203405 Integration of counseling among physicians providing office-based buprenorphine treatment

Tuesday, November 10, 2009: 4:48 PM

James E. Egan, MPH , Center for Urban Epidemiologic Studies (CUES), The New York Academy of Medicine, New York, NY
Tracy Pugh , Division of Health Policy, The New York Academy of Medicine, New York, NY
Julie Netherland, MSW , Division of Health Policy, The New York Academy of Medicine, New York, NY
David Fiellin, MD , Yale University School of Medicine, New Haven, CT
Ruth Finkelstein, ScD , Division of Health Policy, The New York Academy of Medicine, New York, NY
Linda Weiss, PhD , Center for Evaluation, The New York Academy of Medicine, New York, NY
BACKGROUND: Drug counseling can improve outcomes in office-based buprenorphine treatment. However, medical and behavioral health care systems often operate independently. We investigated how physicians meet the counseling needs of buprenorphine patients. METHODS: We recruited buprenorphine prescribers from states with the highest opioid use prevalence. Using a web-based survey (N=195) and qualitative interviews (N=33), we investigated the provision of counseling, services types/locations, and perceived barriers. RESULTS: Almost all physicians felt that counseling was essential to opioid dependence treatment; the majority required counseling for buprenorphine patients (60% for some, 33% for all). Counseling was provided through differing arrangements including onsite by physician (60%), onsite by staff (45%), offsite through contracted individuals/organizations (17%), referrals (60%), online (4%), and resource lists distribution (40%). Most reported having support-staff to assist with buprenorphine treatment, including NPs (42%), substance-abuse counselors (34%), mental-health providers (31%), LSWs (24%), and PAs/NPs (14%). The most significant barriers to counseling were affordability (mean=6.0/10-pt scale); public (6.1) and private (5.6) insurance restrictions; and lack of patient interest (5.9). Other barriers mentioned were time constraints, concerns about treatment efficacy for other drugs, and stigma. Despite these barriers, physicians overwhelmingly supported the integration of buprenorphine, medical care, and counseling. DISCUSSION: Findings suggest that most physicians value counseling and make efforts to connect buprenorphine patients to behavioral health services. It appears as if a range of strategies are used, some of which are likely more effective than others. Additional research is needed to assess the extent to which patients' access and benefit from these disparate approaches

Learning Objectives:
1. Articulate provider perceptions on provision of counseling in buprenorphine treatment. 2. Describe range of strategies used by physicians to provide counseling to patients being treated with buprenorphine. 3. Describe barriers to providing counseling to patients being treated with buprenorphine.

Keywords: Substance Abuse Treatment, Drug Abuse Treatment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: The presenter has completed his MPH and has been working in the field of substance abuse and treatment research for the past 10 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.