The Implementation Climate for Integrating Buprenorphine Prescribing into Rural Primary Care

Background: Rural communities have been significantly affected by opioid use disorder (OUD) and related harms but have less access to evidence-based medications for opioid use disorder (MOUD), such as buprenorphine. Given the shortage of specialists in these areas, rural primary care is an important setting to expand buprenorphine access, but implementation is limited.

Objective: To explore implementation climate factors that support or hinder buprenorphine implementation in rural primary care.

Design: A qualitative study design using in-depth interviews.

Participants: Primary care physicians, nurse practitioners (NPs), and physician associates (PAs) practicing in rural Ohio counties.

Approach: Between December 2022 and March 2023, we interviewed participants about their perspectives on buprenorphine prescribing, including using rural primary care as an implementation setting for buprenorphine. Using a deductive, framework-based approach, codes were grouped based on the Consolidated Framework for Implementation Research (CFIR) inner setting factors that contribute to a positive implementation climate for an intervention.

Key results: Three implementation climate constructs emerged as decision points for whether to implement buprenorphine in rural primary care: (1) relative priority: the extent to which OUD treatment should be prioritized over other chronic diseases; (2) compatibility: whether buprenorphine prescribing protocols are compatible with the rural primary care setting; (3) tension for change: the extent to which current buprenorphine access shortages in rural communities can be tolerated. Participants expressed mixed perspectives on whether the implementation climate in rural primary care currently supports buprenorphine prescribing.

Conclusion: Implementation strategies targeted toward the implementation climate are critical to support buprenorphine prescribing in rural primary care.