Buprenorphine Practice Advisor Framework

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Contents

Key Details

  • Title: Online Buprenorphine Practice Advisor for Physicians
  • Funding: NIDA Contract HHSN271200655304C RFP
  • Funding Project Officer: Richard Denisco, MD, MPH
  • Contract Officer: Craig D. Sager
  • Principal Investigator: T Bradley Tanner
  • Project Leaders: Meghan Coulehan
  • Start: 8/1/06 End: 1/30/09
  • Website

Need

The majority of buprenorphine providers receive standard training such as that provided online by BuprenorphineCME.com. Unfortunately:

  1. They are ill equiped to translate the education into a successful buprenorphine practice that will identify proper patients, engage them in treatment, and ensure a long term success.
  2. Setting up such a practice is especially hard for primary care providers.

In addition, some PCPs do not want to prescribe buprenorphine. They need to know where to find addiction resources, when to refer addiction patients, and how to co-manage these patients with the specialists.

Vision

Primary care and specialist professionals who intend to treat using burprenorphine or who do not intend to treat patients with opioid addiction can enhance their knowledge, gain access to useful resource information, and share experience via a state-of-the-art online environment.

Mission

To provide a web-based solution for primary care providers who want to provide better care for patients suffering from opioid addiction.

Target Audience

  1. Physicians who do not prescribe buprenorphine including patients [Non-prescribers]
    1. in treatment with another doctor who prescribes buprenorphine
    2. that could benefit from bup treatment (i.e., patients w/opioid addiction)
  2. Physicians who treat patients WITH opioid addiction with buprenorphine [Prescribers]
  3. Allied health professionals (PAs, NPs, counselors, social workers, ...)

Overall Constraints

  1. 2+ months - must be done by the end of January 2009
  2. Buprenorphine specialists must be involved and their time is limited and hard to come by.
  3. Need to include non-physician providers such as Physician Assistants and NPs
  4. Collaboration features of web-based software are always changing.
  5. Solution must fit within the vision of the CTI Learning Management System.
  6. It must respond to NIDA's RFP
  7. There is minimal evidence available, so evidence-based medicine (EBM) is not enough to drive the content. Some case studies, epidemiological data and strong clinical consensus will need to be included.
  8. Some care is dictated by guidelines which vary from state to state and which may not be based on science or in agreement with other guidelines
  9. Multiple guidelines exist from different organizations with varying overlap.

User Constraints

  1. Health professional learners do not usually browse the web looking for web sites that will help them alter their practice.
  2. Knowledge Base and experience can vary considerably between users.
  3. Learner audience includes non-physician providers such as Physician Assistants and Nurse Practitioners.
  4. Learning Time: Retaining health professionals once they have been engaged is difficult since they are busy and have multiple demands on their time.
  5. Resistance: Health professionals have established matrices of knowledge, and an attempt to alter a matrix will cause resistance.

Strengths

  1. Understanding of the issues is low as is compliance with standards. Opioid addiction is an area of medicine for which health providers are not well-prepared.
  2. Adding buprenorphine to a practice requires some changes, and thus causes health professionals to seek out help.
  3. The downside of not knowing or practicing incorrectly are multiple; thus there are many incentives, including legal ramifications as well as regulatory requirements.
  4. Strong consensus clinical opinion has been defined by organized medicine that can drive the content where EBM is not available.
  5. Can use a novel content management system (CMS) environment that fits the task

Goal

This SBIR Phase II project will complete development of BupPractice.com and two Web-based Buprenorphine Practice Advisors for primary care physicians. The website will include interactive practice guides for physicians who plan to prescribe buprenorphine directly or refer such patients to other physicians. In Phase II we will develop the interface and programming features of BupPractice.com and the Buprenorphine Practice Advisor content for both prescribing and non-prescribing physicians. The product will include:

  1. a decision-support tool to provide advice to physicians on buprenorphine treatment practices,
  2. tools to educate buprenorphine prescribing physicians about data management, and
  3. a referral system and staff training guide.

Evaluation of the product will occur through formative analysis, usability evaluation, and final prototype analysis.

Objectives

  1. Build a catalog of quality of resources and a e-commerce high quality search engine that gives users a quick and simple way to find the resources they need using any Internet-capable tool, including cell phones with small screens.
  2. Establish tools so learners can communicate with other learners and provide feedback to others who seek to enhance their practice.

Implementation

  1. Develop the Buprenorphine Practice Advisor: Specs
  2. Develop the Buprenorphine Practice Advisor content
  3. Develop the Buprenorphine Practice Advisor interface
  4. Develop all software/programming for the Buprenorphine Practice Advisor
  5. Conduct a series of evaluations: initial formative evaluation (n=18), usability evaluations (n=27), and a final prototype evaluation (n=27)
  6. Finalize the Buprenorphine Practice Advisor and submit the final report

Alternative Solutions

xpert opinion, needs analysis and user feedback may identify components which can be trimmed down. We may find existing resources which complete similar functionality thus eliminating the need for that component.

Evaluation Design

Success is defined as

  1. A mockup of the proposed website and interactive features will need to exist.
  2. Final Site Evaluation
  3. The successful completion of all objectives and
  4. Production of a Phase II report,
  5. Findings and Questions:

New Ideas

Communication

Conferences: ASAM 2008 Talk | AMIA 2008 Poster


Clinical Tools Frameworks

Consumers

Intermediaries

Health Researchers

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