Physician-Pharmacist Collaborative Care Model Improves Access to Buprenorphine
Though buprenorphine is a safe and effective medication that has been used to treat opioid use disorder (OUD) for nearly twenty years, fewer than 10% of primary care providers have obtained the required waiver to be able to prescribe it for that purpose. Pharmacists are both highly trusted and highly accessible healthcare professionals. Approximately 90% of Americans live within 5 miles of a community pharmacy, including those in rural communities. By contrast, almost 20 million US residents live in a county without a buprenorphine-waivered practitioner.
Given this, collaboration between physicians and pharmacists might be one way to help close the treatment gap and improve access to office-based buprenorphine treatment (OBBT). This study, CTN-0075, is the first U.S. pilot trial exploring whether such a collaboration could be implemented successfully and would be accepted by both patients and providers.
The study was conducted in 3 OBBT clinics in North Carolina. Each clinic had at least 2 buprenorphine-waivered physicians who partnered with a single, nearby community pharmacy employing at least 2 licensed pharmacists. Six physicians from 3 clinics, six pharmacists from 3 community pharmacies, and 71 patients participated.
After screening, eligible patients’ buprenorphine care was transferred from their OBBT physician to a community pharmacist for 6 months. Researchers looked at a range of outcomes, including recruitment, treatment retention and adherence, and opioid use, as well as whether the intervention was correctly implemented and participants were satisfied with the care they received.
A high proportion (93.4%) of eligible patients enrolled in the study. There were also high rates of treatment retention (88.7%) and adherence (95.3%). At month 6, 4.9% of urine drug screens tested positive for opioids (down from 8.5% at baseline). Intervention fidelity was excellent, and there were no opioid-related safety events.
Importantly, over 90% of patients said they were “very satisfied with their experience and the quality of treatment offered,” that “treatment transfer from physician’s office to the pharmacy was not difficult at all,” and that “holding buprenorphine visits at the same place the medication is dispensed was very or extremely useful/convenient.” Physicians and pharmacists reported similar ratings of satisfaction.
Conclusions: Bringing buprenorphine treatment to community pharmacies via a collaborative care model between doctors and pharmacists appears to be feasible in the U.S. and have high acceptability for both patients and providers. Future randomized trials are needed to test the efficacy, effectiveness, and implementation of this model for management and treatment of patients with OUD as part of real-world practice.