Changing Minds on MOUD: Impact of Messages to Motivate Expanded Access to Buprenorphine in Primary Care Settings

Changing Minds on MOUD: Impact of Messages to Motivate Expanded Access to Buprenorphine in Primary Care Settings | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Changing Minds on MOUD: Impact of Messages to Motivate Expanded Access to Buprenorphine in Primary Care Settings Karen L. Roper, Melissa Zook, Kory Heier, Kristen McQuerry, Sarah Marks, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8769235/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background Practitioners in primary care (PCPs) face significant barriers and lack of motivation for expansion of medications for opioid use disorder (MOUD) in their service. Educational videos specifically targeted at the primary care setting and utilizing key determinants of behavior change were assessed for impact on PCP viewer’s attitudes and intention to explore MOUD. Methods A rural-setting PCP scripted the videos, describing her extensive experience treating patients using buprenorphine. Content addressed key barriers and negative perceptions of MOUD in the primary video; supplementary videos centered on clinic and societal benefits (external motivation) or personal and professional rewards (internal motivation). Cross-sectional surveys accompanied the videos on a CE platform. Participation was open to family or internal medicine (MD, DO, APRN, PA) professionals in primary care family or internal medicine in Kentucky. Surveys measured demographics, career satisfaction, and change (Post / Retrospective-Pre format) in importance of 19 barriers and 4 areas of confidence for MOUD practice. Intention to explore MOUD was the primary outcome. Educational content was rated for gain in clinical knowledge/skills and information usefulness. Feedback on specific aspects of video content and general impact was probed in open-ended questions. Results Among the 37 professional learners, concern for negative attitudes/perceptions across the practice (staff, other practitioners, patients), limited appointment time, and reimbursement of clinical visits were all reduced in importance in Post-video assessment (Fisher’s non-parametric tests; p’s ≤ .05). A sense that MOUD fits with ones’ calling in being a doctor was positively impacted. Likelihood to screen for OUD was increased, and participants who scored higher on career satisfaction were more likely to consider board certification as an Addiction Medicine Specialist. Conclusions Education that is conceived for and specifically responsive to the primary care environment and especially the challenges of rural practice can help overcome perceived barriers and promote consideration of MOUD service in primary care practice. Addiction Medicine buprenorphine Primary care Rural Health Cross-Sectional Studies Opioid-Related Disorders Education Continuing Figures Figure 1 BACKGROUND Each year, approximately 90% of individuals with substance use disorders (SUDs) in the U.S. do not engage in any form of treatment ( 1 ). Within the 3.7% of the population with opioid use disorders (OUD), only 25.1% receive evidence-based treatment medications ( 2 ). Federal support for expanded access to medications for opioid use disorder (MOUD) including buprenorphine, methadone, or extended-release naltrexone has been ongoing for years ( 3 ), including the elimination in 2023 of a buprenorphine prescribing training requirement. Nevertheless, the OUD population remains underserved, due in part to provider shortages for SUD treatment specialists and limited access to treatment centers, especially in rural areas ( 4 – 7 ). Creating a workforce equipped to address this need could be met through increased coverage for MOUD within primary care settings, where untreated patients have shown greater willingness to enter ( 8 ) and to pay ( 9 ) for treatment, and where MOUD integration can allow for lifelong OUD management and identification of other chronic medical problems, which prior research has identified in 2/3 of MOUD patients ( 10 ). Despite these benefits, more than 60% of Americans are unaware that primary care physicians (PCPs) can prescribe MOUD ( 11 ), and only 1 in 50 PCPs participate in buprenorphine prescribing ( 12 ). Among recent family medicine graduates, just 10% reported being trained to prescribe buprenorphine, and only 7% had ever prescribed it ( 13 ). National web-based educational offerings (e.g., from addiction medicine and pain societies, Providers’ Clinical Support System “PCSS” and “ECHO” tele-health programs) facilitate MOUD training and mentoring in the office-based practice setting (Office-based Opioid Treatment; OBOT). However, little progress in creating a PCP workforce equipped to address patient demand will be made until effective strategies are found to encourage participation and to overcome notable challenges and barriers to OBOT, which include prescribing logistics and reimbursement concerns ( 14 – 16 ); workflow disruption or clinic capability for the caseload ( 17 ), lack of training or institutional support ( 18 – 20 ), and attitudes and stigma regarding patients with OUD ( 14 , 16 , 17 , 21 – 24 ). Characteristics of those most likely to prescribe MOUD in primary care, like recency of training ( 25 ) and willingness to learn/do something new ( 26 ) also apply, and likely also general job satisfaction; however, no prior study has assessed this relationship. Indeed, one goal of our study was to expand on a prior finding that PCP’s who offer MOUD experience increased job satisfaction ( 27 ); specifically asking if PCP job satisfaction would relate to willingness to incorporate MOUD in their practice. We report here on the creation and evaluation of a novel continuing education (CE) video series for professional learners presented by a regional expert who has long been engaged in providing OBOT services in a rural primary care setting. While the educational content was original and genuine to the author/presenter’s own perspectives and experiences of the rewards of buprenorphine prescribing, it directly addressed many of the challenges and concerns already described above. The content was broadly relevant to busy clinic practices; however, some chosen talking points were especially relevant to small rural communities, such as reputational spread and limited availability of outpatient support ( 28 – 30 ). The only prior study we found that explicitly investigated different messaging appeals discovered that PCP enrollment interest in a MOUD ECHO program was aided by solicitation with prosocial messaging, especially if financial compensation was also mentioned ( 31 ). We expanded on this approach to understand persuasive messages for OUD-related care in this population of providers through creation of modules that mitigated concerns and differentially emphasized benefits to identified external (community- or practice- level) or internal (professional or individual-level) influences. Research on physician decision-making and the factors that influence prescribing behavior is largely exploratory rather than theoretical ( 32 ). With careful creation of videos that appeal to several sources of motivation to create behavior change, the study is supported by a strong theoretical basis. Our goal was to change or significantly impact attitudes toward MOUD in PCPs. Better yet, we desired that the videos would inspire change in intention to initiate MOUD in PCP practice. METHODS Population Targeted providers were physicians (MD, DO), Advanced Practice Registered Nurses, or Physician Assistants employed in primary care family or internal medicine in Kentucky. These populations were reached through listserv emails to the learner database of our institution’s continuing education provider (CECentral) and through the disseminated efforts (email campaigns, newsletters, and conference flyers) of several collaborative partners and professional organizations, including the state’s primary care practice-based research network (Kentucky Ambulatory Network). Educational Videos Format The education activities included 3 enduring webcasts written and delivered by a rural PCP (author: MZ). The video sequence was approved for CE credit by CECentral for all professions listed above. Content, theoretical mapping . Scripts and images for the videos were created by the presenting author with no externally provided guidance other than to speak directly to the camera on topics of general concern she has encountered, as well as experienced benefits for MOUD, in the outpatient primary care practice. The primary video (PrimV) lasted approximately 40 minutes and was viewed first. It was followed by two, approximately 10 minutes long, supplementary videos: one emphasizing external motivations and community or practice barriers and benefits (ExV); one emphasizing internal motivation and largely professional or individual-level concerns and benefits (InV). Script content was broken down into primary message features (e.g., goal setting, addressing stigmas, impact to practice) and analyzed for association with core constructs of three prominent behavior change theories: 1) Theory of Planned Behavior (TPB)( 33 ) has shown good predictive validity with intention and ultimately physician behavior, especially the category of beliefs about capabilities ( 34 ). Relevant script content emphasized creating intention for MOUD by reminding of positive professional attitudes toward harm reduction and addressing concerns for perceived control. 2) Self-determination theory (SDT)( 35 ) has helped to describe physician work satisfaction. It emphasizes influences on wellbeing that arise from external influences (especially clinical autonomy, e.g., work hours)( 36 ), and maintaining internal motivation (e.g., confidence, a sense of calling)( 37 , 38 ). SDT-relevant content related to overcoming external challenges to autonomy (pre-authorizations, practice change) and appeal to an internal sense of social or professional mission in OUD patient care. Finally, 3) Behavior Change Wheel ( 39 ) distinguished script attributes related to habit or automatic processes (stigmas and fears) versus analytical ones (as in TPB), and added the core influences of capability (e.g., lack of institutional support, inexperience), opportunity (within the physical/social clinic environment) and motivation on behavior. Results from our theoretical mapping of video content are listed alongside explored themes and example exerts in Table 1 . Table 1 Example Statements from main script mapped to prominent behavior theories. Statement Type (Area Addressed) Theoretical Basis: Behavior Change Model Component Example quote from primary video Worries and concerns re: patients TPB Perceived Control, Capability “Yes, It is likely that some of the buprenorphine that you prescribe will get diverted. However, the risk of overdose from buprenorphine is extremely low and studies have shown that most diverted buprenorphine is used by other people either waiting for treatment, who can’t afford treatment or who do not want to be known to need treatment.” “My staff has not quit — in fact they enjoy the MOUD patients as much as I do — they enjoy seeing them grow — especially the younger ones and the moms who come in with their children” “After eleven years and thousands of patients, I can honestly say, adding MOUD to your practice will not incur the wrath of the DEA” TPB Moral Norm, Social Influences Stigma TPB Perceived Control, Capability “Your office will not be flooded with unruly, difficult patients that suck the life blood out of you - in fact — these are patients who are grateful for care — and many of them are already your own patients” “We have not had any safety issues or an increase in inappropriate patient behaviors in waiting areas or with the staff since initiating the program more than 10 years ago.” BCW Automatic Motivational Influences it to Primary Care SDT Intrinsic Factors: Long-term relationships; Sense of calling “the key to retaining patients in treatment is the relationship that they have with their provider. MOUD patients are already among your patients.” “You already believe in the MOUD model as a primary care physician: harm reduction, prevention, chronic disease management, whole person/whole family and community medicine” TPB Value Beliefs; Role & Identity SDT Intrinsic Factors: Feeling Confident “cautiousness is what makes us careful and thorough and excellent clinicians — we are aware of our limits and know when to ask for help — when learning something new, the key is to learn WHO to ask for help. BCW Capability Impact to practice SDT Extrinsic Factors: Financial Compensation, Workload and Autonomy “Simply screening for patients within your current practice will present opportunities for treatment without having to expand your patient population if you don’t wish to do so” BCW Opportunity Goal-setting TPB Perceived Control, Capability “people ‘recover’ to various degrees depending on a host of circumstances beyond your control — not up to you to judge — only to decide if this patient can continue to be prescribed the medication safely and to offer referral to higher level of treatment if necessary” “Sometimes better is the best you can do at the moment. As long as people are working and trying to move forward, work with them — when they stop: set a plan — they refuse: then part ways.” BCW Capability Note. This mapping is not exhaustive: Other ties could be posited for several of the statements as the underlying theories have significant overlap, and concepts beyond these shown were covered in the script. Abbreviations: TPB: Theory of Planned Behavior SDT: Self-determination theory BCW: Behavior Change Wheel Insert Table 1 Here Procedures Following Institutional Review Board approval, research surveys were available to all participants across a 9-month funding period, April 24, 2023 − January 24, 2024. Blast emails from CECentral provided the landing page/registration site to 5,259 members meeting inclusion criterion, with two repeat emails following unopened emails. Additional participation was gained from our partner’s advertising efforts, and through direct link to the site from CECentral’s topic directory. Upon opening the landing page site, participants completed the pre-video survey and viewed the PrimV. Participants were randomized to next view either the ExV or the InV, followed by Post-video survey. Participants could also watch and evaluate the supplementary video not already viewed as part of the random assignment. E-gift cards were sent and medical education credits provided to all who completed Post-video surveys: $ 50 and 1.0 CME credits for PrimV + the randomly selected supplementary video; $ 75 and 1.25 CME for PrimV + both supplementary videos. Research Survey Face validity of the survey was assessed by two PCP authors (SM, MZ) and one external PCP and refined accordingly. Pre-video survey assessed demographics and other characteristics including profession, degree, and