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Background:
Academic detailing (AD) is a tailored, interactive educational outreach intervention that may improve patient outcomes. Insight into the design of AD interventions and the extent to which they are effective can help inform future AD-based programmes. The objective of this scoping review was to characterize opioid-focused AD interventio...
Context in source publication
Citations
... These findings suggest that our AD strategy with pharmacists in Oslo, Norway, demonstrates a similar level of feasibility and acceptability to that observed in Smart et al "s study. In a systematic review conducted by Kulbokas et al, 43 5 interventions 44-48 further supported these findings and highlighted the effectiveness of AD as an intervention tool associated with high reported satisfaction, both in terms of feasibility and acceptability. Moreover, Smart et al 33 reported a WTC score of 2.66 (SD 1.23) which is lower than our WTC score at 3.83 (SD 0.86). ...
... A systematic review that included 22 studies reported visit durations ranging from 16 to 31 min. 43 In our study, the mean visit duration was 31 min, which is longer than the initially indicated 20 min during recruitment. However, the AD visits were designed to be a dialog between the pharmacist and the detailer. ...
Excessive and incorrect use of antibiotics contributes to the rise of antimicrobial resistance (AMR). Given that pharmacists act as final checkpoint before antibiotics is handled over to patients, they play a crucial role in promoting proper antibiotic use and ensuring treatment adherence. However, there is often a gap between the patients’ needs and perceptions, and what the pharmacists provide. Improving pharmacists’ training is essential for enhancing patient-centered care. The aim of this research was to evaluate the suitability of academic detailing (AD) for improving Norwegian pharmacists’ knowledge and practice on adherence promoting counseling of antibiotic patients. Key insights from prior qualitative research regarding community pharmacists’ position in promoting optimized antibiotic use were incorporated in a tailored AD program. The AD’s suitability was evaluated using the validated “Provider Satisfaction with Academic Detailing” (PSAD) and “Detailer Assessment of Visit Effectiveness” (DAVE) instruments. Additionally, participants preferred knowledge updates method were assessed. Eighty-one of 86 visits completed PSAD (94% response rate). Satisfaction summary score for PSAD was 40.03 (of maximum 45) and scale summary score for DAVE 12.45 (of maximum 15). One-sample t-test (P < .001) indicated preference for AD over other knowledge update methods. This study confirmed that AD is a successful knowledge updating tool for improving adherence promoting counseling among Norwegian pharmacists. Future research should align practice change intentions with actions post-AD and evaluate patient impact.
... External facilitators provide ongoing support, recommendations, education, and academic detailing for two years. Academic detailing entails in-person one-on-one education visits providing unbiased evidence-based recommendations between expert external facilitators and rural hospital staff [47]. ...
Background
Opioid related overdose morbidity and mortality continue to significantly impact rural communities. Nationwide, emergency departments (EDs) have seen an increase in opioid use disorder (OUD)-related visits compared to other substance use disorders (SUD). ED-initiated buprenorphine is associated with increased treatment engagement at 30 days. However, few studies assess rural ED-initiated buprenorphine implementation, which has unique implementation barriers. This protocol outlines the rationale and methods of a rural ED-initiated buprenorphine program implementation study.
Methods
This is a two-year longitudinal implementation design with repeated qualitative and quantitative measures of an ED-initiated buprenorphine program in the rural Mountain West. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outlines intervention assessments. The primary outcome is implementation measured by ED-initiated buprenorphine protocol core components. Reach, adoption, and maintenance are secondary outcomes. External facilitators from an academic institution with addiction medicine and prior program implementation expertise partnered with community hospital internal facilitators to form an implementation team. External facilitators provide ongoing support, recommendations, education, and academic detailing. The implementation team designed and implemented the rural ED-initiated buprenorphine program. The program includes OUD screening, low-threshold buprenorphine initiation, naloxone distribution and administration training, and patient navigator incorporation to provide warm hand off referrals for outpatient OUD management. To address rural based implementation barriers, we organized implementation strategies based on Expert Recommendations for Implementing Change (ERIC). Implementation strategies include ED workflow redesign, local needs assessments, ED staff education, hospital leadership and clinical champion involvement, as well as patient and community resources engagement.
Discussion
Most ED-initiated buprenorphine implementation studies have been conducted in urban settings, with few involving rural areas and none have been done in the rural Mountain West. Rural EDs face unique barriers, but tailored implementation strategies with external facilitation support may help address these. This protocol could help identify effective rural ED-initiated buprenorphine implementation strategies to integrate more accessible OUD treatment within rural communities to prevent further morbidity and mortality.
