive opioid UT. CONCLUSION: Clinical needs of many patients receiving OBOT are similar to those of the general population, supporting calls for PCPs to provide OBOT.

This study describes the frequency and comfort of pediatric primary care clinicians (PCCs) as it relates to initiating, continuing, and stopping medications for attention-deficit/hyperactivity disorder (ADHD), anxiety/depression, and sleep problems across age groups (≤5 years, 6-12, and 13+). Primary care clinicians (N = 148) within an integrated primary care national research consortium participated in an anonymous online survey including questions examining practice settings, provider characteristics, prescribing frequency, and prescribing comfort. Results indicate that comfort and prescribing practices vary by patient age, practice setting, provider experience, and presenting diagnoses. Primary care clinicians generally felt more comfortable prescribing for school-age children and older and prescribing for ADHD-related concerns. Primary care clinicians appeared similarly comfortable starting, maintaining, and stopping medications. Rural PCCs reported greater comfort initiating and managing medication. Results highlight the need for ongoing training and support for PCCs in managing common childhood mental health conditions. Implications for establishing collaborative infrastructure support and team-based care are discussed.