Discussion
SUDs, OUD, ’
This study demonstrated that a stigma reduction intervention was not significantly related to PCC stigma, intentions, or CDS tool use. However, as hypothesized, PCCs who reported greater stigma also had lower desire to work with patients with OUD (across multiple measures, including intentions to get waivered, intentions to prescribe buprenorphine, and willingness to work with OUD) and believed that treatments were less effective and patients would be less likely to adhere to treatments. However, stigma was not related to an objective measure of management of OUD, i.e., CDS tool use. Thus, stigma likely acts as a barrier to care for OUD in primary care settings based on PCC’s attitudes towards working with people with OUD, but it is not clear how this affects PCC behavior.To our knowledge, only two interventions have been studied to reduce stigma toward patients with SUDs among practicing healthcare clinicians, [The stigma reduction training incorporated patient narratives to reduce stigma. Hearing patients tell their stories has been shown to be the most effective approach for reducing stigma towards people with a stigmatized health condition [Our hypothesis that stigma towards OUD was related to desire to treat OUD was supported. Specifically, PCCs who reported more stigma also reported lower intentions to get waivered and to prescribe buprenorphine if a waiver were no longer required and less willingness to work with patients with OUD. Further, stigma was related to their perceived effectiveness of and patients’ adherence to treatment for OUD. Previous studies have shown that healthcare providers hold many of the same stigmatizing beliefs toward people with OUD as the general population [Our study also examined whether training assignment and self-reported stigma were related to an objective measure of PCC behavior: CDS tool use in the 6 months following the training. A major limitation of this analysis was that PCCs infrequently clicked into the CDS tool. Although PCCs in our system have used CDS tools in our system before, [The strengths of this study include the randomized design and the delivery of an intervention to practicing PCCs. In addition to the design limitations described previously, there was no measure of training engagement or treatment fidelity, and the intervention was delivered in one integrated healthcare system, which may limit generalizability to other systems and settings. In addition, as noted in our a priori power analysis, we had goal of 112 PCCs completing the training. We had initially estimated that there would be more eligible PCCs in the clinics, and we were unable to encourage more than 50% of PCCs to participate, likely at least in part because this intervention was delivered during the COVID-19 pandemic and PCCs were understandably overwhelmed. Nonetheless, the observed effect sizes were very small, indicating that even with a larger sample size, we may not have seen statistically significant effects of our intervention. Finally, the measure of stigma was self-report, which may be subject to social desirability.