Navigating Changes in Clinical Practice: Lessons from Supporting Buprenorphine Prescribing

Key Message: Implementing clinical practice changes, such as onboarding an entire practice to prescribing buprenorphine for palliative care patients, can be challenging. However, change is possible and can be welcomed when there is support from leadership, input from all interdisciplinary team members, interprofessional collaboration, written clinical protocols, dedicated education, and real-time support.

Abstract: Relevance & Evidence-Base:
Changes in clinical practice are often implemented years after supporting research and guidelines are published.(1) A recent and evolving clinical practice change within palliative care (PC) is prescribing buprenorphine for pain management. The barriers to implementing buprenorphine prescribing are similar to the challenges of implementing other clinical changes in PC including provider resistance to change, inadequate knowledge, lack of training, and complexity of workflows.(2) Recent study has found that most PC specialists report discomfort initiating or managing buprenorphine, and despite growing resources to support PC clinicians in buprenorphine prescribing,(3) most PC specialists have not prescribed in actual practice.(4) To successfully implement clinical practice changes like buprenorphine prescribing, PC teams should leverage known facilitators of practice change including leadership support, inclusion of the entire interdisciplinary team, and availability of easy-to-use references and educational materials.(2)

Contributions to Expertise:
In this session, an interdisciplinary team of clinicians representing four organizations will describe how interventions to support buprenorphine prescribing utilized best practices for implementing sustainable change in clinical care. Several interventions were shared across organizations including cultivating leadership stakeholders, identifying clinical champions, developing written “start-up” guides, providing dedicated education, supplying on-demand help for frontline clinicians, creating patient-facing education, and collaborating with pharmacies. Implementation features unique to specific organizations include pursuing needs assessments prior to implementation, contracting with a dual-trained PC and addiction medicine expert to assist with education and on-demand help, and rolling out buprenorphine prescribing in a tiered manner to help clinicians gain confidence before taking on complex cases. Challenges shared across organizations included facilitating culture change across disciplines, creating shared motivation to encourage participation, and acknowledging the need for adequate time and support.

Impact on Field of HPM:
Presenters will discuss outcomes from their interventions including changes in prescribing and team members’ evaluations of their programs.

References: 1. Morris ZS, Wooding S, Grant J. The answer is 17 years, what is the question: understanding time lags in translational research. Journal of the Royal Society of Medicine. 2011;104(12):510-520.
2. Ernst A, Schade F, Stiel S, van Baal K, Herbst FA. The implementation of guidelines in palliative care – a scoping review. BMC Palliative Care. 2025;24(1):102.
3. Neale KJ, Weimer MB, Davis MP, et al. Top Ten Tips Palliative Care Clinicians Should Know About Buprenorphine. J Palliat Med. 2023;26(1):120-130.
4. Ho JJ, Jones KF, Sager Z, et al. Barriers to Buprenorphine Prescribing for Opioid Use Disorder in Hospice and Palliative Care. Journal of Pain and Symptom Management. 2022;64(2):119-127.