Trial Registration
ClinicalTrials.gov National Clinical Trials, NCT06087991. Registered 11 October 2023 – Retrospectively registered, https://clinicaltrials.gov/study/NCT06087991 .
... Examples include "has been on chronic narcotics for years," "rare diazepam use," "I have been prescribing same dose of Klonopin for years," "for broken toes," and "I am not prescribing opioids" highlight the need for additional education for naloxone prescribing. A review article showed that targeted provider education described as "academic detailing" can improve naloxone prescribing habits, especially when the education is provided one-on-one, typically between providers and clinical pharmacists [15]. This shows an opportunity for targeted education at our institution underscoring a potential educational need for residents and medical students. ...
Background: Despite national guidelines recommending naloxone co-prescription with high-risk medications, rates remain low nationally. This was reflected at our institution with remarkably low naloxone prescribing rates. We sought to determine if a clinical decision support (CDS) tool could increase rates of naloxone co-prescribing with high-risk prescriptions.
Methods: An alert in the electronic health record was triggered upon signing an order for a high-risk opioid medication without a naloxone co-prescription. We examined all opioid prescriptions written by family and general internal medicine practitioners at the University of Iowa Hospitals and Clinics in outpatient encounters between November 30, 2020, and February 28, 2022. Once triggered by a high-risk prescription, the CDS tool had the option to choose an order set with an automatically selected co-prescription for naloxone along with patient instructions automatically added to the patient's after-visit summary (AVS). We examined the monthly percentage of patients receiving Schedule II opioid prescriptions ≥90 morphine milliequivalents (MME)/day who received concurrent naloxone prescriptions in the 12 months before the CDS went live and the three months following go-live.
Results: Concurrent naloxone prescriptions increased from 1.1% in the 12 months prior to implementation in November 2021 to 9.4% (p<0.001) during the post-intervention period across eight family medicine and internal medicine clinics.
Discussion: This single-center quality improvement project with retrospective analysis demonstrates the potential efficacy of a single CDS tool in increasing the rate of naloxone prescription. The impact of such prescribing on overall mortality requires further research.
Conclusions: The CDS tool was easy to implement and improved rates of appropriate naloxone co-prescribing.
... In the context of opioid prescribing for acute pain management after dental procedures, these may be considered as [1] knowledge regarding risks and benefits of analgesics; [2] pressure to prescribe opioids, which we have previously established is related to patient expectations; [20] and [3] removing immediate barriers to acute pain management [21]. In that context, this study will combine three elements to create a multicomponent intervention to modify prescriber behavior: [1] prescriber education using academic detailing [22,23], [2] standardized patient post-extraction instructions for distribution, and [3] blister packaged acetaminophen and ibuprofen for distribution. ...
Background
Dentists and oral surgeons are leading prescribers of opioids to adolescents and young adults (AYA), who are at high risk for developing problematic opioid use after an initial exposure. Most opioids are prescribed after tooth extraction, but non-opioid analgesics provide similar analgesia and are recommended by multiple professional organizations.
Methods
This multi-site stepped wedge cluster-randomized trial will assess whether a multicomponent behavioral intervention can influence opioid prescribing behavior among dentists and oral surgeons compared to usual practice. Across up to 12 clinical practices (clusters), up to 33 dentists/oral surgeons (provider participants) who perform tooth extractions for individuals 12–25 years old will be enrolled. After enrollment, all provider participants will receive the intervention at a time based on the sequence to which their cluster is randomized. The intervention consists of prescriber education via academic detailing plus provision of standardized patient post-extraction instructions and blister packs of acetaminophen and ibuprofen. Provider participants will dispense the blister packs and distribute the patient instructions at their discretion to AYA undergoing tooth extraction, with or without additional analgesics. The primary outcome is a binary, patient-level indicator of electronic post-extraction opioid prescription. Data for the primary outcome will be collected from the provider participant’s electronic health records quarterly throughout the study. Provider participants will complete a survey before and approximately 3 months after transitioning into the intervention condition to assess implementation outcomes. AYA patients undergoing tooth extraction will be offered a survey to assess pain control and satisfaction with pain management in the week after their extraction. Primary analyses will use generalized estimating equations to compare the binary patient-level indicator of being prescribed a post-extraction opioid in the intervention condition compared to usual practice. Secondary analyses will assess provider participants’ perceptions of feasibility and appropriateness of the intervention, and patient-reported pain control and satisfaction with pain management. Analyses will adjust for patient-level factors (e.g., sex, number of teeth extracted, etc.).
Discussion
This real-world study will address an important need, providing information on the effectiveness of a multicomponent intervention at modifying dental prescribing behavior and reducing opioid prescriptions to AYA.
