Table 1 The PROUD intervention: three implementation strategies

(1) Providing funding and guidance to hire a NCM The PC clinic is provided funding for 1.0 Full Time Equivalent salary for a NCM for 2 years. The clinic leaders and health system then recruit, hire, and onboard a full-time NCM. Of note, although the PROUD trial provides financial support for the NCM salary and support for training and TA for the NCMs, health system leaders, not researchers, implement the MA Model in the intervention clinic. Further, the health system and its clinicians provide all clinical care to patients

(2) Training and ongoing technical assistance (TA) A TA team at Boston Medical Center provides training before the NCMs begin seeing patients and subsequent, ongoing support. This TA support includes training, an OBAT manual [27], a weekly videoconference to support and coach PROUD NCMs, and one-on-one consultation for questions as needed. The TA team’s OBAT nurses train the site NCMs in Boston for approximately 1.5–2 days. Training includes both didactic sessions and “shadowing” experienced NCMs while they provide care for patients with OUD. After each NCM is trained, a member of the TA team makes an in-person site visit to that intervention clinic offering training to all PC staff and meeting with the team providing PC OUD treatment. The weekly videoconferences consist of checking in with the NCMs about their patients, with a focus on problem-solving patient-, clinic- and system-level challenges, didactics on common challenges, and modeling of non-stigmatizing language and patient-centered care. A second site visit is optional to address challenges at the nursing level

(3) PC providers trained and mentored At least three PC providers are required to agree to prescribe buprenorphine, obtaining training and a Drug Enforcement Administration (DEA) waiver if not already waivered. Each PC prescriber is also asked to identify a mentor who can either be a local addictions expert in their health system or a mentor from a national program of voluntary mentors through the Providers Clinical Support System [30]. The TA team facilitates engagement between buprenorphine prescribers and their mentors during the site visit(s)