Table 3.
Self-assessed factors affecting likelihood of buprenorphine prescribing among nonwaivered primary care clinicians by confidence and abilities in OUD diagnosis and treatment.
| Buprenorphine prescription if requested by patient with OUD | Buprenorphine prescription if OUD-CDS tool available | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Factor | Overall (%) (n = 305) | Would (%) (n = 78) | Would not/unsure (%) (n = 227) | P | aOR (95% CI) | Likely (%) (n = 191) | Not likely (%) (n = 114) | P | aOR (95% CI) |
| PCC confidence in screening for OUD | |||||||||
| Not at all confident | 11 | 5 | 13 | .37 | 0.78 (0.45-1.34) | 11 | 11 | .49 | 0.85 (0.52-1.37) |
| Somewhat confident | 53 | 55 | 52 | 55 | 49 | ||||
| Moderately confident | 31 | 35 | 30 | 31 | 32 | ||||
| Very confident | 6 | 5 | 6 | 4 | 8 | ||||
| PCC confidence in diagnosing OUD | |||||||||
| Not at all confident | 17 | 9 | 20 | .02 | 1.78 (1.08-2.98) | 17 | 17 | .82 | 0.95 (0.61-1.48) |
| Somewhat confident | 46 | 45 | 46 | 45 | 47 | ||||
| Moderately confident | 31 | 37 | 29 | 34 | 27 | ||||
| Very confident | 6 | 9 | 5 | 4 | 10 | ||||
| PCC confidence for when refer to specialist | |||||||||
| Not at all confident | 7 | 10 | 5 | .05 | 0.65 (0.41-1.00) | 8 | 4 | .79 | 0.95 (0.65-1.39) |
| Somewhat confident | 30 | 21 | 34 | 28 | 33 | ||||
| Moderately confident | 49 | 60 | 45 | 51 | 45 | ||||
| Very confident | 15 | 9 | 17 | 13 | 18 | ||||
| PCC ability to provide motivational counseling | |||||||||
| Low ability | 3 | 1 | 3 | .28 | 0.81 (0.53-1.20) | 1 | 6 | .28 | 1.20 (0.86-1.68) |
| Some ability | 28 | 30 | 27 | 29 | 25 | ||||
| Adequate ability | 39 | 33 | 41 | 37 | 42 | ||||
| Moderately high ability | 28 | 33 | 26 | 31 | 23 | ||||
| High ability | 3 | 3 | 3 | 2 | 4 | ||||
| PCC ability for using overdose-prevention treatment strategies | |||||||||
| Low ability | 7 | 4 | 8 | .01 | 1.71 (1.10-2.68) | 5 | 11 | .12 | 1.34 (0.92-1.96) |
| Some ability | 36 | 30 | 39 | 37 | 35 | ||||
| Adequate ability | 43 | 45 | 42 | 42 | 44 | ||||
| Moderately high ability | 13 | 19 | 10 | 15 | 9 | ||||
| High ability | 1 | 3 | 1 | 1 | 2 | ||||
| PCC ability to refer to specialist | |||||||||
| Low ability | 4 | 4 | 4 | .61 | 1.10 (0.76-1.59) | 3 | 4 | .25 | 0.83 (0.60-1.14) |
| Some ability | 27 | 24 | 27 | 28 | 25 | ||||
| Adequate ability | 36 | 32 | 37 | 37 | 35 | ||||
| Moderately high ability | 27 | 31 | 25 | 26 | 27 | ||||
| High ability | 7 | 9 | 7 | 6 | 9 | ||||
n = 305. Generalized linear models included all PCC confidence and ability variables as covariates. Column percentages in each clinician response section may not sum to 100 due to rounding. Source: Author's analysis of data collected in the pragmatic trial for reference 22.
Abbreviations: aOR, adjusted odds ratio; CDS, clinical decision support tool; CI, confidence interval; OUD, opioid use disorder; PCC, primary care clinician.