ClinicalTrials.gov
NCT06275191.
... When designing initiatives to reduce low-value care, it is important to appreciate that any strategy or component is unlikely to be effective across all quality and safety problems in general. 9 Evidence shows that even frequently used components, like audit and feedback, 18 academic detailing 19 and policy interventions work some of the time but none work all the time, the observed effects are often modest and it is not always clear why the modest change occurred. 9 In addition, some barriers faced in de-implementation interventions such as how clinicians handle diagnostic uncertainty may require adaptation or different components. ...
... A literature review provides insight on academic detailing efforts that serve as targeted interventions to ensure clinicians are appropriately trained in opioid prescribing and to improve opioid-related outcomes. 10 This work highlights the critical role clinicians play in curbing the overdose epidemic by reducing initial exposure to opioids and ensuring safe prescribing practices. Empirical work in this issue points to advancements in understanding the impact of problem-solving courts as a prevention strategy for reducing opioid overdose. ...
The United States drug overdose epidemic has reached an all-time high, with 2020 provisional mortality data indicating that over 90,000 lives were lost to drug overdose in the 12-months ending in December 2020. The overdose epidemic has evolved over time with respect to the substances involved in overdose deaths and also with respect to the geographic distribution and epidemiology of deaths involving specific substances. Thus, a nimble approach to addressing the epidemic and preventing future overdoses is needed. CDC’s response to the overdose epidemic supports implementation efforts at the state and local levels, where partners can better detect and respond to the evolving drug overdose landscape and implement prevention measures that meet their needs. CDC’s framework for responding to the overdose epidemic focuses on five areas: (1) conducting surveillance and research; (2) building state, local and tribal capacity; (3) supporting providers, health systems and payers; (4) partnering with public safety; and (5) empowering consumers to make safe choices. Central to informing the implementation of evidence-based strategies to prevent drug overdose is rigorous research that undergirds the evidence. This Commentary describes recent investments in overdose prevention research and outlines opportunities for ensuring that future research efforts allow for the flexibility necessary to effectively respond to the continually evolving epidemic. © 2021 Holland KM, DePadilla L, Gervin DW, Parker EM, Wright M.
Background
Opinion leadership, educational outreach visiting, and innovation championing are commonly used strategies to address barriers to implementing innovations and evidence-based practices in healthcare settings. Despite voluminous research, ambiguities persist in how these strategies work and under what conditions they work well, work poorly, or work at all. The current paper develops middle-range theories to address this gap.
Methods
Conceptual articles, systematic reviews, and empirical studies informed the development of causal pathway diagrams (CPDs). CPDs are visualization tools for depicting and theorizing about the causal process through which strategies operate, including the mechanisms they activate, the barriers they address, and the proximal and distal outcomes they produce. CPDs also clarify the contextual conditions (i.e., preconditions and moderators) that influence whether, and to what extent, the strategy's causal process unfolds successfully. Expert panels of implementation scientists and health professionals rated the plausibility of these preliminary CPDs and offered comments and suggestions on them.
Findings
Theoretically, opinion leadership addresses potential adopters' uncertainty about likely consequences of innovation use (determinant) by promoting positive attitude formation about the innovation (mechanism), which results in an adoption decision (proximal outcome), which leads to innovation use (intermediate outcome). As this causal process repeats, penetration, or spread of innovation use, occurs (distal outcome). Educational outreach visiting addresses knowledge barriers, attitudinal barriers, and behavioral barriers (determinants) by promoting critical thinking and reflection about evidence and practice (mechanism), which results in behavioral intention (proximal outcome), behavior change (intermediate outcome), and fidelity, or guideline adherence (distal outcome). Innovation championing addresses organizational inertia, indifference, and resistance (determinants) by promoting buy-in to the vision, fostering a positive implementation climate, and increasing collective efficacy (mechanisms), which leads to participation in implementation activities (proximal outcome), initial use of the innovation with increasing skill (intermediate outcome) and, ultimately, greater penetration and fidelity (distal outcomes). Experts found the preliminary CPDs plausible or highly plausible and suggested additional mechanisms, moderators, and preconditions, which were used to amend the initial CPD.
Discussion
The middle-range theories depicted in the CPDs furnish testable propositions for implementation research and offer guidance for selecting, designing, and evaluating these social influence implementation strategies in both research studies and practice settings.
Rationale
The shift toward virtual academic detailing (AD) was accelerated by the COVID‐19 pandemic.
Aims and Objectives
We aimed to examine the role of external, contextual, and intrinsic programme‐specific factors in virtual engagement of healthcare providers (HCPs) and delivery of AD.