specialty/subspecialty. To describe rural practice characteristics, zip code information was retrieved from CECentral registration. A second block of 5 questions were selected from prior survey items ( 36 , 38 , 40 ) to evaluate job satisfaction. Post-video survey utilized a ‘Post / Retrospective-Pre’ survey format following the PrimV, in which participants provided two ratings on the importance of listed concerns as a potential barrier to MOUD, and specifically buprenorphine, in their practice. Each concerned a topic raised in the videos, with the first set (6 ratings) related to concerns for patients with OUD and the second set (13 ratings) related to personal or professional barriers. An additional 8 ratings asked about change in participant’s confidence and intention to explore MOUD in their own office setting. The Post / Retrospective-Pre format provides comparison of participant’s “now” ratings to when they think back to their attitudes and beliefs prior to the video. The format reduces completion time and may be more accurate when the educational intervention could change participant’s understanding of the measured construct ( 41 , 42 ). Additional Figure AF1 depicts the format and example questions. Following these ratings, two open-response questions asked what was compelling about and what was not as well received from the videos. Learning Assessment Required for obtaining CE credit, questions following the research survey assessed: confidence that the knowledge and/or skills gained will improve participant’s ability to practice (Likert scale: strongly agree – strongly disagree), whether the obtained information/ ideas will be useful (yes/no), and the “impact that the activity will have on your practice ” (open-ended). Statistical Analyses Summary statistics were generated for the variables of interest: Continuous variables were summarized using means and standard deviations and categorical variables were summarized using counts and percentages. Survey responses were analyzed for differences using Fisher’s exact non-parametric tests. Other planned analyses were conducted to assess difference in the primary outcome, intention to incorporate specific MOUD practices, by each supplementary video type and job satisfaction status. Job satisfaction status was a created variable derived from five Career Satisfaction questions. Responses on two career commitment questions (“In the next few years…”) were not included in the determination for persons over age 60 given proximity to retirement; otherwise, if participants had a negative view of any of the 5 questions, they were classified as “Unsatisfied”. Data were analyzed using RStudio version 4.4.2. The significance level for all statistical tests is α = 0.05. Qualitative Analysis Participant responses to the survey’s three open-ended questions were analyzed for broad themes using the survey questions as prompts using OpenAI (Gemini, 2.0 Flash; accessed 2/3/2025). The primary author separately developed a code book and categorized responses to each question using the qualitative software program QDA dataMiner lite (Provalis Research), organized all coded responses into themes, and compared these themes for alignment with the AI output for each question prompt. The approach, closely aligned with previously successful analytic techniques for use of AI combined with manual investigator review of the dataset ( 43 ), resulted in the appropriate level of thematic representation of key concepts for the targeted questions within this small qualitative dataset. Representative quotes were chosen by the investigator. RESULTS Participant Profile As shown in Table 2 , of the 37 participants, over 50% were physicians, with family medicine as the predominant specialty or subspecialty across a variety of practice settings. Nurse practitioners comprised the next largest group (30%). Research participants ranged in age from 33 to 53; most were white (83.3%) with a greater representation of females (58%). Almost half of the respondents (44.4%: 16/36 with 1 unknown) registered with a practice in a predominantly rural zip code. Most respondents provided positive responses to each of the 5 career satisfaction items; the calculated composite score designated 24 (66.7%) as satisfied with their job. Commitment to stay in clinical practice was high (86% disagreed somewhat or strongly that they would leave); however, a third of respondents (33.6%) desire to reduce time spent in direct patient care. Despite this, 67% of respondents characterize their patient relationships as long-term and meaningful. Table 2 Primary Care Respondent Demographics, Practice Characteristics, Markers of Career Satisfaction (N = 37) Age mean Median (IQR) 44 47 (33,53) Gender n % Female 21 57.0 Male 15 41.0 Refused 1 2.7 Race/Ethnicity Asian 6 16.0 Black 0 0.0 White 30 81.0 Other 0 0.0 Not Hispanic, Latino or Spanish origin 36 97.0 Specialty Family medicine 11 30.0 Gastroenterology 1 2.7 Geriatric medicine 2 5.4 Hospice; Palliative Medicine 1 2.7 Internal medicine 5 14.0 Internal Medicine/Pediatrics 1 2.7 Unknown 16 43.0 Role Physician 21 57.0 Degree: DO 8 38.1 Degree: MD 13 61.9 Nurse APN 11 30.0 Physician Assistant 3 8.1 Student 1 2.7 Unspecified 1 2.7 Practice Characteristics Academic health center/faculty practice 5 14.0 Federally qualified health center or look alike 7 19.0 Hospital/health system owned medical practice 10 27.0 Independently owned medical practice 6 16.0 Rural health clinic (federally qualified) 2 5.4 Work site clinic 1 2.7 Unknown/Other 5 14.0 Added response: Hospice 1 2.7 County zip code Census population ≥ 50% rural 16 44.4 Drug Enforcement Administration X-waiver obtained yes 16 44.4 % hours/week in direct patient care mean Median (IQR) 39 40 ( 30 , 46 ) Job Satisfaction* n % Career satisfaction : “Thinking very generally about your satisfaction with your overall career in medicine, would you say that you are currently…” Very dissatisfied 0 0.0 Somewhat dissatisfied 4 11.1 Somewhat satisfied 9 25.0 Very satisfied 23 63.9 Commitment to direct patient care : “In the next few years, I hope to reduce the amount of time I spend in direct patient care” Disagree strongly 9 25.0 Disagree somewhat 16 44.4 Agree somewhat 6 19.7 Agree strongly 5 13.9 Commitment to clinical practice : “In the next few years, I hope to leave the practice of medicine” Disagree strongly 21 58.3 Disagree somewhat 10 27.8 Agree somewhat 3 8.3 Agree strongly 2 5.6 Sense of calling : “For me, the practice of medicine is a calling.” Disagree strongly 0 0.0 Disagree somewhat 1 2.8 Agree somewhat 12 33.3 Agree strongly 23 63.9 Patient relationships : “ With respect to your patients, with how many do you have a meaningful, long-term relationship?” None 1 2.8 A few 11 30.6 Many 13 36.1 Most 11 30.6 Job Satisfaction : Answered negatively to any of the prior 5 questions. Satisfied 24 66.7 Unsatisfied 12 33.3 *n = 36 (1 respondent refused all) †Zipcode provided in CE registration and categorized per 2020 Decennial Census. Obtained from Kentucky Association of Counties ( https://kaco.org/articles/county-stats-rural-and-urban-population-breakdown/ ) Insert Table 2 Here Research Survey A significant reduction in importance scores was found for 6 of 19 barriers to MOUD, each reflective of professional or personal barriers rather than with the patients themselves: negative attitudes (of their practice’s employees, of their other patients), limited reimbursement, lack of clinical time, and professional fit/sense of calling. Significant change for the item, “Little management/administrative support for buprenorphine service line” reflected high importance ratings overall: of the 85% of the sample that deemed this a 4 or 5 (5-point scale) in Retrospective-Pre ratings, 27% considered this less, and 22% considered this more important post-video. Figure 1 depicts change scores for significant items. These and all items with non-significant change scores, which included all items regarding patient-related barriers, are shown in Table 3 . Additional Table AT1 presents all pre-test ratings and retrospective evaluation of change across each item. Table 3 Items by Type and Change Rating (Post / Retrospective-Pre) Significance Levels (N = 37)* Importance of Barriers to Buprenorphine Prescribing a. Personal or Professional Barriers Professional licensing board oversight p = 0.50 Negative attitudes/perceptions of staff, other practitioners in my practice p=.009 Negative attitudes /perceptions of other patients in my practice p=.041 Negative impact on my reputation p = 0.13 Work-load/paperwork for insurance prior authorization requirements p = 0.30 Learning curve to take on new procedures p=.088 Low or no need for this service in my practice p = 0.10 Unfavorable change in patient population mix p = 0.10 Little management/ administrative support for buprenorphine service line p=.002 Limited reimbursement rate of buprenorphine therapy/return on investment p=.024 Lack of fit to my sense of who I am as a doctor, my calling p=.008 Limited time in clinic setting for these appointments p=.016 Insufficient supportive psychotherapy in the community p = 0.60 Barriers related to Patients with Opioid Use Disorder Patients are a Source of Frustration p = 0.20 Patients are a risk for medication diversion p = 0.10 Patients lack interest in treatment p = 0.20 Costs/coverage of medication for patients p = 0.80 Patients already see specialists for these medications p=.089 Inappropriate patient behaviors present safety issues p=.094 Confidence in Offering Treatment Identifying patients at risk for misuse of pain medication p = 0.80 Managing patients in your practice who receive buprenorphine from other treatment providers p = 0.20 Managing buprenorphine prescribing in my practice p = 0.20 Likelihood to Engage in Treatment Screen patients for Opioid Use Disorder within my practice p = 0.04 Screen for patients already receiving buprenorphine within my practice p = 0.20 Manage buprenorphine prescribing in my practice p = 0.40 Prescribe buprenorphine p = 0.50 Consider board certification as an Addiction Medicine Specialist p = 0.07 *Listed in order presented within the research survey. See Additional Table AT1 for full analytic detail and Fig. 1 for significant findings Insert Fig. 1 Here Participants randomized to view the supplementary video promoting external motivations (ExV, n = 21) showed significant reduction, as compared to those who viewed the InV video (n = 16), in the importance of two additional barriers: patient’s medication costs/coverage (p=.039) and inappropriate patient behaviors (safety; p = 0.02). Additional evaluations were available from 65% (24/37) of participants who chose to continue watching the alternative (not assigned) video, but aside from demonstrating sufficient interest to invest additional time, the evaluative findings did not differ substantially and did not warrant further analysis. All respondents reported either no change or increased confidence in buprenorphine prescribing and patient management that was not statistically significant. Regarding the primary outcome, intention to make changes in practice to incorporate specific MOUD practices, participants endorsed a significantly greater likelihood to screen patients for OUD (see significant change scores: Fig. 1 ). Of other future intentions, the consideration of addiction medicine certification, which bordered on significance in the primary analysis (p=.07), was significantly more likely among those who scored as “satisfied” in the job satisfaction composite score. These data are shown as the bottom five questions in Table 3 . Additional Table AT2 shows all pre-test ratings and retrospective evaluation of change across each item. Insert Table 3 Here Qualitative Responses Table 4 shows developed themes and example written evaluations of the videos. Responses indicate that participants appreciated that MOUD implementation was presented with a practical lens that altered their perception of feasibility and need for MOUD in primary care settings. A greater sense that OUD treatment maintains the values of PCPs by supporting a holistic care model for chronic diseases (from script; Value Beliefs; Role & Identity; Table 1 ) was especially prominent. The presenter's relatable and passionate approach also resonated, in particular the video’s emphasis on the positive impact MOUD can have on, and potential to save, patients' lives. While the presenter made the process of clinic implementation seem less daunting, some viewers felt the challenges were overly simplified. A need for specific practical advice, further training, and implementation support were each mentioned as key hesitations regarding MOUD that respondents believe the video underemphasized. Table 4 Open-ended Research Survey Questions* and Learning Assessment † : Qualitative Themes Identified (example quotes). Learning Assessment † Scale Averages * The one thing that stood out to me and that I found compelling about this video was ___. Theme: Feasibility of Clinic Implementation “the ease of prescribing buprenorphine in a family practice setting and identifying those who may need it” • Sub-theme: time commitment/burden on the practice “Seeing patients for buprenorphine does not necessarily add time to your day and put you behind” | “Made it less daunting” | “Patients with addiction are already a part of my practice.” Theme: Need/ Impact of/ Importance of Treatment “Strong need in community” | “How much the presenter emphasized that providing treatment for addiction is saving lives. I think we often think about our own lack of comfort when treating addiction but this puts things into a better perspective” • Sub-theme: Recovery Paths “The ability to come alongside patients and improve their lives, which may look like abstinence and sobriety for some or may look like staying out of jail or the hospital for others: no path of recovery will look the same” Theme: Chronic Disease Model/Fit to Primary Care “Addiction is a chronic disease. If I treat diabetes with medications, why wouldn’t I treat addiction with medications.” * The one thing that I did not receive well from this video, or that dissuaded me about the use of buprenorphine medications for opioid use disorder (MOUD) in my clinic was___. Theme: Implementation Barriers “no scope to change my clinical schedule, incorporate new patients, train medical assistants to answer questions related to SUD” | “lack of practical advice about office operations” • Sub-Theme: Reimbursement Barriers “Most of the patients I see who need buprenorphine are Medicaid and they pay very little per visit.” Theme: Continued Training Needs “Still need more training on side effects, dosing, monitoring, etc.” | “actual dosing and pharmacology review” Theme: Concern for Patient Behaviors (relapse, diversion) and regulations “It would be difficult to see cycles of relapse” | “We can never fully stop diversion” † I feel confident that the knowledge and/or skills gained from this activity will improve my ability