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APHA Scientific Session and Event Listing

Sarita Bhalotra, MD, PhD, Timothy C. Martin, PhD, Mathew Neuman, MS, Stanley S. Wallack, PhD, and Jon Chilingerian, PhD. Schneider Institute for Health Policy, Brandeis University, 415 South Street, Waltham, MA 02454, 781 736 4997, tmartin@brandeis.edu

Despite legislation allowing office-based physicians to provide treatment with buprenorphine for the treatment of opiate-addicted persons, organizational change resulting in its uptake has been slow. We surveyed organizations providing substance abuse treatment (n=125; 51% response rate) in order to determine organizational attributes associated with adopting office-based prescribing of buprenorphine; quantitative analyses revealed adopters were distinguished from non-adopters by attributes collapsed into seven categories labeled “atmosphere”, “communication”, degree of system receptiveness to new technology”, “patient attributes”, “scope of service”, “system attributes, “treatment orientation”. We found that a treatment orientation supporting the use of pharmacotherapeutic agents, having a greater scope of service and having a greater percentage of white patients were highly predictive of buprenorphine adoption. In order to provide context to these findings, we conducted case studies of six organizations from our survey in one of the four metropolitan areas using a non-probabilistic sampling technique. Our key domains of enquiry included a short history of the organization, its regulatory and market environment, structure, scope and scale of services, clinical and demographic case-mix of clientele, a narration of how the decision to adopt buprenorphine or not came about, and what the prediction was for the utilization of buprenorphine in the future. After transcription and coding organizational contextual themes inductively, we consulted literature to label them organizational culture, organizational climate, organizational structure, and external environment. The paper describes the relationship among these constructs and develops a model that hypothesizes how organizational context links to adoption of buprenorphine by influencing work attitudes and behavior.

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