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Impact of Academic Detailing on Opioid Prescribing Among Primary Care Providers in the Chicagoland Region
thesisposted on 01.12.2019, 00:00 by Christopher D Saffore
Academic detailing (AD) is an effective strategy to educate clinicians on current clinical guidelines to modify and improve prescribing behavior. An AD program focused on safe opioid prescribing was delivered to primary care clinicians within a large heath system in the metropolitan Chicago area from June 2018 to August 2018.Three studies were conducted to evaluate the impact of this AD program on opioid and non-opioid prescribing in primary care. First, a difference-in-differences (D-I-D) approach was used to compare changes in total opioid prescribing and high-dose (>90 morphine milligram equivalents/day) opioid prescribing among AD-exposed clinicians who reported an intention to change or no/low intention to change their practice. Opioid prescribing outcomes were compared six months before and after the AD program, via repeated measures linear regression models, using data from the Illinois Prescription Monitoring Program. The intention to change group had a 1.48 (95% CI: -2.48, -0.47) and a 0.50 (95% CI: -0.69, -0.31) lower mean change in the monthly rate of total opioid prescriptions and high-dose opioid prescriptions, respectively, compared to the no/low intention to change group. Second, the secondary effects of the opioid-focused AD program were evaluated by comparing changes in benzodiazepine (BZD), non-BZD sedative hypnotic, and carisoprodol prescriptions among AD-exposed providers and a control group. This study used the same study design and data source used in the first study. BZD prescriptions declined in both groups after implementation of the AD program. However, the AD-exposed group had a 0.73 (95% CI: 0.14, 1.31) higher rate of BZD prescriptions compared to the control group following the AD program. There was no meaningful change in the rate of non-BZD sedative-hypnotic and carisoprodol prescriptions between the two groups. Third, a qualitative analysis of field notes documenting encounters with clinicians during the AD program was conducted to identify recurring themes related to opioid prescribing barriers in primary care. Barriers to safe opioid prescribing were organized into six themes: 1) gaps in knowledge; 2) lack of prescription monitoring program (PMP) utilization; 3) patient pressures to prescribe opioids; 4) insurance coverage policies; 5) provider beliefs; and 6) health system pain management practices. This body of work demonstrates the utility of AD is an effective to approach to modify controlled substance prescribing and elicit barriers to safe opioid prescribing in primary care.