to practice. Strongly disagree Disagree Agree Strongly Agree 0 (0.0%) 1 (1.5%) 31 (47.7%) 33 (50.7%) † Based on the learning objectives, I obtained information and ideas that will be useful. Yes No 62 (95.4%) 3 (4.6%) †” Thinking about the knowledge and skills you learned during this activity, please describe the impact that the activity will have on your practice ”. Theme: Openness/Willingness/Confidence a) to Prescribe “I will be more confident if I ever decide to prescribe bupe(renorphine) in Primary Care Setting.” b) to screen and identify OUD “Recognizing opioid use disorder and understanding the role of PCPs” c) to obtain further training/certification Theme: Enhanced Informed Decision-Making “I will be able to address misconceptions both patients and providers have around MAT for opioid use disorder” • Sub-Theme: Practice Compassionate Care/ Empathy/ Reduce Bias “openness to patient experiences and challenges” Other overriding themes from above prompts Theme: Appeal of the Presenter “The presenter's conviction toward the subject. She was very astute at identifying concerns that I also had” “I like the one provider experience in rural health. It made prescribing seem a little less daunting and a little more manageable” Theme: Learning Curve “I felt somewhat like the presenter felt it was an easier thing to do then what it is.” | “It will give me reassurance that it’s okay to be nervous and cautious starting out” | “emphasis on support and mentorship” Insert Table 4 Here Learning Assessment Participants responded that the content was both useful (95.4% yes) and provided knowledge/skills that would improve their ability to practice (98.4% Agree or Strongly Agree). Qualitative responses reinforced that the content increased intention to screen for opioid use disorder. An especially prominent theme was the recognition of participant’s own biases and desire to maintain a more compassionate, empathetic standard of care for patients with OUD. DISCUSSION Research Objectives and Findings The video education evaluated here reduced the importance of several clinically important barriers to MOUD. These included PCP’s concerns for limited reimbursement, clinical time, and attitudinal concerns for their practice’s employees or patients. The video author offered a clear perspective that MOUD fits strongly with the practice model of a PCP. The impact of this was reflected in the significant change for the item “Lack of fit to my sense of who I am as a doctor, my calling”. While many (30%) maintained that this was not an important barrier for them (rank = 1 in Retrospective-Pre and a rating of unchanged in Post assessment), across all retrospective Pre rating levels, this statement was deemed less important by 25% of the professional learners. Not unrelated, for those already highly satisfied with their clinical role, interest in expansion of their skills toward addiction medicine certification was significantly more likely. Primary care settings have shown equivalent efficacy and outcomes as specialty SUD centers for MOUD ( 44 ). Education (especially early in medical training)( 45 ), mentoring, and expanded implementation interventions that are supported by leadership ( 15 , 19 , 46 ) are needed to initiate and maintain interest in providing MOUD in primary care. Three concerns deemed less important post-video rating were specific to implementation in the respondent’s own practice setting and so could be among the barriers that such training and support could best overcome. These included concerns for limited reimbursement, little management/administrative support, and lack of clinical time. One area where additional content could be added regards addressing concerns for management/administrative support. This item was the most frequently rated (59.5%) as being highly important pre-video, yet post-assessment ratings were equivalent. This reinforces the qualitative comment that the videos provided a “ lack of practical advice about office operations” (Table 4 ). One especially encouraging finding was that the videos created inspiration to screen for OUD, which can be a beginning point for the more committed actions that we sought to motivate. Video content highlighted the potential for appropriate referral for those who do not wish to prescribe or manage buprenorphine prescribing in their practice, likely enhancing receptiveness to this practice change. The presentation reinforced that PCPs would not need to expand patient volume and that, “Simply screening for patients within your current practice will present opportunities for treatment without having to expand your patient population if you don’t wish to do so” (exert, Table 1 , “Impacts to Practice”). Other studies have revealed suboptimal OUD screening by PCPs ( 47 ) and reported on the need to educate PCPs that, as one participant noted, “Patients with addiction are already a part of my practice” (feasibility theme, Table 4 ). In making this point, the videos also appeared to allay concerns for the negative attitudes of their practice’s employees, and of their other patients; a stigmatization that is especially concerning for rural practices ( 28 ). Almost half of our sample was comprised of rural PCPs who have unique challenges for buprenorphine prescribing ( 29 , 30 ); their receptivity to the messaging provides a starting point for development of additional content to address their needs with greater specificity. Limitations Expanded access to evidence-based buprenorphine medication for OUD is a critical need, especially in rural areas, but efforts to engage PCPs in providing this service will not reach the desired level of impact without adequate educational outreach. Our dissemination effort was purposely limited to a single state as we desired messaging that could convey a sense of place and connectedness to our state’s practices and their largely rural patient populations. One discouraging finding was the difficulty in reaching this audience for potential participation. Despite soliciting over 5,200 potentially eligible learners by advertisement and active email solicitation, our small sample size remains a clear weakness. Potential self-selection of individuals already interested or engaged in MOUD practice also limits interpretation and is indicated in the finding that a Drug Enforcement Administration (DEA) X-waiver had already been obtained by 44% of the sample despite the termination of this requirement. Exploration of ways to enhance dissemination and to assure uptake of similar educational campaigns remains an outstanding need. In addition to our study’s restricted professional reach, the Post / Retrospective-Pre survey format may also limit our interpretations. Constraints of this format have been described elsewhere ( 41 , 42 ); namely, that participants may not accurately recall or are ambiguous about their prior attitudes (recall bias), respond to an expectation for change (demand characteristics), or may change their perceptions of their initial attitudes after gaining new knowledge (response shift bias). Our study was not designed to assess potential over- or under- estimation of baseline attitudes. CONCLUSION This video series was scripted and presented by and for PCPs in an honest and informal way and emphasizes the transformative experiences of treating OUD in primary care. Advantages are the format’s easy online accessibility, minimal time commitment, motivational appeals utilizing behavior theory constructs, and direct approach to countering known negative perceptions and stigma for prescribing buprenorphine. The videos are housed as enduring material as a resource of our state’s practice-based research network ( 48 ), allowing us to continue disseminating this education and further sustain reach to outpatient practices. Messages that create support for more empathetic care – and that emphasize a sense of purpose and fit with one’s calling for a career in primary care medicine – could serve as an especially important motivator for expanding MOUD treatment capacity to address the continuing epidemic of opioid dependency and overdose. Declarations Ethics approval and consent to participate The University of Kentucky Internal Review Board reviewed all activities, and a waiver of documentation of informed consent for the collection of evaluative data from the professional learners was granted. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Funding for this project was received from the Substance Use Priority Research Area of the University of Kentucky, Pilot Award (Office of the Vice President for Research, research priority areas) and from the University of Kentucky Department of Family & Community Medicine. Authors' contributions All authors provided substantial contributions to the design of the work and reviewed the final manuscript. KLR conceptualized the study, conducted thematic analysis of scripts and analyzed qualitative data. MZ conceptualized and prepared the educational content. KLR and HK acquired funding and wrote the original manuscript draft. KLR, SM, HK, and MZ created the survey questions and design. KLR and SM assisted with dissemination to professional partners in the state. KH and KM conducted analyses and prepared statistical tables. Acknowledgements We wish to thank Kennith Harris of the University of Kentucky CECentral for his significant assistance in filming the video and creating the landing page for the content. Jessica Sass, APRN, of the University of Kentucky Department of Family & Community medicine graciously reviewed the survey for face validity for this professional audience. References Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58): Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2023 [Available from: https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report] Dowell D, Brown S, Gyawali S et al. Treatment for opioid use disorder: population estimates — United States, 2022. MMWR Morb Mortal Wkly Rep. 2024;73:567–74. doi:10.15585/mmwr.mm7325a1 Johnson K, Jones C, Compton W, Baldwin G, Fan J, Mermin J, et al. Federal response to the opioid crisis . Curr HIV/AIDS Rep. 2018;15(4):293-301. doi:10.1007/s11904-018-0398-8 Andrilla CHA, Moore TE, Patterson DG, Larson EH. Geographic distribution of providers with a DEA waiver to prescribe buprenorphine for the treatment of opioid use disorder: a 5-year update. J Rural Health. 2019;35(1):108-12. doi:10.1111/jrh.12307 McNeely J, Schatz D, Olfson M, Appleton N, Williams AR. How physician workforce shortages are hampering the response to the opioid crisis. Psychiatr Serv. 2022;73(5):547-54. doi:10.1176/appi.ps.202000565 Rizk JG, Saini J, Kim K, Pathan U, Qato DM. County-level factors associated with a mismatch between opioid overdose mortality and availability of opioid treatment facilities. PLoS One. 2024;19(4):e0301863. doi:10.1371/journal.pone.0301863 Sadeghi A, Thornton JD, Varisco TJ. Gaps in buprenorphine access: examining provider availability and treatment continuity. J Subst Use Addict Treat. 2026;180:209818. doi: 10.1016/j.josat.2025.209818 Barry CL, Epstein AJ, Fiellin DA, Fraenkel L, Busch SH. Estimating demand for primary care-based treatment for substance and alcohol use disorders. Addiction. 2016;111(8):1376-84. doi:10.1111/add.13364 Epstein AJ, Barry CL, Fiellin DA, Busch SH. Consumers’ valuation of primary care–based treatment options for mental and substance use disorders. Psychiatr Serv. 2015;66(8):772-4. doi:10.1176/appi.ps.201500077 Rowe TA, Jacapraro JS, Rastegar DA. Entry into primary care-based buprenorphine treatment is associated with identification and treatment of other chronic medical problems. Addict Sci Clin Pract. 2012;7(1):22. doi:10.1186/1940-0640-7-22 del Pozo B, Park JN, Taylor BG, Wakeman SE, Ducharme L, Pollack HA, et al. Knowledge, attitudes, and beliefs about opioid use disorder treatment in primary care. 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JAMA network open. 2024;7(7):e2420837-e. doi: 10.1001/jamanetworkopen.2024.20837 Chang ET, Oberman RS, Cohen AN, Taylor SL, Gumm E, Mardian AS, et al. Increasing access to medications for opioid use disorder and complementary and integrative health services in primary care. J Gen Intern Med. 2020;35(Suppl 3):918-26. doi: 10.1007/s11606-020-06255-6 Cioe K, Biondi BE, Easly R, Simard A, Zheng X, Springer SA. A systematic review of patients' and providers' perspectives of medications for treatment of opioid use disorder. J Subst Abuse Treat. 2020;119:108146. doi: 10.1016/j.jsat.2020.108146 Harder VS, Villanti AC, Heil SH, Smith ML, Gaalema DE, Meyer MC, et al. Opioid use disorder treatment in rural settings: The primary care perspective. Prev Med. 2021;152(Pt 2):106765. doi:10.1016/j.ypmed.2021.106765 Lai B, Croghan I, Ebbert JO. Buprenorphine waiver attitudes among primary care providers. J Prim Care Community Health. 2022;13:21501319221112272. doi: 10.1177/21501319221112272 Roper KL, Jones J, Rowland C, Thomas-Eapen N, Cardarelli R. Mixed methods study of patient and primary care provider perceptions of chronic pain treatment. Patient Educ Couns. 2021;104(3):585-94. doi:10.1016/j.pec.2020.08.038 Peterson LE, Morgan ZJ, Eden AR. Early-Career and Graduating Physicians More Likely to Prescribe Buprenorphine. J Am Board Fam Med. 2020;33(1):7-8. doi:10.3122/jabfm.2020.01.190230 Lott A, Danner AN, Malte CA, Salameh HA, Bachowski D, Gordon AJ, et al. Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysis. Addict Sci Clin Pract. 2025;20(1):38. doi:10.1186/s13722-025-00568-9 Mazzarelli S, Blewer AL, Østbye T, Rhodes K, Plasencia G, Hart L, et al. Impact of implementing primary care-based medication for opioid use disorder on provider and staff perceptions. Family Practice. 2024;41(6):1018-24. doi: 10.1093/fampra/cmae044 Franz B, Dhanani LY, Bogart S, Fenstemaker C, Miller WC, Hall OT, et al. Different forms of stigma and rural primary care professionals' willingness to prescribe buprenorphine. J Subst Use Addict Treat. 2025;171:209633. doi: 10.1016/j.josat.2025.209633 Morenz AM, Nance RM, Mixson LS, Feinberg J, Smith G, Korthuis PT, et al. Barriers to accessing medications for opioid use disorder among rural individuals. Int J Drug Policy, 140: 104805. doi: 10.1016/j.drugpo.2025.104805 Stopka TJ, Estadt AT, Leichtling G, Schleicher JC, Mixson LS, Bresett J, et al. Barriers to opioid use disorder treatment among people who use drugs in the rural United States: a qualitative, multi-site study. Soc Sci Med. 2024;346:116660. doi: 10.1016/j.socscimed.2024.116660 Domino ME, Sylvia S, Green S. Nudging primary care providers to expand the opioid use disorder workforce. Health Serv Res. 2022;57(2):403-10. doi: 10.1111/1475-6773.13894 Murshid MA, Mohaidin Z. Models and theories of prescribing decisions: A review and suggested a new model. Pharm Pract (Granada). 