A Collaborative Care Model for Primary Care Delivery of Buprenorphine to Opioid-addicted Patients
Buprenorphine is an effective treatment for opioid addiction, but most primary care settings have little experience in delivering this type of care. In this study, researchers describe their 5-year experience with a collaborative care program to deliver buprenorphine treatment in a primary care setting. The program used a full-time nurse program director, a program coordinator, 9 part-time physicians, and nurse care managers with expanded clinical responsibilities (e.g., assessment, education, referral, and monitoring). Outcomes were measured 12 months after program entry. Of the 408 patients who entered the program between 2003 and 2008, 383 (94%) were eligible for analysis.
- Nurse care managers saw an average of 75 patients per week.
- At 12 months, 51% of patients remained in treatment or were successfully tapered, 42% were lost to follow-up or discharged, and 6% were transferred to methadone maintenance.
- Patients who remained in treatment or were successfully tapered were more likely female, white, older, employed, and using buprenorphine illegally upon program entry.
- Urine testing was negative for opioids and cocaine in 91% of patients who remained in treatment at 12 months.
Comments:This study shows collaborative care with nurse care managers can be an effective means of delivering buprenorphine treatment in a large urban academic primary care practice. It is not clear if this model would have similar effectiveness and feasibility in a smaller practice or in areas with fewer eligible opioid-addicted patients. Kevin L. Kraemer, MD, MSc
Alford DP, LaBelle CT, Kretsch N, et al. Collaborative care of opioid-addicted patients in primary care using buprenorphine: five-year experience. Arch Intern Med. 2011;171(5):