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Kithulegoda N, Chu C, Tadrous M, Bean T, Salach L, Regier L, Bevan L, Burton V, Price D, Ivers N, Desveaux L. Academic detailing to improve appropriate opioid prescribing: a mixed-methods process evaluation. CMAJ Open 2023; 11:E932-E941. [PMID: 37848255 PMCID: PMC10586496 DOI: 10.9778/cmajo.20210050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Academic detailing, an educational outreach service for family physicians, was funded by the Ontario government to address gaps in opioid prescribing and pain management. We sought to evaluate the impact of academic detailing on opioid prescribing, and to understand how and why academic detailing may have influenced opioid prescribing. METHODS In this mixed-methods study, we collected quantitative and qualitative data concurrently from 2017 to 2019 in Ontario, Canada. We analyzed prescribing outcomes descriptively for a sample of participating physicians and compared them with a matched control group. We invited physicians to participate in qualitative interviews to discuss their experiences in academic detailing. Development and analysis of qualitative interviews was informed by the Theoretical Domains Framework. We triangulated qualitative and quantitative findings to understand the mechanisms that drove changes in opioid prescribing. RESULTS Physicians receiving academic detailing (n = 238) achieved a greater reduction in opioid prescribing than matched controls (n = 238). Seventeen physicians completed interviews and reported that academic detailing addressed barriers to pain care, including lack of confidence, difficult interactions with patients and prescribing and tapering decisions. Academic detailing reinforced knowledge about opioid prescribing and pain management. Discussion of complex patients and talking points to use during challenging conversations were described as key drivers of practice change. INTERPRETATION The findings of this real-world, mixed-methods evaluation explain how an academic detailing service addressed key barriers and enablers to limit high-risk opioid prescribing in primary care. This nuanced understanding will be used to inform, spread and scale academic detailing.
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Affiliation(s)
- Natasha Kithulegoda
- Women's College Institute for Health Systems Solutions and Virtual Care (Kithulegoda, Chu, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Institute of Health Policy, Management, and Evaluation (Kithulegoda, Desveaux), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Desveaux), Trillium Health Partners, Mississauga, Ont.; Centre for Effective Practice (Bean, Salach, Regier, Bevan, Burton, Price), Toronto, Ont.; Department of Family Medicine (Price), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont.
| | - Cherry Chu
- Women's College Institute for Health Systems Solutions and Virtual Care (Kithulegoda, Chu, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Institute of Health Policy, Management, and Evaluation (Kithulegoda, Desveaux), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Desveaux), Trillium Health Partners, Mississauga, Ont.; Centre for Effective Practice (Bean, Salach, Regier, Bevan, Burton, Price), Toronto, Ont.; Department of Family Medicine (Price), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Mina Tadrous
- Women's College Institute for Health Systems Solutions and Virtual Care (Kithulegoda, Chu, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Institute of Health Policy, Management, and Evaluation (Kithulegoda, Desveaux), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Desveaux), Trillium Health Partners, Mississauga, Ont.; Centre for Effective Practice (Bean, Salach, Regier, Bevan, Burton, Price), Toronto, Ont.; Department of Family Medicine (Price), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Tupper Bean
- Women's College Institute for Health Systems Solutions and Virtual Care (Kithulegoda, Chu, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Institute of Health Policy, Management, and Evaluation (Kithulegoda, Desveaux), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Desveaux), Trillium Health Partners, Mississauga, Ont.; Centre for Effective Practice (Bean, Salach, Regier, Bevan, Burton, Price), Toronto, Ont.; Department of Family Medicine (Price), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Lena Salach
- Women's College Institute for Health Systems Solutions and Virtual Care (Kithulegoda, Chu, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Institute of Health Policy, Management, and Evaluation (Kithulegoda, Desveaux), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Desveaux), Trillium Health Partners, Mississauga, Ont.; Centre for Effective Practice (Bean, Salach, Regier, Bevan, Burton, Price), Toronto, Ont.; Department of Family Medicine (Price), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Loren Regier
- Women's College Institute for Health Systems Solutions and Virtual Care (Kithulegoda, Chu, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Institute of Health Policy, Management, and Evaluation (Kithulegoda, Desveaux), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Desveaux), Trillium Health Partners, Mississauga, Ont.; Centre for Effective Practice (Bean, Salach, Regier, Bevan, Burton, Price), Toronto, Ont.; Department of Family Medicine (Price), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Lindsay Bevan