2017;15(2):990. doi:10.18549/PharmPract.2017.02.990 Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process 1991;50(2):179-211. doi: 10.1016/0749-5978(91)90020-T Godin G, Bélanger-Gravel A, Eccles M, Grimshaw J. Healthcare professionals' intentions and behaviours: A systematic review of studies based on social cognitive theories. Implement Sci. 2008;3(1):36. doi:10.1186/1748-5908-3-36 Ryan RM DE. Self-determination theory: Basic psychological needs in motivation, development, and wellness. New York: Guilford Press; 2017. doi: 10.7202/1041847ar Landon BE, Reschovsky J, Blumenthal D. Changes in career satisfaction among primary care and specialist physicians, 1997-2001. J Am Med Assoc. 2003;289(4):442-449. doi:10.1001/jama.289.4.442 Moller AC, Jager AJ, Williams GC, Kao AC. US physicians' work motivation and their occupational health: A national survey of practicing physicians. Med Care. 2019;57(5):334-340. doi:10.1097/mlr.0000000000001101 Tak HJ, Curlin FA, Yoon JD. Association of intrinsic motivating factors and markers of physician well-being: a national physician survey. J Gen Int Med. 2017;32(7):739-746. doi:10.1007/s11606-017-3997-y Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6(1):42. doi:10.1186/1748-5908-6-42 Rasinski KA, Lawrence RE, Yoon JD, Curlin FA. A sense of calling and primary care physicians’ satisfaction in treating smoking, alcoholism, and obesity. Arch Intern Med (Chic). 2012;172(18):1423-1424. doi:10.1001/archinternmed.2012.3269 Hill LG, Betz DL. Revisiting the retrospective pretest. Am J Eval. 2005;26(4):501-517. doi:10.1177/1098214005281356 Hwalek M, Cassandra S-F, and Wasserman D. Retrospective pretests: recent use in visitor studies research and ways to make them more informative. Visit Stud. 2022;25(1):1-21. doi:10.1080/10645578.2021.1977084 Salazar M, Chaw M, Hellier Y, Hsia S, Gruenberg K. Comparison of qualitative analyses conducted by artificial intelligence versus traditional methods. Am J Pharm Educ. 2025;89(12). doi: 10.1016/j.ajpe.2025.101882 Lagisetty P, Klasa K, Bush C, Heisler M, Chopra V, Bohnert A. Primary care models for treating opioid use disorders: What actually works? A systematic review. PloS one. 2017;12(10):e0186315-e. Shuey B, Lee D, Ugalde I, Borgan S, Bresnan C, Qureshi M, et al. Evaluation of resident physicians' knowledge of and attitudes towards prescribing buprenorphine for patients with opioid use disorder. J Addict Med. 2021;15(3):219-25. doi: 10.1097/adm.0000000000000750 Wyse JJ, Eckhardt A, Newell S, Gordon AJ, Morasco BJ, Carlson K, et al. . Integrating buprenorphine for opioid use disorder into Rural, Primary Care Settings. J Gen Int Med. 2024;39(12):2142-9. doi:10.1007/s11606-024-08898-1 Cole ES, DiDomenico E, Cochran G, Gordon AJ, Gellad WF, Pringle J, et al. The role of primary care in improving access to medication-assisted treatment for rural medicaid enrollees with opioid use disorder. J Gen Int Med. 2019;34(6):936-943. doi:10.1007/s11606-019-04943-6 Prescribing Buprenorphine in Primary Care. CE Central course site. https://bit.ly/KAN_Resources. Accessed 2 February 2026. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 21 Apr, 2026 Reviewers agreed at journal 30 Mar, 2026 Reviews received at journal 18 Mar, 2026 Reviewers agreed at journal 04 Mar, 2026 Reviewers invited by journal 10 Feb, 2026 Editor assigned by journal 09 Feb, 2026 Submission checks completed at journal 04 Feb, 2026 First submitted to journal 02 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8769235","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":589287276,"identity":"e4f4de52-f78e-49d1-88e7-4a56dc2ee582","order_by":0,"name":"Karen L. Roper","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYBACCSQ24wOGAyA6gXgtzAYka2GTIEqLZPvZh48LGO7JmbP3PqvmOXOYgZ89xwCvFmmedGPjGQzFxpY9x81u89w4zCDZ8wa/FjmGNDZpHoaExA030thu83w4zGBwg4AtcvzP2H+Dtdx/xlYM0mJPSIu0RBobM8QWNiAD6DADCQJaJGc8Y5bmMUgA+iWNWXLOmXQeiTPPCvBqkTifxviZpyIBGGLHGD+8OWYtx9+evAGvFggwACMQaOYhQjlCFwjUEa9jFIyCUTAKRgwAADy8PwhUycaKAAAAAElFTkSuQmCC","orcid":"","institution":"University of Kentucky College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Karen","middleName":"L.","lastName":"Roper","suffix":""},{"id":589287281,"identity":"621fa52a-a65e-4daa-980b-67f32c3025e6","order_by":1,"name":"Melissa Zook","email":"","orcid":"","institution":"London Women's Care","correspondingAuthor":false,"prefix":"","firstName":"Melissa","middleName":"","lastName":"Zook","suffix":""},{"id":589287286,"identity":"9d5d8e09-3ee3-4e24-8096-5d269ac84db1","order_by":2,"name":"Kory Heier","email":"","orcid":"","institution":"University of Kentucky College of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Kory","middleName":"","lastName":"Heier","suffix":""},{"id":589287288,"identity":"d4531d11-34fb-44e5-baa8-852d78a1076b","order_by":3,"name":"Kristen McQuerry","email":"","orcid":"","institution":"University of Kentucky College of Public Health","correspondingAuthor":false,"prefix":"","firstName":"Kristen","middleName":"","lastName":"McQuerry","suffix":""},{"id":589287295,"identity":"d98321bc-8f8f-4817-b7e8-52667102008b","order_by":4,"name":"Sarah Marks","email":"","orcid":"","institution":"University of Kentucky College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Sarah","middleName":"","lastName":"Marks","suffix":""},{"id":589287297,"identity":"cfac0338-34e4-4461-9b66-eef966ca69a3","order_by":5,"name":"Hannah K. Knudsen","email":"","orcid":"","institution":"University of Kentucky","correspondingAuthor":false,"prefix":"","firstName":"Hannah","middleName":"K.","lastName":"Knudsen","suffix":""}],"badges":[],"createdAt":"2026-02-02 22:38:58","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8769235/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8769235/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102791308,"identity":"2c47caee-6f2c-44cd-a8d1-e6631f804f18","added_by":"auto","created_at":"2026-02-16 17:18:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":360632,"visible":true,"origin":"","legend":"\u003cp\u003eScoring Detail for Items with Significant Change Ratings\u003c/p\u003e\n\u003cp\u003eSignificant Items #1-6: Statements followed the header: \u003cem\u003e“How important do you feel each of the following is as a potential barrier to your use of buprenorphine, specifically, as a medication for opioid use disorder (MOUD) in your clinic?”\u003c/em\u003e: \u003cem\u003e“Reflect back and rate your attitude before viewing the video.”\u003c/em\u003e [1= “Not important” to 5= “Very important”].\u003c/p\u003e\n\u003cp\u003eSignificant Item #7: Statement followed the header: \u003cem\u003e“Reflect back and consider your likelihood to engage in each of the following before viewing the video.”\u003c/em\u003e [1= “Highly Unlikely” to 5= “Highly Likely”].\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eColor bars represent the Post video rating.\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eSignificant Items #1-6: \u003cem\u003e“Consider your current attitude now, or after viewing this video. Rate if your attitude has changed.” \u003c/em\u003e[Blue: Seems less important to me now. Orange: No Change in level of importance. Green: Seems more important to me now.]\u003c/p\u003e\n\u003cp\u003eSignificant Item #7: “\u003cem\u003eConsider your likelihood to do each of the following now, or after viewing this video. Rate if the likelihood has changed”\u003c/em\u003e [Orange: No change in likelihood. Green: I am more likely now]. No respondents selected response option “I am less likely now”.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8769235/v1/34ef03832f3ce8606efea38a.png"},{"id":103056459,"identity":"56120c59-fbe8-4d70-b559-607fce1268a7","added_by":"auto","created_at":"2026-02-20 09:10:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2092654,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8769235/v1/4a6b9fe5-7bcb-4136-89bd-de87e00f3b32.pdf"},{"id":102791309,"identity":"4391e6ad-338d-480c-a4e8-3747211c26de","added_by":"auto","created_at":"2026-02-16 17:18:25","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":173043,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile.docx","url":"https://assets-eu.researchsquare.com/files/rs-8769235/v1/5251848dcf427e6f0f43aa3e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Changing Minds on MOUD: Impact of Messages to Motivate Expanded Access to Buprenorphine in Primary Care Settings","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eEach year, approximately 90% of individuals with substance use disorders (SUDs) in the U.S. do not engage in any form of treatment (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Within the 3.7% of the population with opioid use disorders (OUD), only 25.1% receive evidence-based treatment medications (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Federal support for expanded access to medications for opioid use disorder (MOUD) including buprenorphine, methadone, or extended-release naltrexone has been ongoing for years (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), including the elimination in 2023 of a buprenorphine prescribing training requirement. Nevertheless, the OUD population remains underserved, due in part to provider shortages for SUD treatment specialists and limited access to treatment centers, especially in rural areas (\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCreating a workforce equipped to address this need could be met through increased coverage for MOUD within primary care settings, where untreated patients have shown greater willingness to enter (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and to pay (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) for treatment, and where MOUD integration can allow for lifelong OUD management and identification of other chronic medical problems, which prior research has identified in 2/3 of MOUD patients (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Despite these benefits, more than 60% of Americans are unaware that primary care physicians (PCPs) can prescribe MOUD (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), and only 1 in 50 PCPs participate in buprenorphine prescribing (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Among recent family medicine graduates, just 10% reported being trained to prescribe buprenorphine, and only 7% had ever prescribed it (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNational web-based educational offerings (e.g., from addiction medicine and pain societies, Providers\u0026rsquo; Clinical Support System \u0026ldquo;PCSS\u0026rdquo; and \u0026ldquo;ECHO\u0026rdquo; tele-health programs) facilitate MOUD training and mentoring in the office-based practice setting (Office-based Opioid Treatment; OBOT). However, little progress in creating a PCP workforce equipped to address patient demand will be made until effective strategies are found to encourage participation and to overcome notable challenges and barriers to OBOT, which include prescribing logistics and reimbursement concerns (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e); workflow disruption or clinic capability for the caseload (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), lack of training or institutional support (\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), and attitudes and stigma regarding patients with OUD (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22 CR23\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Characteristics of those most likely to prescribe MOUD in primary care, like recency of training (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and willingness to learn/do something new (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) also apply, and likely also general job satisfaction; however, no prior study has assessed this relationship. Indeed, one goal of our study was to expand on a prior finding that PCP\u0026rsquo;s who offer MOUD experience increased job satisfaction (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e); specifically asking if PCP job satisfaction would relate to willingness to incorporate MOUD in their practice.\u003c/p\u003e \u003cp\u003eWe report here on the creation and evaluation of a novel continuing education (CE) video series for professional learners presented by a regional expert who has long been engaged in providing OBOT services in a rural primary care setting. While the educational content was original and genuine to the author/presenter\u0026rsquo;s own perspectives and experiences of the rewards of buprenorphine prescribing, it directly addressed many of the challenges and concerns already described above. The content was broadly relevant to busy clinic practices; however, some chosen talking points were especially relevant to small rural communities, such as reputational spread and limited availability of outpatient support (\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe only prior study we found that explicitly investigated different messaging appeals discovered that PCP enrollment interest in a MOUD ECHO program was aided by solicitation with prosocial messaging, especially if financial compensation was also mentioned (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). We expanded on this approach to understand persuasive messages for OUD-related care in this population of providers through creation of modules that mitigated concerns and differentially emphasized benefits to identified external (community- or practice- level) or internal (professional or individual-level) influences.\u003c/p\u003e \u003cp\u003eResearch on physician decision-making and the factors that influence prescribing behavior is largely exploratory rather than theoretical (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). With careful creation of videos that appeal to several sources of motivation to create behavior change, the study is supported by a strong theoretical basis. Our goal was to change or significantly impact attitudes toward MOUD in PCPs. Better yet, we desired that the videos would inspire change in intention to initiate MOUD in PCP practice.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003ePopulation\u003c/h2\u003e\n \u003cp\u003eTargeted providers were physicians (MD, DO), Advanced Practice Registered Nurses, or Physician Assistants employed in primary care family or internal medicine in Kentucky. These populations were reached through listserv emails to the learner database of our institution\u0026rsquo;s continuing education provider (CECentral) and through the disseminated efforts (email campaigns, newsletters, and conference flyers) of several collaborative partners and professional organizations, including the state\u0026rsquo;s primary care practice-based research network (Kentucky Ambulatory Network).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eEducational Videos\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eFormat\u003c/h2\u003e\n \u003cp\u003eThe education activities included 3 enduring webcasts written and delivered by a rural PCP (author: MZ). The video sequence was approved for CE credit by CECentral for all professions listed above.