"I didn't feel like a number": The impact of nurse care managers on the provision of buprenorphine treatment in primary care settings.

BACKGROUND AND OBJECTIVE: To promote increased access to and retention in buprenorphine treatment for opioid use disorder, the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) implemented the Buprenorphine Nurse Care Manager Initiative (BNCMI) in 2016, in which nurse care managers (NCMs) coordinate buprenorphine treatment in safety-net primary care clinics. To explore how patients experienced the care they received from NCMs, DOHMH staff conducted in-person, in-depth interviews with patients who had, or were currently receiving, buprenorphine treatment at BNCMI clinics. Participants were patients who were receiving, or had received, buprenorphine treatment through BNCMI at one of the participating safety-net primary care practices. METHODS: The study team used a thematic analytic and framework analysis approach to capture concepts related to patient experiences of care received from NCMs, and to explore differences between those who were in treatment for at least six consecutive months and those who left treatment within the first six months. RESULTS: Themes common to both groups were that NCMs showed care and concern for patients' overall well-being in a nonjudgmental manner. In addition, NCMs provided critical clinical and logistical support. Among out-of-treatment participants, interactions with the NCM were rarely the catalyst for disengaging with treatment. Moreover, in-treatment participants perceived the NCM as part of a larger clinical team that collectively offered support, and the care provided by NCMs was often a motivating factor for them to remain engaged in treatment. CONCLUSION: Findings suggest that by providing emotional, clinical, and logistical support, as well as intensive engagement (e.g., frequent phone calls), the care that NCMs provide could encourage retention of patients in buprenorphine treatment.

Increasing Access to Buprenorphine in Safety-Net Primary Care Clinics: The New York City Buprenorphine Nurse Care Manager Initiative.

The Buprenorphine Nurse Care Manager Initiative (BNCMI) sought to increase access to opioid use disorder treatment in underserved New York City populations by expanding buprenorphine treatment capacity in safety-net primary care clinics.During 2016 to 2020, BNCMI added 116 new buprenorphine providers across 27 BNCMI clinics, and 1212 patients were enrolled; most patients identified as Latinx or Hispanic and were Medicaid beneficiaries.BNCMI increased access to buprenorphine, reached underserved populations, and is part of the New York City Health Department's multipronged approach to reducing opioid overdose deaths.