Objective Buprenorphine is effective for chronic pain and safer than full-agonist opioids; however, limited education and support regarding buprenorphine can result in under-prescribing in primary care and reduced access in specialty pain clinics. The purpose of this quality improvement initiative was to optimize and evaluate procedures for transferring patients stable on buprenorphine for chronic pain from a specialty pain clinic back to primary care. Setting Eight primary care clinics within a Veterans Health Administration Healthcare System. Methods A standard operating procedure for facilitated transfer of prescribing was developed following a needs assessment, and was introduced during an educational session with primary care providers, and providers completed a survey assessing attitudes about buprenorphine prescribing. Success of the initiative was measured through number of patients transferred back to primary care over the course of 18 months. Results Survey results indicated primary care providers with previous experience prescribing buprenorphine were more likely to view buprenorphine prescribing for pain as within the scope of their practice and endorse feeling comfortable managing a buprenorphine regimen. Providers identified systemic and educational barriers to prescribing, as well as ongoing support from specialty pain care and primary care as facilitators. Metrics suggested the standard operating procedure was generally successful in transferring and retaining eligible patients in primary care. Conclusion This quality improvement initiative suggests a facilitated transfer procedure can be useful in increasing buprenorphine prescribing for pain in primary care. Future efforts to increase primary care provider comfort and address systemic barriers to buprenorphine prescribing are needed.

中文翻译：

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增加慢性疼痛患者获得丁丙诺啡的机会：一项质量改进计划

目的 丁丙诺啡治疗慢性疼痛有效，且比全激动剂阿片类药物更安全；然而，有关丁丙诺啡的教育和支持有限可能导致初级保健处方不足，并减少专业疼痛诊所的就诊机会。这项质量改进计划的目的是优化和评估将使用丁丙诺啡治疗慢性疼痛的患者从专业疼痛诊所转回初级保健的程序。在退伍军人健康管理局医疗保健系统内设置八个初级保健诊所。方法 在需求评估后制定了促进处方转移的标准操作程序，并在与初级保健提供者的教育课程中介绍，提供者完成了一项评估对丁丙诺啡处方态度的调查。该举措的成功通过 18 个月内转回初级保健的患者数量来衡量。结果 调查结果表明，具有开具丁丙诺啡处方经验的初级保健提供者更有可能将丁丙诺啡处方治疗疼痛视为在其执业范围内，并认可管理丁丙诺啡治疗方案感到舒适。提供者确定了处方的系统性和教育性障碍，以及作为促进者的专业疼痛护理和初级护理的持续支持。指标表明，标准操作程序总体上成功地将符合条件的患者转移并保留在初级保健中。结论 这一质量改进举措表明，便利的转移程序可有助于增加初级保健中用于治疗疼痛的丁丙诺啡处方。未来需要努力提高初级保健提供者的舒适度并解决丁丙诺啡处方的系统性障碍。