\u003c/p\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eContent, theoretical mapping\u003c/span\u003e. Scripts and images for the videos were created by the presenting author with no externally provided guidance other than to speak directly to the camera on topics of general concern she has encountered, as well as experienced benefits for MOUD, in the outpatient primary care practice.\u003c/p\u003e\n \u003cp\u003eThe primary video (PrimV) lasted approximately 40 minutes and was viewed first. It was followed by two, approximately 10 minutes long, supplementary videos: one emphasizing external motivations and community or practice barriers and benefits (ExV); one emphasizing internal motivation and largely professional or individual-level concerns and benefits (InV).\u003c/p\u003e\n \u003cp\u003eScript content was broken down into primary message features (e.g., goal setting, addressing stigmas, impact to practice) and analyzed for association with core constructs of three prominent behavior change theories: 1) Theory of Planned Behavior (TPB)(\u003cspan class=\"CitationRef\"\u003e33\u003c/span\u003e) has shown good predictive validity with intention and ultimately physician behavior, especially the category of beliefs about capabilities (\u003cspan class=\"CitationRef\"\u003e34\u003c/span\u003e). Relevant script content emphasized creating intention for MOUD by reminding of positive professional attitudes toward harm reduction and addressing concerns for perceived control. 2) Self-determination theory (SDT)(\u003cspan class=\"CitationRef\"\u003e35\u003c/span\u003e) has helped to describe physician work satisfaction. It emphasizes influences on wellbeing that arise from external influences (especially clinical autonomy, e.g., work hours)(\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e), and maintaining internal motivation (e.g., confidence, a sense of calling)(\u003cspan class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e). SDT-relevant content related to overcoming external challenges to autonomy (pre-authorizations, practice change) and appeal to an internal sense of social or professional mission in OUD patient care. Finally, 3) Behavior Change Wheel (\u003cspan class=\"CitationRef\"\u003e39\u003c/span\u003e) distinguished script attributes related to habit or automatic processes (stigmas and fears) versus analytical ones (as in TPB), and added the core influences of capability (e.g., lack of institutional support, inexperience), opportunity (within the physical/social clinic environment) and motivation on behavior. Results from our theoretical mapping of video content are listed alongside explored themes and example exerts in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eExample Statements from main script mapped to prominent behavior theories.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStatement Type (Area Addressed)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTheoretical Basis: Behavior Change Model Component\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExample quote from primary video\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eWorries and concerns re: patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived Control, Capability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026ldquo;Yes, It is likely that some of the buprenorphine that you prescribe will get diverted. However, the risk of overdose from buprenorphine is extremely low and studies have shown that most diverted buprenorphine is used by other people either waiting for treatment, who can\u0026rsquo;t afford treatment or who do not want to be known to need treatment.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;My staff has not quit \u0026mdash; in fact they enjoy the MOUD patients as much as I do \u0026mdash; they enjoy seeing them grow \u0026mdash; especially the younger ones and the moms who come in with their children\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;After eleven years and thousands of patients, I can honestly say, adding MOUD to your practice will not incur the wrath of the DEA\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMoral Norm, Social Influences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eStigma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived Control, Capability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026ldquo;Your office will not be flooded with unruly, difficult patients that suck the life blood out of you - in fact \u0026mdash; these are patients who are grateful for care \u0026mdash; and many of them are already your own patients\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;We have not had any safety issues or an increase in inappropriate patient behaviors in waiting areas or with the staff since initiating the program more than 10 years ago.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBCW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAutomatic Motivational Influences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eit to Primary Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSDT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntrinsic Factors: Long-term relationships; Sense of calling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026ldquo;the key to retaining patients in treatment is the relationship that they have with their provider. MOUD patients are already among your patients.\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;You already believe in the MOUD model as a primary care physician: harm reduction, prevention, chronic disease management, whole person/whole family and community medicine\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eValue Beliefs; Role \u0026amp; Identity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSDT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIntrinsic Factors: Feeling Confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026ldquo;cautiousness is what makes us careful and thorough and excellent clinicians \u0026mdash; we are aware of our limits and know when to ask for help \u0026mdash; when learning something new, the key is to learn WHO to ask for help.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBCW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCapability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eImpact to practice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSDT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExtrinsic Factors: Financial Compensation, Workload and Autonomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026ldquo;Simply screening for patients within your current practice will present opportunities for treatment without having to expand your patient population if you don\u0026rsquo;t wish to do so\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBCW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOpportunity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGoal-setting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTPB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived Control, Capability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u0026ldquo;people \u0026lsquo;recover\u0026rsquo; to various degrees depending on a host of circumstances beyond your control \u0026mdash; not up to you to judge \u0026mdash; only to decide if this patient can continue to be prescribed the medication safely and to offer referral to higher level of treatment if necessary\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Sometimes better is the best you can do at the moment. As long as people are working and trying to move forward, work with them \u0026mdash; when they stop: set a plan \u0026mdash; they refuse: then part ways.\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBCW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCapability\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eNote. This mapping is not exhaustive: Other ties could be posited for several of the statements as the underlying theories have significant overlap, and concepts beyond these shown were covered in the script.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eAbbreviations:\u003c/p\u003e\n \u003cp\u003eTPB: Theory of Planned Behavior\u003c/p\u003e\n \u003cp\u003eSDT: Self-determination theory\u003c/p\u003e\n \u003cp\u003eBCW: Behavior Change Wheel\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eInsert\u003c/span\u003e Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHere\u003c/span\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eProcedures\u003c/h3\u003e\n\u003cp\u003eFollowing Institutional Review Board approval, research surveys were available to all participants across a 9-month funding period, April 24, 2023\u0026thinsp;\u0026minus;\u0026thinsp;January 24, 2024. Blast emails from CECentral provided the landing page/registration site to 5,259 members meeting inclusion criterion, with two repeat emails following unopened emails. Additional participation was gained from our partner\u0026rsquo;s advertising efforts, and through direct link to the site from CECentral\u0026rsquo;s topic directory.\u003c/p\u003e\n\u003cp\u003eUpon opening the landing page site, participants completed the pre-video survey and viewed the PrimV. Participants were randomized to next view either the ExV or the InV, followed by Post-video survey. Participants could also watch and evaluate the supplementary video not already viewed as part of the random assignment. E-gift cards were sent and medical education credits provided to all who completed Post-video surveys: \u003cspan\u003e$\u003c/span\u003e50 and 1.0 CME credits for PrimV\u0026thinsp;+\u0026thinsp;the randomly selected supplementary video; \u003cspan\u003e$\u003c/span\u003e75 and 1.25 CME for PrimV\u0026thinsp;+\u0026thinsp;both supplementary videos.\u003c/p\u003e\n\u003ch3\u003eResearch Survey\u003c/h3\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eFace validity of the survey was assessed by two PCP authors (SM, MZ) and one external PCP and refined accordingly.\u003c/p\u003e\n \u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003ePre-video survey\u003c/span\u003e assessed demographics and other characteristics including profession, degree, and specialty/subspecialty. To describe rural practice characteristics, zip code information was retrieved from CECentral registration. A second block of 5 questions were selected from prior survey items (\u003cspan class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e40\u003c/span\u003e) to evaluate job satisfaction.\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003ePost-video survey\u003c/span\u003e utilized a \u0026lsquo;Post / Retrospective-Pre\u0026rsquo; survey format following the PrimV, in which participants provided two ratings on the importance of listed concerns as a potential barrier to MOUD, and specifically buprenorphine, in their practice. Each concerned a topic raised in the videos, with the first set (6 ratings) related to concerns for patients with OUD and the second set (13 ratings) related to personal or professional barriers. An additional 8 ratings asked about change in participant\u0026rsquo;s confidence and intention to explore MOUD in their own office setting. The Post / Retrospective-Pre format provides comparison of participant\u0026rsquo;s \u0026ldquo;now\u0026rdquo; ratings to when they think back to their attitudes and beliefs prior to the video. The format reduces completion time and may be more accurate when the educational intervention could change participant\u0026rsquo;s understanding of the measured construct (\u003cspan class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e42\u003c/span\u003e). Additional Figure AF1 depicts the format and example questions. Following these ratings, two open-response questions asked what was compelling about and what was not as well received from the videos.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eLearning Assessment\u003c/h2\u003e\n \u003cp\u003eRequired for obtaining CE credit, questions following the research survey assessed: confidence that the knowledge and/or skills gained will improve participant\u0026rsquo;s ability to practice (Likert scale: strongly agree \u0026ndash; strongly disagree), whether the obtained information/ ideas will be useful (yes/no), and the \u003cem\u003e\u0026ldquo;impact that the activity will have on your practice\u003c/em\u003e\u0026rdquo; (open-ended).\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStatistical Analyses\u003c/h3\u003e\n\u003cp\u003eSummary statistics were generated for the variables of interest: Continuous variables were summarized using means and standard deviations and categorical variables were summarized using counts and percentages. Survey responses were analyzed for differences using Fisher\u0026rsquo;s exact non-parametric tests. Other planned analyses were conducted to assess difference in the primary outcome, intention to incorporate specific MOUD practices, by each supplementary video type and job satisfaction status. Job satisfaction status was a created variable derived from five Career Satisfaction questions. Responses on two career commitment questions (\u0026ldquo;In the next few years\u0026hellip;\u0026rdquo;) were not included in the determination for persons over age 60 given proximity to retirement; otherwise, if participants had a negative view of any of the 5 questions, they were classified as \u0026ldquo;Unsatisfied\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eData were analyzed using RStudio version 4.4.2. The significance level for all statistical tests is \u0026alpha;\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e\n\u003ch3\u003eQualitative Analysis\u003c/h3\u003e\n\u003cp\u003eParticipant responses to the survey\u0026rsquo;s three open-ended questions were analyzed for broad themes using the survey questions as prompts using OpenAI (Gemini, 2.0 Flash; accessed 2/3/2025). The primary author separately developed a code book and categorized responses to each question using the qualitative software program QDA dataMiner lite (Provalis Research), organized all coded responses into themes, and compared these themes for alignment with the AI output for each question prompt. The approach, closely aligned with previously successful analytic techniques for use of AI combined with manual investigator review of the dataset (\u003cspan class=\"CitationRef\"\u003e43\u003c/span\u003e), resulted in the appropriate level of thematic representation of key concepts for the targeted questions within this small qualitative dataset. Representative quotes were chosen by the investigator.