- Women's College Institute for Health Systems Solutions and Virtual Care (Kithulegoda, Chu, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Institute of Health Policy, Management, and Evaluation (Kithulegoda, Desveaux), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Desveaux), Trillium Health Partners, Mississauga, Ont.; Centre for Effective Practice (Bean, Salach, Regier, Bevan, Burton, Price), Toronto, Ont.; Department of Family Medicine (Price), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Victoria Burton
- Women's College Institute for Health Systems Solutions and Virtual Care (Kithulegoda, Chu, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Institute of Health Policy, Management, and Evaluation (Kithulegoda, Desveaux), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Desveaux), Trillium Health Partners, Mississauga, Ont.; Centre for Effective Practice (Bean, Salach, Regier, Bevan, Burton, Price), Toronto, Ont.; Department of Family Medicine (Price), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - David Price
- Women's College Institute for Health Systems Solutions and Virtual Care (Kithulegoda, Chu, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Institute of Health Policy, Management, and Evaluation (Kithulegoda, Desveaux), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Desveaux), Trillium Health Partners, Mississauga, Ont.; Centre for Effective Practice (Bean, Salach, Regier, Bevan, Burton, Price), Toronto, Ont.; Department of Family Medicine (Price), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Noah Ivers
- Women's College Institute for Health Systems Solutions and Virtual Care (Kithulegoda, Chu, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Institute of Health Policy, Management, and Evaluation (Kithulegoda, Desveaux), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Desveaux), Trillium Health Partners, Mississauga, Ont.; Centre for Effective Practice (Bean, Salach, Regier, Bevan, Burton, Price), Toronto, Ont.; Department of Family Medicine (Price), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
| | - Laura Desveaux
- Women's College Institute for Health Systems Solutions and Virtual Care (Kithulegoda, Chu, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Institute of Health Policy, Management, and Evaluation (Kithulegoda, Desveaux), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.; Institute for Better Health (Desveaux), Trillium Health Partners, Mississauga, Ont.; Centre for Effective Practice (Bean, Salach, Regier, Bevan, Burton, Price), Toronto, Ont.; Department of Family Medicine (Price), McMaster University, Hamilton, Ont.; Department of Family and Community Medicine (Ivers), University of Toronto, Toronto, Ont
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Ojo OC, Arno JN, Tao G, Patel CG, Zhang Z, Wang J, Holderman J, Dixon BE. Gonorrhea testing, morbidity, and reporting using an integrated sexually transmitted disease registry in Indiana: 2004-2016. Int J STD AIDS 2020; 32:30-37. [PMID: 32998639 DOI: 10.1177/0956462420953718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surveillance of gonorrhea (GC), the second most common notifiable disease in the United States, depends on case reports. Population-level data that contain the number of individuals tested in addition to morbidity are lacking. We performed a cross-sectional analysis of data obtained from individuals tested for GC recorded in a sexually transmitted disease (STD) registry in the state of Indiana. Descriptive statistics were performed, and a Poisson generalized linear model was used to evaluate the number of individuals tested for GC and the positivity rate. GC cases from a subset of the registry were compared to CDC counts to determine the completeness of the registry. A total of 1,870,811 GC tests were linked to 627,870 unique individuals. Individuals tested for GC increased from 54,334 in 2004 to 269,701 in 2016; likewise, GC cases increased from 2,039 to 5,997. However, positivity rate decreased from 3.75% in 2004 to 2.22% in 2016. The difference in the number of GC cases captured by the registry and those reported to the CDC was not statistically significant (P = 0.0665). Population-level data from an STD registry combining electronic medical records and public health case data may inform STD control efforts. In Indiana, increased testing rates appeared to correlate with increased GC morbidity.
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Affiliation(s)
- Opeyemi C Ojo
- Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Janet N Arno
- Marion County Public Health Department, Health and Hospital Corporation, Indianapolis, IN, USA.,Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Guoyu Tao
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Chirag G Patel
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Zuoyi Zhang
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Jane Wang
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Justin Holderman
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brian E Dixon
- Department of Epidemiology, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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