Financial incentives boost doctor training in opioid treatment medication
The results aim to act as a "playbook" of sorts for leaders and administrators who are looking for better ways to keep their group properly trained.
A financial incentive can dramatically increase the number of emergency department physicians trained to prescribe a potentially life-saving medication that prevents patients from fatal opioid overdose, a new study shows.
Led by researchers in Emergency Medicine at the Perelman School of Medicine at the University of Pennsylvania (Penn Medicine), the study showed that, at its start, just 6% of eligible physicians across three different emergency departments had the proper training to prescribe the medication buprenorphine. But by offering reimbursement for training and a $750 incentive, 89% of physicians in those EDs were fully trained six weeks later.
The results aim to act as a "playbook" of sorts for leaders and administrators who are looking for better ways to keep their group properly trained.
WHAT'S THE IMPACT?
Buprenorphine is an "agonist" drug, meaning it soothes the brain's cravings for opioids and has a ceiling effect on their toxic effects, preventing fatal overdose. By prescribing buprenorphine, ED doctors provide a "bridge" from acute care to longer-term care that can include everything from counseling to continuing medications that will better support recovery.
A post-intervention survey for the study and actual buprenorphine prescribing data showed that in addition to having such a high rate of those trained, which is called getting an "X waiver," the physicians used their certification fairly quickly. Roughly 65% of respondents reported that they either administered or prescribed buprenorphine within the five months of their training.
A lack of X waivered providers is linked to the underutilization of buprenorphine, in addition to the perception that one is trading one drug for another. But buprenorphine has been shown to decrease opioid overdose deaths and decrease transmission of infections such as HIV or hepatitis C.
To get their X waiver, physicians must devote an entire day to training, which can be difficult to schedule amidst their many responsibilities. It also wasn't very common until recently for the emergency department to be the venue for buprenorphine prescription. The incentive and reimbursement ($750 and $200, respectively, in this case) as well as changing attitudes toward the medication seem to make the decision to get an X waiver much easier for the 67 physicians it was offered to.
Of the three emergency department locations, two actually achieved a 100% X waiver rate. This included one site that went from zero X waivers to all of its ED doctors having one, and another site that went from just three of its physicians having X waivers to 26.
The variation in X waiver rates by site was not directly studied, but the reason why one site did especially well may be due to its readily available access to certified recovery specialists.
A related project at Penn Medicine called CORE, which utilized both certified recovery specialists and the promotion of X waiver training, resulted in seven out of 10 patients being in active recovery a month after visiting the emergency department. Typical national numbers without buprenorphine prescriptions hover around one in 10.
While $750 could be seen as steep for some health systems, the post-intervention survey revealed that two-thirds of respondents would have felt moved to get their X waiver even if the incentive was $500 or less.
Moving forward, to explore more ways to introduce buprenorphine use, the team hopes to explore the effectiveness of "mini X waivers," a shorter training course.
THE LARGER TREND
About 1% of U.S. opioid providers account for nearly half of all opioid doses and more than a quarter of all opioid prescriptions, a BMJ study found in January.
The findings suggest that efforts to promote careful prescribing should focus on these top providers and their patients, rather than imposing rigid thresholds on all providers, researchers said.
Opioid prescribing remains far higher in the U.S. than in other countries, despite efforts to reduce inappropriate prescribing. Previous studies have noted that opioid prescribing in the U.S. is skewed, but were limited to narrow samples of providers or patients over shorter periods.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