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Profile\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, of the 37 participants, over 50% were physicians, with family medicine as the predominant specialty or subspecialty across a variety of practice settings. Nurse practitioners comprised the next largest group (30%). Research participants ranged in age from 33 to 53; most were white (83.3%) with a greater representation of females (58%). Almost half of the respondents (44.4%: 16/36 with 1 unknown) registered with a practice in a predominantly rural zip code. Most respondents provided positive responses to each of the 5 career satisfaction items; the calculated composite score designated 24 (66.7%) as satisfied with their job. Commitment to stay in clinical practice was high (86% disagreed somewhat or strongly that they would leave); however, a third of respondents (33.6%) desire to reduce time spent in direct patient care. Despite this, 67% of respondents characterize their patient relationships as long-term and meaningful.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrimary Care Respondent Demographics, Practice Characteristics, Markers of Career Satisfaction (N\u0026thinsp;=\u0026thinsp;37)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003emean\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eMedian (IQR)\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e47 (33,53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003en\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e%\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e57.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRefused\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRace/Ethnicity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e81.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Hispanic, Latino or Spanish origin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e97.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpecialty\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastroenterology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeriatric medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospice; Palliative Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternal Medicine/Pediatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e43.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRole\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e57.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDegree: DO\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e8\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cem\u003e38.1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDegree: MD\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e13\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cem\u003e61.9\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse APN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysician Assistant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e8.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnspecified\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePractice Characteristics\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAcademic health center/faculty practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFederally qualified health center or look alike\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital/health system owned medical practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependently owned medical practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e16.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural health clinic (federally qualified)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork site clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown/Other\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdded response: Hospice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCounty zip code\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCensus population\u0026thinsp;\u0026ge;\u0026thinsp;50% rural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrug Enforcement Administration X-waiver obtained\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e% hours/week in direct patient care\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003emean\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eMedian (IQR)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e40 (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eJob Satisfaction*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003en\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e%\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCareer satisfaction\u003c/b\u003e: \u003cem\u003e\u0026ldquo;Thinking very generally about your satisfaction with your overall career in medicine, would you say that you are currently\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery dissatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSomewhat dissatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSomewhat satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e63.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommitment to direct patient care\u003c/b\u003e: \u003cem\u003e\u0026ldquo;In the next few years, I hope to reduce the amount of time I spend in direct patient care\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree strongly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree somewhat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree somewhat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e19.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree strongly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCommitment to clinical practice\u003c/b\u003e: \u003cem\u003e\u0026ldquo;In the next few years, I hope to leave the practice of medicine\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree strongly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree somewhat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree somewhat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree strongly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSense of calling\u003c/b\u003e: \u003cem\u003e\u0026ldquo;For me, the practice of medicine is a calling.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree strongly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisagree somewhat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree somewhat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgree strongly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e63.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePatient relationships\u003c/b\u003e: \u003cb\u003e\u0026ldquo;\u003c/b\u003e\u003cem\u003eWith respect to your patients, with how many do you have a meaningful, long-term relationship?\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA few\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMany\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMost\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eJob Satisfaction\u003c/b\u003e: Answered negatively to any of the prior 5 questions.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnsatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c5\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*n\u0026thinsp;=\u0026thinsp;36 (1 respondent refused all)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026dagger;Zipcode provided in CE registration and categorized per 2020 Decennial Census. Obtained from Kentucky Association of Counties (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://kaco.org/articles/county-stats-rural-and-urban-population-breakdown/\u003c/span\u003e\u003cspan address=\"https://kaco.org/articles/county-stats-rural-and-urban-population-breakdown/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cem\u003e)\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eInsert\u003c/span\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHere\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eResearch Survey\u003c/h2\u003e \u003cp\u003eA significant reduction in importance scores was found for 6 of 19 barriers to MOUD, each reflective of professional or personal barriers rather than with the patients themselves: negative attitudes (of their practice\u0026rsquo;s employees, of their other patients), limited reimbursement, lack of clinical time, and professional fit/sense of calling. Significant change for the item, \u0026ldquo;Little management/administrative support for buprenorphine service line\u0026rdquo; reflected high importance ratings overall: of the 85% of the sample that deemed this a 4 or 5 (5-point scale) in Retrospective-Pre ratings, 27% considered this less, and 22% considered this more important post-video. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e depicts change scores for significant items. These and all items with non-significant change scores, which included all items regarding patient-related barriers, are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Additional Table AT1 presents all pre-test ratings and retrospective evaluation of change across each item.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eItems by Type and Change Rating (Post / Retrospective-Pre) Significance Levels (N\u0026thinsp;=\u0026thinsp;37)*\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eImportance of Barriers to Buprenorphine Prescribing\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ea. \u003cem\u003ePersonal or Professional Barriers\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional licensing board oversight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative attitudes/perceptions of staff, other practitioners in my practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep=.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative attitudes /perceptions of other patients in my practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep=.041\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative impact on my reputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork-load/paperwork for insurance prior authorization requirements\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLearning curve to take on new procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep=.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow or no need for this service in my practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnfavorable change in patient population mix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLittle management/ administrative support for buprenorphine service line\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep=.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimited reimbursement rate of buprenorphine therapy/return on investment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep=.024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of fit to my sense of who I am as a doctor, my calling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep=.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimited time in clinic setting for these appointments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep=.016\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsufficient supportive psychotherapy in the community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBarriers related to Patients with Opioid Use Disorder\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients are a Source of Frustration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients are a risk for medication diversion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients lack interest in treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCosts/coverage of medication for patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatients already see specialists for these medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep=.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInappropriate patient behaviors present safety issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep=.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eConfidence in Offering Treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIdentifying patients at risk for misuse of pain medication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManaging patients in your practice who receive buprenorphine from other treatment providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManaging buprenorphine prescribing in my practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLikelihood to Engage in Treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScreen patients for Opioid Use Disorder within my practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003ep\u0026thinsp;=\u0026thinsp;0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScreen for patients already receiving buprenorphine within my practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManage buprenorphine prescribing in my practice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrescribe buprenorphine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConsider board certification as an Addiction Medicine Specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e*Listed in order presented within the research survey. See Additional Table AT1 for full analytic detail and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for significant findings\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eInsert\u003c/span\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHere\u003c/span\u003e\u003c/p\u003e \u003cp\u003eParticipants randomized to view the supplementary video promoting external motivations (ExV, n\u0026thinsp;=\u0026thinsp;21) showed significant reduction, as compared to those who viewed the InV video (n\u0026thinsp;=\u0026thinsp;16), in the importance of two additional barriers: patient\u0026rsquo;s medication costs/coverage (p=.039) and inappropriate patient behaviors (safety; p\u0026thinsp;=\u0026thinsp;0.02). Additional evaluations were available from 65% (24/37) of participants who chose to continue watching the alternative (not assigned) video, but aside from demonstrating sufficient interest to invest additional time, the evaluative findings did not differ substantially and did not warrant further analysis.\u003c/p\u003e \u003cp\u003eAll respondents reported either no change or increased confidence in buprenorphine prescribing and patient management that was not statistically significant. Regarding the primary outcome, intention to make changes in practice to incorporate specific MOUD practices, participants endorsed a significantly greater likelihood to screen patients for OUD (see significant change scores: Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Of other future intentions, the consideration of addiction medicine certification, which bordered on significance in the primary analysis (p=.07), was significantly more likely among those who scored as \u0026ldquo;satisfied\u0026rdquo; in the job satisfaction composite score. These data are shown as the bottom five questions in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Additional Table AT2 shows all pre-test ratings and retrospective evaluation of change across each item.