A Buprenorphine Pocket Card and Tool Kit Tailored to Palliative Care Clinicians: An Education and Implementation Cohort Study

Abstract

Background:

Buprenorphine is an underused opioid therapy for patients with serious illnesses. Using the principles of implementation science, we developed, distributed, and tested a Buprenorphine Pocket Card and Tool Kit (Bupe PC&TK).

Objectives:

We conducted an online survey to assess buprenorphine learning needs, confidence, and knowledge. We then tested the impact of the Bupe PC&TK using a pre-/poststudy design.

Setting/Subjects:

Palliative care clinicians located throughout the United States.

Measurement:

Investigator-initiated online mixed-methods survey at baseline and six weeks following distribution of a Bupe PC&TK.

Results:

Among the 179 baseline participants, most were physicians (n = 114) with more than six years of opioid prescribing experience (n = 99). The majority rated buprenorphine prescribing as an important skill, but only 15 participants reported they were very confident in prescribing or managing buprenorphine, and inaccurate knowledge was common. Participants reported that information on buprenorphine dosing and initiation would be most helpful in a Bupe PC&TK. Fifty-six participants completed the follow-up survey; the majority were physicians (n = 33). Most participants used the Bupe PC&TK (n = 47) and rated it as helpful or very helpful (n = 45). A paired samples t-test revealed that participants were significantly more confident after receiving the Bupe PC&TK (p < 0.001). Knowledge accuracy improved for buccal buprenorphine (p = 0.003) and formulations for opioid use disorder (p < 0.001).

Conclusion:

Palliative care clinicians ascribe a large degree of importance to prescribing buprenorphine but have knowledge and confidence gaps. The Bupe PC&TK can be readily implemented to increase clinician confidence and knowledge in prescribing buprenorphine to patients with serious illness.