Pain Clinical Pharmacist Practitioner/PMOP Coordinator Carl Vinson VA Medical Center Macon, Georgia
Abstract Title: Enhancing Buprenorphine Access in Primary Care at Veteran Affairs Facilities: The Role of In-Person Pharmacist-led Workshops
Background: Despite recent pain management guidelines released in 2022 from the VA/DoD and CDC recommending the use of buprenorphine over full agonist opioids when opioid therapy may be appropriate and the 2023 Consolidation Appropriations Act removing the X-wavier, buprenorphine products for pain management remained an underutilized medication at the Columbia, South Carolina and Dublin, Georgia Veterans Affairs Medical Centers (VAMC). Large group virtual education efforts during facility meetings also fell short for expansion efforts and boosting provider confidence with prescribing buprenorphine for Veterans. Although other options were considered to improve confidence and incentivize buprenorphine prescribing such as financial incentives, reduction in Veteran panel sizes, and protected time for training opportunities, education was still a preferred method by leadership to expand buprenorphine prescribing due to resources needed to accomplish educational opportunities versus other interventions.
The Pain Management, Opioid Safety and PDMP (PMOP) coordinators, Academic Detailing Pharmacists and Pain Management Clinical Pharmacy Practitioners (CPP) at the Columbia and Dublin VAMC teamed up to deliver in-person, small group (averaging 5-8 prescribers), interactive buprenorphine workshops. Due to unsuccessful attempts with prior large group buprenorphine education efforts, these workshops focused on interactive cases and applications.
Purpose/Objectives: Due to failed buprenorphine expansion efforts with large virtual buprenorphine educational offerings, the Columbia and Dublin VAMC PMOP, Academic Detailing and Pain CPP team aimed to see improvement in buprenorphine efforts in terms of prescriber comfort with selecting a buprenorphine product, transition from a full agonist opioid to a buprenorphine product and providing buprenorphine medication counseling to Veterans. Our team’s primary objective is to expand buprenorphine prescribing when an appropriate long-term opioid analgesic is warranted for chronic pain management.
Methods: The VAMC in Columbia, South Carolina and Dublin, Georgia developed a face-to-face educational training course on buprenorphine in chronic pain management for primary care providers. Before completing the workshop training, providers were given a pre-survey to assess confidence in selecting an appropriate buprenorphine product, performing initiations, and conducting patient counseling. The training course comprised of an interactive didactic lecture and case vignettes to apply key prescribing principles of buprenorphine for chronic pain. Following the education session, the providers were asked to complete a post-survey which consisted of the same questions as the pre-survey to show if their confidence levels in buprenorphine prescribing had improved. Primary care provider prescribing patterns will also be reviewed through the collection of outpatient prescription data.
Results: Between January 2023-April 2024 a total of 20 in-person workshops were completed at the primary facilities and community-based outpatient clinics (CBOCs) at the Columbia and Dublin VAMC. Ninety-four primary care providers completed the workshops (Columbia VA n=58; Dublin VA n=36) and completed surveys. The pre-survey response rate was 61% (57 out of 94) and post-survey response rate was 100% (94 out of 94). Prior to the workshop, 58% of providers were not confident in selecting a buprenorphine product based on current opioid dosage or patient’s preference, 56% were not confident in creating a plan to transition from full opioid agonist to buprenorphine, and 44% were not confident in counseling patients on how to use buprenorphine products. After completion of the workshops, provider confidence improved in all three categories, above 70%. Data on provider prescribing patterns is currently being collected.
Conclusions/Implications for future research and/or clinical care: Expansion of buprenorphine can offer Veterans a safer and effective option for chronic pain management. We have found that in-person, small interactive group education, can be more advantageous compared to large virtual training platforms. Trainings were well received by providers who attended the workshops and confidence was enhanced in understanding buprenorphine’s place in therapy. The next part of this project will analyze prescription data to assess for changes in buprenorphine prescribing.
References:
1 . Department of Veterans Affairs and Department of Defense. “VA/DoD Clinical Practice Guidelines: The Use of Opioids in the Management of Chronic Pain - Provider Summary.” VA/DoD Clinical Practice Guideline for the Use of Opioids in the Management of Chronic Pain - Provider Summary, 2022, www.healthquality.va.gov/guidelines/Pain/cot/VADoDOpioidsCPGProviderSummary.pdf.
2. Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain — United States, 2022. MMWR Recomm Rep 2022;71(No. RR-3):1–95. DOI: http://dx.doi.org/10.15585/mmwr.rr7103a1.