Methods
AD groups throughout North America were contacted to participate in semistructured interviews. An interview guide was constructed by adapting the Consolidated Framework for Implementation Research (CFIR). A point of emphasis included strategies AD groups employed for provider engagement while implementing virtual AD programmes. Independent coders conducted qualitative analysis using the framework method.
Results
Fifteen AD groups from Canada ( n = 3) and the United States ( n = 12) participated. Technological issues and training detailers and HCPs were challenges during the transition to virtual AD visits. Restrictions on in‐person activities during the pandemic created difficulties engaging HCPs and fewer AD visits. Continuing education was one strategy to incentivize participation, but credits were often not claimed by HCPs. Groups with established networks and prior experience with virtual AD leveraged connections to mitigate disruptions and continue AD visits. Other facilitators included emphasizing contemporary topics, including opioid education beyond fundamental guidelines. Virtual AD had the additional benefit of expanding geographic reach and flexible scheduling with providers.
Conclusions
AD groups across North America have shifted to virtual outreach and delivery strategies. This trend toward virtual AD may aid outreach to vulnerable rural communities, improving health equity. More research is needed on the effectiveness of virtual AD and its future implications.
Introduction:
After laparoscopic cholecystectomy (LC), there is a wide variation in opioid prescription miligram morphine equivalent dose (MED) and refills across US medical institutions. Given wide variation and opioid prescription guidelines, it is essential to conduct thorough health services research across medical, surgical, and patient-level factors that can be implemented to improve system-wide prescribing practices. Therefore, this study describes discharge MED variation and opioid refill probability after emergent and nonemergent LC.
Materials and methods:
This retrospective cohort study included medical record data of adult patients (N = 20,025) undergoing LC from January 2016 to June 2021 in the US Military Health System. Data visualizations and bivariate analyses examined prescription patterns across hospitals and evaluated the relationship between patient-level, care-level, and system-level factors and each outcome: discharge MED and opioid refill probability. Two generalized additive mixed models evaluated the relationship between predictors and each outcome.
Results:
There was a significant variation in opioid and nonopioid pain medication prescribing practices across hospitals. While several factors were associated with discharge MED and opioid refill probability, the strongest effects were related to time period (before versus after a June 2018 Defense Health Agency policy release) and receipt of an opioid/nonopioid combination medication. Despite decreases in MED, the MED remained almost twice the recommended dose per prior research.
Conclusions:
Variation by hospital suggests the need for system-level changes that target genuine practice change and opioid stewardship. Inclusion of patient-reported outcomes, electronic health record decision support tools, and academic detailing programs may support system-level improvements.
Background:
Academic detailing is an educational outreach approach to disseminate evidence-based information to healthcare professionals and improve clinical decision-making. Pharmacists and physicians are recognized as the most qualified individuals to perform academic detailing; however, trained pharmacy students may also serve as suitable academic detailers.
Objectives:
To describe our academic detailing intervention which used trained pharmacy students to disseminate an updated pneumococcal vaccination clinical pathway (i.e., decision-support tool) and education to community pharmacists in Rhode Island and Massachusetts.
Methods:
We updated an academic detailing initiative that included a pneumococcal vaccination clinical pathway and education for community pharmacists in 2021. Two University of Rhode (URI) Island College of Pharmacy pharmacist faculty members trained six doctor of pharmacy candidates to perform academic detailing. Pharmacy students visited URI-affiliated community pharmacies throughout RI and MA. After each session, each participant received a 6-question anonymous paper survey to assess the effectiveness of the updated pathway and academic detailing session. The survey used a 5-point Likert-type scale. We assessed the percentage agreement with each question.
Results:
Academic detailing was delivered to 76 community pharmacists from May-August 2021. Most respondents agreed (89.2%, 58/65) that their knowledge of which patient populations met eligibility for the pneumococcal conjugate vaccine (PCV13) or pneumococcal polysaccharide vaccine (PPSV23) improved. Respondents were confident they could apply the knowledge gained (93.8%, 61/65) and intended to apply the pathway (93.8%, 61/65) to clinical practice. Most respondents expected vaccination practices to change because of the academic detailing and education materials received (83.6%, 51/61). Almost all respondents (95.4%, 62/65) found the educational materials easy-to-understand.
Conclusion:
Trained pharmacy students can deliver academic detailing regarding adult pneumococcal vaccination to community pharmacists. Enlisting the help of pharmacy students may be a sustainable approach to academic detailing and provides students with valuable opportunities to practice delivering educational outreach to community pharmacists.
