Practice change intentions after academic detailing align with subsequent opioid prescribing

Area of Science:

• Clinical Practice and Quality Improvement
• Health Services Research
• Opioid Prescribing Behavior

Background:

• Educational outreach interventions, such as academic detailing (AD), aim to improve clinician behavior.
• Self-reported behavior change is a common metric, but its accuracy in reflecting actual practice change is often uncertain.
• Evaluating the alignment between stated intentions and observed practice is crucial for intervention effectiveness.

Purpose of the Study:

• To assess the concordance between primary care clinicians' self-reported intentions to change opioid prescribing.
• To compare these intentions with actual changes in opioid prescribing behavior following an academic detailing intervention.

Main Methods:

• A difference-in-differences approach analyzed opioid prescribing data from the Illinois Prescription Monitoring Program.
• An opioid-focused academic detailing intervention was delivered to primary care clinicians.
• Clinicians were grouped based on self-reported intention to change practice post-intervention; prescribing outcomes were compared pre- and post-intervention.

Main Results:

• 149 clinicians were analyzed; 72 reported intention to change, 77 reported no-to-moderate intention.
• Clinicians intending to change prescribed significantly fewer total opioid prescriptions per month (-1.48).
• The intention-to-change group also showed a reduction in high-dose opioid prescriptions per month (-0.50).

Conclusions:

• A notable alignment exists between clinicians' self-reported intentions and their actual opioid prescribing behavior changes.
• Standardized single-item practice change measures can serve as immediate indicators of future behavioral shifts.
• Findings support the utility of self-reported measures in evaluating opioid-focused educational outreach interventions.