\u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eInsert\u003c/span\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHere\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eQualitative Responses\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows developed themes and example written evaluations of the videos. Responses indicate that participants appreciated that MOUD implementation was presented with a practical lens that altered their perception of feasibility and need for MOUD in primary care settings. A greater sense that OUD treatment maintains the values of PCPs by supporting a holistic care model for chronic diseases (from script; Value Beliefs; Role \u0026amp; Identity; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) was especially prominent. The presenter's relatable and passionate approach also resonated, in particular the video\u0026rsquo;s emphasis on the positive impact MOUD can have on, and potential to save, patients' lives. While the presenter made the process of clinic implementation seem less daunting, some viewers felt the challenges were overly simplified. A need for specific practical advice, further training, and implementation support were each mentioned as key hesitations regarding MOUD that respondents believe the video underemphasized.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOpen-ended Research Survey Questions* and Learning Assessment\u003csup\u003e\u0026dagger;\u003c/sup\u003e: Qualitative Themes Identified \u003cem\u003e(example quotes).\u003c/em\u003e Learning Assessment\u003csup\u003e\u0026dagger;\u003c/sup\u003e Scale Averages\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*\u003cem\u003eThe one thing that stood out to me and that I found compelling about this video was ___.\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTheme: Feasibility of Clinic Implementation\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;the ease of prescribing buprenorphine in a family practice setting and identifying those who may need it\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSub-theme: time commitment/burden on the practice\u003c/span\u003e \u003cem\u003e\u0026ldquo;Seeing patients for buprenorphine does not necessarily add time to your day and put you behind\u0026rdquo; | \u0026ldquo;Made it less daunting\u0026rdquo; | \u0026ldquo;Patients with addiction are already a part of my practice.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eTheme: Need/ Impact of/ Importance of Treatment\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Strong need in community\u0026rdquo; | \u0026ldquo;How much the presenter emphasized that providing treatment for addiction is saving lives. I think we often think about our own lack of comfort when treating addiction but this puts things into a better perspective\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSub-theme: Recovery Paths\u003c/span\u003e \u003cem\u003e\u0026ldquo;The ability to come alongside patients and improve their lives, which may look like abstinence and sobriety for some or may look like staying out of jail or the hospital for others: no path of recovery will look the same\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eTheme: Chronic Disease Model/Fit to Primary Care \u003cem\u003e\u0026ldquo;Addiction is a chronic disease. If I treat diabetes with medications, why wouldn\u0026rsquo;t I treat addiction with medications.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e*\u003cem\u003eThe one thing that I did not receive well from this video, or that dissuaded me about the use of buprenorphine medications for opioid use disorder (MOUD) in my clinic was___.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTheme: Implementation Barriers\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;no scope to change my clinical schedule, incorporate new patients, train medical assistants to answer questions related to SUD\u0026rdquo; | \u0026ldquo;lack of practical advice about office operations\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSub-Theme: Reimbursement Barriers\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Most of the patients I see who need buprenorphine are Medicaid and they pay very little per visit.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eTheme: Continued Training Needs\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Still need more training on side effects, dosing, monitoring, etc.\u0026rdquo; | \u0026ldquo;actual dosing and pharmacology review\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eTheme: Concern for Patient Behaviors (relapse, diversion) and regulations\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It would be difficult to see cycles of relapse\u0026rdquo; | \u0026ldquo;We can never fully stop diversion\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026dagger;\u003cem\u003eI feel confident that the knowledge and/or skills gained from this activity will improve my ability to practice.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrongly disagree\u003c/p\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003cp\u003eAgree\u003c/p\u003e \u003cp\u003eStrongly Agree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0%)\u003c/p\u003e \u003cp\u003e1 (1.5%)\u003c/p\u003e \u003cp\u003e31 (47.7%)\u003c/p\u003e \u003cp\u003e33 (50.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026dagger;\u003cem\u003eBased on the learning objectives, I obtained information and ideas that will be useful.\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62 (95.4%)\u003c/p\u003e \u003cp\u003e3 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003csup\u003e\u0026dagger;\u0026rdquo;\u003c/sup\u003e\u003cem\u003eThinking about the knowledge and skills you learned during this activity, please describe the impact that the activity will have on your practice\u003c/em\u003e\u0026rdquo;.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTheme: Openness/Willingness/Confidence\u003c/b\u003e\u003c/p\u003e \u003cp\u003ea) to Prescribe\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I will be more confident if I ever decide to prescribe bupe(renorphine) in Primary Care Setting.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003eb) to screen and identify OUD\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Recognizing opioid use disorder and understanding the role of PCPs\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003ec) to obtain further training/certification\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTheme: Enhanced Informed Decision-Making\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I will be able to address misconceptions both patients and providers have around MAT for opioid use disorder\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u0026bull; \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSub-Theme: Practice Compassionate Care/ Empathy/ Reduce Bias\u003c/span\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;openness to patient experiences and challenges\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther overriding themes from above prompts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTheme: Appeal of the Presenter\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The presenter's conviction toward the subject. She was very astute at identifying concerns that I also had\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I like the one provider experience in rural health. It made prescribing seem a little less daunting and a little more manageable\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eTheme: Learning Curve\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I felt somewhat like the presenter felt it was an easier thing to do then what it is.\u0026rdquo; | \u0026ldquo;It will give me reassurance that it\u0026rsquo;s okay to be nervous and cautious starting out\u0026rdquo; | \u0026ldquo;emphasis on support and mentorship\u0026rdquo;\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eInsert\u003c/span\u003e Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHere\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLearning Assessment\u003c/h2\u003e \u003cp\u003eParticipants responded that the content was both useful (95.4% yes) and provided knowledge/skills that would improve their ability to practice (98.4% Agree or Strongly Agree). Qualitative responses reinforced that the content increased intention to screen for opioid use disorder. An especially prominent theme was the recognition of participant\u0026rsquo;s own biases and desire to maintain a more compassionate, empathetic standard of care for patients with OUD.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eResearch Objectives and Findings\u003c/h2\u003e \u003cp\u003eThe video education evaluated here reduced the importance of several clinically important barriers to MOUD. These included PCP\u0026rsquo;s concerns for limited reimbursement, clinical time, and attitudinal concerns for their practice\u0026rsquo;s employees or patients. The video author offered a clear perspective that MOUD fits strongly with the practice model of a PCP. The impact of this was reflected in the significant change for the item \u0026ldquo;Lack of fit to my sense of who I am as a doctor, my calling\u0026rdquo;. While many (30%) maintained that this was not an important barrier for them (rank\u0026thinsp;=\u0026thinsp;1 in Retrospective-Pre and a rating of unchanged in Post assessment), across all retrospective Pre rating levels, this statement was deemed less important by 25% of the professional learners. Not unrelated, for those already highly satisfied with their clinical role, interest in expansion of their skills toward addiction medicine certification was significantly more likely.\u003c/p\u003e \u003cp\u003ePrimary care settings have shown equivalent efficacy and outcomes as specialty SUD centers for MOUD (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). Education (especially early in medical training)(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), mentoring, and expanded implementation interventions that are supported by leadership (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) are needed to initiate and maintain interest in providing MOUD in primary care. Three concerns deemed less important post-video rating were specific to implementation in the respondent\u0026rsquo;s own practice setting and so could be among the barriers that such training and support could best overcome. These included concerns for limited reimbursement, little management/administrative support, and lack of clinical time. One area where additional content could be added regards addressing concerns for management/administrative support. This item was the most frequently rated (59.5%) as being highly important pre-video, yet post-assessment ratings were equivalent. This reinforces the qualitative comment that the videos provided a \u0026ldquo;\u003cem\u003elack of practical advice about office operations\u0026rdquo;\u003c/em\u003e (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOne especially encouraging finding was that the videos created inspiration to screen for OUD, which can be a beginning point for the more committed actions that we sought to motivate. Video content highlighted the potential for appropriate referral for those who do not wish to prescribe or manage buprenorphine prescribing in their practice, likely enhancing receptiveness to this practice change. The presentation reinforced that PCPs would not need to expand patient volume and that, \u0026ldquo;Simply screening for patients within your current practice will present opportunities for treatment without having to expand your patient population if you don\u0026rsquo;t wish to do so\u0026rdquo; (exert, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u0026ldquo;Impacts to Practice\u0026rdquo;). Other studies have revealed suboptimal OUD screening by PCPs (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e) and reported on the need to educate PCPs that, as one participant noted, \u003cem\u003e\u0026ldquo;Patients with addiction are already a part of my practice\u0026rdquo;\u003c/em\u003e (feasibility theme, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In making this point, the videos also appeared to allay concerns for the negative attitudes of their practice\u0026rsquo;s employees, and of their other patients; a stigmatization that is especially concerning for rural practices (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Almost half of our sample was comprised of rural PCPs who have unique challenges for buprenorphine prescribing (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e); their receptivity to the messaging provides a starting point for development of additional content to address their needs with greater specificity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eExpanded access to evidence-based buprenorphine medication for OUD is a critical need, especially in rural areas, but efforts to engage PCPs in providing this service will not reach the desired level of impact without adequate educational outreach. Our dissemination effort was purposely limited to a single state as we desired messaging that could convey a sense of place and connectedness to our state\u0026rsquo;s practices and their largely rural patient populations. One discouraging finding was the difficulty in reaching this audience for potential participation. Despite soliciting over 5,200 potentially eligible learners by advertisement and active email solicitation, our small sample size remains a clear weakness. Potential self-selection of individuals already interested or engaged in MOUD practice also limits interpretation and is indicated in the finding that a Drug Enforcement Administration (DEA) X-waiver had already been obtained by 44% of the sample despite the termination of this requirement. Exploration of ways to enhance dissemination and to assure uptake of similar educational campaigns remains an outstanding need.\u003c/p\u003e \u003cp\u003eIn addition to our study\u0026rsquo;s restricted professional reach, the Post / Retrospective-Pre survey format may also limit our interpretations. Constraints of this format have been described elsewhere (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e); namely, that participants may not accurately recall or are ambiguous about their prior attitudes (recall bias), respond to an expectation for change (demand characteristics), or may change their perceptions of their initial attitudes after gaining new knowledge (response shift bias). Our study was not designed to assess potential over- or under- estimation of baseline attitudes.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis video series was scripted and presented by and for PCPs in an honest and informal way and emphasizes the transformative experiences of treating OUD in primary care. Advantages are the format\u0026rsquo;s easy online accessibility, minimal time commitment, motivational appeals utilizing behavior theory constructs, and direct approach to countering known negative perceptions and stigma for prescribing buprenorphine. The videos are housed as enduring material as a resource of our state\u0026rsquo;s practice-based research network (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e), allowing us to continue disseminating this education and further sustain reach to outpatient practices.