Academic detailing to improve appropriate opioid prescribing: a mixed-methods process evaluation.

Area of Science:

• Health Services Research
• Medical Education
• Pain Management

Background:

• Academic detailing, an educational outreach service, was implemented in Ontario to improve opioid prescribing and pain management among family physicians.
• The study aimed to evaluate the impact of this service on opioid prescribing practices.

Purpose of the Study:

• To assess the effectiveness of academic detailing in modifying opioid prescribing patterns.
• To explore the mechanisms through which academic detailing influenced physicians' prescribing behaviors and pain management strategies.

Main Methods:

• A mixed-methods approach was employed, collecting quantitative prescribing data and qualitative interview data from 2017 to 2019.
• Prescribing outcomes were compared between physicians receiving academic detailing and a matched control group.
• Qualitative interviews, guided by the Theoretical Domains Framework, explored physicians' experiences and perceptions of academic detailing.

Main Results:

• Physicians participating in academic detailing demonstrated a greater reduction in opioid prescribing compared to the control group (n=238 vs. n=238).
• Interviews with 17 physicians revealed that academic detailing addressed barriers such as lack of confidence, patient interaction challenges, and prescribing/tapering decisions.
• Key drivers of practice change included reinforced knowledge, discussion of complex patient cases, and strategies for difficult conversations.

Conclusions:

• Academic detailing effectively addressed barriers and enablers to reduce high-risk opioid prescribing in primary care.
• This study provides a nuanced understanding of how educational outreach can improve opioid stewardship.
• The findings will inform the broader implementation and scaling of academic detailing services.