“Evaluating Provider-Level Interventions to Increase Willingness to Prescribe Buprenorphine as Medication for Opioid Use Disorder”

Dissertation Committee

Mark S. Roberts, MD, MPP Distinguished Professor, Department of Health Policy and Management (Committee Chair)

Lucy A. Savitz, PhD, MBA, Professor, Department of Health Policy and Management

Praveen Kumar, PhD, Assistant Professor, Department of Health Policy and Management

Jourdain Lamperski, Assistant Professor, Department of Industrial Engineering, Pitt Swanson School of Engineering

Abstract

The goal of this dissertation is to understand and compare the impact of interventions aimed at increasing provider willingness to prescribe buprenorphine as medication for opioid use disorder (MOUD).

This study first examined the impact of an intervention at the federal policy level, the elimination of the X waiver, which was implemented to improve buprenorphine prescription rates. After finding no evidence that this policy increased buprenorphine use in Pennsylvania, the study conducted a rapid scoping review and interviews with subject matter experts to identify other interventions that experts have found to be successful. Based on the literature review and expert interviews, this study used a modified Delphi study to generate consensus on which of these interventions are perceived to be the most effective.

This study built and calibrated an agent-based simulation model of provider willingness to prescribe buprenorphine as MOUD, informed by the rankings from the modified Delphi study. This dissertation compares the impact of different interventions on provider willingness to prescribe buprenorphine and on opioid overdose death rates in Pennsylvania.

The results of this work will help guide decisions on which interventions to implement, offering a more sophisticated tool for stakeholders, such as policymakers and health system leaders, to select interventions for pilot programs and allocate implementation resources.