\u003c/p\u003e \u003cp\u003e Messages that create support for more empathetic care \u0026ndash; and that emphasize a sense of purpose and fit with one\u0026rsquo;s calling for a career in primary care medicine \u0026ndash; could serve as an especially important motivator for expanding MOUD treatment capacity to address the continuing epidemic of opioid dependency and overdose.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe University of Kentucky Internal Review Board reviewed all activities, and a waiver of documentation of informed consent for the collection of evaluative data from the professional learners was granted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for this project was received from the Substance Use Priority Research Area of the University of Kentucky, Pilot Award (Office of the Vice President for Research, research priority areas) and from the University of Kentucky Department of Family \u0026amp; Community Medicine.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors provided substantial contributions to the design of the work and reviewed the final manuscript. KLR conceptualized the study, conducted thematic analysis of scripts and analyzed qualitative data. MZ conceptualized and prepared the educational content. KLR and HK acquired funding and wrote the original manuscript draft. KLR, SM, HK, and MZ created the survey questions and design. KLR and SM assisted with dissemination to professional partners in the state. KH and KM conducted analyses and prepared statistical tables.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe wish to thank Kennith Harris of the University of Kentucky CECentral for his significant assistance in filming the video and creating the landing page for the content. Jessica Sass, APRN, of the University of Kentucky Department of Family \u0026amp; Community medicine graciously reviewed the survey for face validity for this professional audience.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSubstance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: Results from the 2022 National Survey on Drug Use and Health (HHS Publication No. PEP23-07-01-006, NSDUH Series H-58): Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2023 [Available from: https://www.samhsa.gov/data/report/2022-nsduh-annual-national-report]\u003c/li\u003e\n \u003cli\u003eDowell D, Brown S, Gyawali S et al. Treatment for opioid use disorder: population estimates \u0026mdash; United States, 2022. 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Entry into primary care-based buprenorphine treatment is associated with identification and treatment of other chronic medical problems. Addict Sci Clin Pract. 2012;7(1):22. doi:10.1186/1940-0640-7-22\u003c/li\u003e\n \u003cli\u003edel Pozo B, Park JN, Taylor BG, Wakeman SE, Ducharme L, Pollack HA, et al. Knowledge, attitudes, and beliefs about opioid use disorder treatment in primary care. JAMA Netw Open. 2024;7(6):e2419094-e. doi: 10.1001/jamanetworkopen.2024.19094\u003c/li\u003e\n \u003cli\u003eAbraham R, Wilkinson E, Jabbarpour Y, Bazemore A. Family physicians play key role in bridging the gap in access to opioid use disorder Treatment. Am Fam Physician. 2020;102(1):10.\u003c/li\u003e\n \u003cli\u003eTong ST, Hochheimer CJ, Peterson LE, Krist AH. Buprenorphine provision by early career family physicians Ann Fam Med. 2018;16(5):443-6. doi: doi:10.1370/afm.2261\u003c/li\u003e\n \u003cli\u003eHaffajee RL, Andraka-Christou B, Attermann J, Cupito A, Buche J, Beck AJ. 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A systematic review of patients\u0026apos; and providers\u0026apos; perspectives of medications for treatment of opioid use disorder. J Subst Abuse Treat. 2020;119:108146. doi: 10.1016/j.jsat.2020.108146\u003c/li\u003e\n \u003cli\u003eHarder VS, Villanti AC, Heil SH, Smith ML, Gaalema DE, Meyer MC, et al. Opioid use disorder treatment in rural settings: The primary care perspective. Prev Med. 2021;152(Pt 2):106765. doi:10.1016/j.ypmed.2021.106765\u003c/li\u003e\n \u003cli\u003eLai B, Croghan I, Ebbert JO. Buprenorphine waiver attitudes among primary care providers. J Prim Care Community Health. 2022;13:21501319221112272. doi: 10.1177/21501319221112272\u003c/li\u003e\n \u003cli\u003eRoper KL, Jones J, Rowland C, Thomas-Eapen N, Cardarelli R. Mixed methods study of patient and primary care provider perceptions of chronic pain treatment. Patient Educ Couns. 2021;104(3):585-94. doi:10.1016/j.pec.2020.08.038\u003c/li\u003e\n \u003cli\u003ePeterson LE, Morgan ZJ, Eden AR. Early-Career and Graduating Physicians More Likely to Prescribe Buprenorphine. J Am Board Fam Med. 2020;33(1):7-8. doi:10.3122/jabfm.2020.01.190230\u003c/li\u003e\n \u003cli\u003eLott A, Danner AN, Malte CA, Salameh HA, Bachowski D, Gordon AJ, et al. Implementing buprenorphine for opioid use disorder in veterans health administration primary care: a qualitative analysis. Addict Sci Clin Pract. 2025;20(1):38. doi:10.1186/s13722-025-00568-9\u003c/li\u003e\n \u003cli\u003eMazzarelli S, Blewer AL, \u0026Oslash;stbye T, Rhodes K, Plasencia G, Hart L, et al. Impact of implementing primary care-based medication for opioid use disorder on provider and staff perceptions. Family Practice. 2024;41(6):1018-24. doi: 10.1093/fampra/cmae044\u003c/li\u003e\n \u003cli\u003eFranz B, Dhanani LY, Bogart S, Fenstemaker C, Miller WC, Hall OT, et al. Different forms of stigma and rural primary care professionals\u0026apos; willingness to prescribe buprenorphine. J Subst Use Addict Treat. 2025;171:209633. doi: 10.1016/j.josat.2025.209633\u003c/li\u003e\n \u003cli\u003eMorenz AM, Nance RM, Mixson LS, Feinberg J, Smith G, Korthuis PT, et al. Barriers to accessing medications for opioid use disorder among rural individuals. Int J Drug Policy, 140: 104805. doi: 10.1016/j.drugpo.2025.104805\u003c/li\u003e\n \u003cli\u003eStopka TJ, Estadt AT, Leichtling G, Schleicher JC, Mixson LS, Bresett J, et al. Barriers to opioid use disorder treatment among people who use drugs in the rural United States: a qualitative, multi-site study. Soc Sci Med. 2024;346:116660. doi: 10.1016/j.socscimed.2024.116660\u003c/li\u003e\n \u003cli\u003eDomino ME, Sylvia S, Green S. Nudging primary care providers to expand the opioid use disorder workforce. Health Serv Res. 2022;57(2):403-10. doi: 10.1111/1475-6773.13894\u003c/li\u003e\n \u003cli\u003eMurshid MA, Mohaidin Z. Models and theories of prescribing decisions: A review and suggested a new model. Pharm Pract (Granada). 2017;15(2):990. doi:10.18549/PharmPract.2017.02.990\u003c/li\u003e\n \u003cli\u003eAjzen I. The theory of planned behavior. Organ Behav Hum Decis Process 1991;50(2):179-211. doi: 10.1016/0749-5978(91)90020-T\u003c/li\u003e\n \u003cli\u003eGodin G, B\u0026eacute;langer-Gravel A, Eccles M, Grimshaw J. Healthcare professionals\u0026apos; intentions and behaviours: A systematic review of studies based on social cognitive theories. Implement Sci. 2008;3(1):36. doi:10.1186/1748-5908-3-36\u003c/li\u003e\n \u003cli\u003eRyan RM DE. Self-determination theory: Basic psychological needs in motivation, development, and wellness. New York: Guilford Press; 2017. doi: 10.7202/1041847ar\u003c/li\u003e\n \u003cli\u003eLandon BE, Reschovsky J, Blumenthal D. Changes in career satisfaction among primary care and specialist physicians, 1997-2001. J Am Med Assoc. 2003;289(4):442-449. doi:10.1001/jama.289.4.442\u003c/li\u003e\n \u003cli\u003eMoller AC, Jager AJ, Williams GC, Kao AC. US physicians\u0026apos; work motivation and their occupational health: A national survey of practicing physicians. Med Care. 2019;57(5):334-340. doi:10.1097/mlr.0000000000001101\u003c/li\u003e\n \u003cli\u003eTak HJ, Curlin FA, Yoon JD. Association of intrinsic motivating factors and markers of physician well-being: a national physician survey. J Gen Int Med. 2017;32(7):739-746. doi:10.1007/s11606-017-3997-y\u003c/li\u003e\n \u003cli\u003eMichie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6(1):42. doi:10.1186/1748-5908-6-42\u003c/li\u003e\n \u003cli\u003eRasinski KA, Lawrence RE, Yoon JD, Curlin FA. A sense of calling and primary care physicians\u0026rsquo; satisfaction in treating smoking, alcoholism, and obesity. Arch Intern Med (Chic). 2012;172(18):1423-1424. doi:10.1001/archinternmed.2012.3269\u003c/li\u003e\n \u003cli\u003eHill LG, Betz DL. Revisiting the retrospective pretest. Am J Eval. 2005;26(4):501-517. doi:10.1177/1098214005281356\u003c/li\u003e\n \u003cli\u003eHwalek M, Cassandra S-F, and Wasserman D. Retrospective pretests: recent use in visitor studies research and ways to make them more informative. Visit Stud. 2022;25(1):1-21. doi:10.1080/10645578.2021.1977084\u003c/li\u003e\n \u003cli\u003eSalazar M, Chaw M, Hellier Y, Hsia S, Gruenberg K. Comparison of qualitative analyses conducted by artificial intelligence versus traditional methods. Am J Pharm Educ. 2025;89(12). doi: 10.1016/j.ajpe.2025.101882\u003c/li\u003e\n \u003cli\u003eLagisetty P, Klasa K, Bush C, Heisler M, Chopra V, Bohnert A. Primary care models for treating opioid use disorders: What actually works? A systematic review. PloS one. 2017;12(10):e0186315-e.\u003c/li\u003e\n \u003cli\u003eShuey B, Lee D, Ugalde I, Borgan S, Bresnan C, Qureshi M, et al. Evaluation of resident physicians\u0026apos; knowledge of and attitudes towards prescribing buprenorphine for patients with opioid use disorder. J Addict Med. 2021;15(3):219-25. doi: 10.1097/adm.0000000000000750\u003c/li\u003e\n \u003cli\u003eWyse JJ, Eckhardt A, Newell S, Gordon AJ, Morasco BJ, Carlson K, et al. . Integrating buprenorphine for opioid use disorder into Rural, Primary Care Settings. J Gen Int Med. 2024;39(12):2142-9. doi:10.1007/s11606-024-08898-1\u003c/li\u003e\n \u003cli\u003eCole ES, DiDomenico E, Cochran G, Gordon AJ, Gellad WF, Pringle J, et al. The role of primary care in improving access to medication-assisted treatment for rural medicaid enrollees with opioid use disorder. J Gen Int Med. 2019;34(6):936-943. doi:10.1007/s11606-019-04943-6\u003c/li\u003e\n \u003cli\u003ePrescribing Buprenorphine in Primary Care. CE Central course site. https://bit.ly/KAN_Resources. Accessed 2 February 2026.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"addiction-science-and-clinical-practice","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ascp","sideBox":"Learn more about [Addiction Science \u0026 Clinical Practice](https://ascpjournal.biomedcentral.com/)","snPcode":"13722","submissionUrl":"https://submission.nature.com/new-submission/13722/3","title":"Addiction Science \u0026 Clinical Practice","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Addiction Medicine, buprenorphine, Primary care, Rural Health, Cross-Sectional Studies, Opioid-Related Disorders, Education, Continuing","lastPublishedDoi":"10.21203/rs.3.rs-8769235/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8769235/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePractitioners in primary care (PCPs) face significant barriers and lack of motivation for expansion of medications for opioid use disorder (MOUD) in their service. Educational videos specifically targeted at the primary care setting and utilizing key determinants of behavior change were assessed for impact on PCP viewer\u0026rsquo;s attitudes and intention to explore MOUD.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA rural-setting PCP scripted the videos, describing her extensive experience treating patients using buprenorphine. Content addressed key barriers and negative perceptions of MOUD in the primary video; supplementary videos centered on clinic and societal benefits (external motivation) or personal and professional rewards (internal motivation). Cross-sectional surveys accompanied the videos on a CE platform. Participation was open to family or internal medicine (MD, DO, APRN, PA) professionals in primary care family or internal medicine in Kentucky. Surveys measured demographics, career satisfaction, and change (Post / Retrospective-Pre format) in importance of 19 barriers and 4 areas of confidence for MOUD practice. Intention to explore MOUD was the primary outcome. Educational content was rated for gain in clinical knowledge/skills and information usefulness. Feedback on specific aspects of video content and general impact was probed in open-ended questions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 37 professional learners, concern for negative attitudes/perceptions across the practice (staff, other practitioners, patients), limited appointment time, and reimbursement of clinical visits were all reduced in importance in Post-video assessment (Fisher\u0026rsquo;s non-parametric tests; p\u0026rsquo;s \u0026le; .05). A sense that MOUD fits with ones\u0026rsquo; calling in being a doctor was positively impacted. Likelihood to screen for OUD was increased, and participants who scored higher on career satisfaction were more likely to consider board certification as an Addiction Medicine Specialist.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eEducation that is conceived for and specifically responsive to the primary care environment and especially the challenges of rural practice can help overcome perceived barriers and promote consideration of MOUD service in primary care practice.\u003c/p\u003e","manuscriptTitle":"Changing Minds on MOUD: Impact of Messages to Motivate Expanded Access to Buprenorphine in Primary Care Settings","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 17:18:20","doi":"10.21203/rs.3.rs-8769235/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-21T19:24:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"254675756946834316521914941333223656209","date":"2026-03-30T15:41:50+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-18T18:34:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173761818745779937996627748075719077456","date":"2026-03-04T12:24:06+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-11T01:48:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-09T18:13:38+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-04T07:25:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"Addiction Science \u0026 Clinical Practice","date":"2026-02-02T22:21:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"addiction-science-and-clinical-practice","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ascp","sideBox":"Learn more about [Addiction Science \u0026 Clinical Practice](https://ascpjournal.biomedcentral.com/)","snPcode":"13722","submissionUrl":"https://submission.nature.com/new-submission/13722/3","title":"Addiction Science \u0026 Clinical Practice","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cb609d1b-4d84-4dbe-93a5-bd7fdf46881a","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-16T17:18:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 17:18:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8769235","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8769235","identity":"rs-8769235","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}