Academic Detailing to Improve Opioid Safety: Implementation Lessons from a Qualitative Evaluation.

Midboe AM, Wu J, Erhardt T, Carmichael JM, Bounthavong M, Christopher MLD, Gale RC. Academic Detailing to Improve Opioid Safety: Implementation Lessons from a Qualitative Evaluation. Pain medicine (Malden, Mass.). 2018 Sep 1; 19(suppl_1):S46-S53.

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Abstract:

Objective: Academic detailing (AD) is a promising intervention to address the growing morbidity and mortality associated with opioids. While AD has been shown to be effective in improving provider prescribing practices across a range of conditions, it is unclear how best to implement AD. The present study was designed to identify key lessons for implementation based on a model AD program in the Veterans Health Administration (VA). Design: Qualitative process evaluation using semistructured interviews. Setting: Seven VA health care systems in the Sierra Pacific region. Subjects: Current and former academic detailers (N? = 10) and VA providers with varying exposure to AD (high, low, or no; N? = 20). Methods: Semistructured interviews were audio-recorded and transcribed. We used a team-based, mixed inductive and deductive approach guided by the Consolidated Framework for Implementation Research. Results: Key lessons identified by academic detailers and providers coalesced around key themes: 1) one-on-one sessions customized to the provider's patient population are most useful; 2) leadership plays a critical role in supporting providers' participation in AD programs; 3) tracking academic detailer and provider performance is important for improving performance for both groups; 4) academic detailers play a key role in motivating provider behavior change and thus training in Motivational Interviewing is highly valuable; and 5) academic detailers noted that networking is important for sharing implementation strategies and resources. Conclusions: Identifying and incorporating these key lessons into the implementation of complex interventions like AD are critical to facilitating uptake of evidence-based interventions addressing the opioid epidemic.