1
|
Sachidanandan G, Sud A. From Two Dimensions to Multidimensions: A Mechanistic Model to Support Deliberate CPD Development, Coordination, and Evaluation. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00099. [PMID: 37782259 DOI: 10.1097/ceh.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
INTRODUCTION The effectiveness of continuing professional development as an intervention to improve health professional behavior and patient health is variable and contentious. To clarify the causal relationships underlying program outcomes and facilitate a necessary shift from outcomes-only-based approaches to outcome-based and theory-based approaches in program development and evaluation, we developed a model of mechanisms mapped to relevant outcomes. METHODS Mechanisms identified in a prior realist synthesis of opioid agonist therapy continuing professional development programs were iteratively tested and refined using purposive and opportunistic sampling and realist approaches against two systematic reviews of programs in analgesic prescribing and palliative care. Further testing involved practical application within programs in sustainable health care and pain management. RESULTS Ninety reports on 75 programs and practical application to multiple additional programs informed the final model consisting of five distinct mechanisms: motivation transformation, expert influence, confidence development, self-efficacy facilitation, and community of practice expansion. The mechanisms and related analysis emphasize that continuing professional development is heterogeneous, complex, and context dependent. DISCUSSION Shifting toward outcome-based and theory-based approaches facilitates further conceptual shifts at intraprogram and interprogram and interintervention levels toward more deliberate program development and evaluation, increased program complementarity and subsequent collaboration. It clarifies opportunities for intercalation of continuing professional development with other intervention sciences. The model presents a resource for practitioners, researchers, and policymakers to advance continuing professional development planning, coordination, and evaluation.
Collapse
Affiliation(s)
- Grahanya Sachidanandan
- Ms. Sachidanandan: Medical Student, Temerty Faculty of Medicine, University of Toronto. Dr. Sud: Research Chair, Primary Care & Population Health Systems, Humber River Hospital, and Assistant Professor, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto
| | | |
Collapse
|
2
|
Sud A, Hodgson K, Bloch G, Upshur R. A Conceptual Framework for Continuing Medical Education and Population Health. TEACHING AND LEARNING IN MEDICINE 2022; 34:541-555. [PMID: 34459333 DOI: 10.1080/10401334.2021.1950540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
ISSUE Health systems have been increasingly called upon to address population health concerns and continuing medical education (CME) is an important means through which clinical practices can be improved. This manuscript elaborates on existing conceptual frameworks in order to support CME practitioners, funders, and policy makers to develop, implement, and evaluate CME vis-a-vis population health concerns. EVIDENCE Existing CME conceptual models and conceptions of CME effectiveness require elaboration in order to meet goals of population health improvement. Frameworks for the design, implementation and evaluation of CME consistently reference population health, but do not adequately conceptualize it beyond the aggregation of individual patient health. As a pertinent example, opioid prescribing CME programs use the opioid epidemic to justify their programs, but evaluation approaches are inadequate for demonstrating population health impacts. CME programs that are built to have population health outcomes using frameworks intended primarily for physician performance and patient health outcomes are thus not able to recognize either non-linear associations or negative unintended consequences. IMPLICATIONS This proposed conceptual framework draws on the fields of clinical population medicine, the social determinants of health, health equity, and philosophies of population health to build conceptual bridges between the CME outcome levels of physician performance and patient health to population health. The authors use their experience developing, delivering, and evaluating opioid prescribing- and poverty-focused CME programs to argue that population health-focused CME must be re-oriented in at least five ways. These include: 1) scaling effective CME programs while evaluating at population health levels; 2) (re)interpreting evidence for program content from a population perspective; 3) incorporating social determinants of health into clinically-oriented CME activities; 4) explicitly building fluency in population health concepts and practices among health care providers and CME planners; and 5) attending to social inequity in every aspect of CME programs.
Collapse
Affiliation(s)
- Abhimanyu Sud
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kate Hodgson
- Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Bloch
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ross Upshur
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Underwood NL, Cance JD, Kane H, Hennessy C, Christensen A, Rooks-Peck C. Understanding State-Level Variations in Implementing Academic Detailing for Prescribing Opioids: Findings from 11 States Within the United States. PAIN MEDICINE (MALDEN, MASS.) 2022; 23:1644-1653. [PMID: 35218348 PMCID: PMC11215816 DOI: 10.1093/pm/pnac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Academic detailing is a clinical education technique characterized by targeted, one-on-one, interactive conversations between trained staff and the clinician. This study describes variations in implementing academic detailing among jurisdictions receiving funding from the U.S. Centers for Disease Control and Prevention (CDC) to prevent prescription drug overdoses. DESIGN In 2015, CDC started the Prescription Drug Overdose Prevention for States (PfS) program. SUBJECTS This study focuses on 11 of the 29 funded jurisdictions that implemented academic detailing as part of their PfS efforts. METHODS Jurisdictions provided annual progress reports from 2016 to 2019. We conducted semistructured interviews in 2017 and 2018 with all funded jurisdictions and conducted follow-up interviews with three jurisdictions in 2020 to obtain additional context. We used an analytic matrix display to identify themes from annual progress report data, the coding report from the 2017/2018 interviews, and the three follow-up interviews from 2020. RESULTS Two academic detailing models emerged: 1) one-on-one detailing, where centrally trained staff conducted all visits, and 2) a train-the-trainer model. Jurisdictions also described a hybrid model, which they referred to as academic detailing despite not meeting the definition of academic detailing. We identified variations in delivery strategies, staffing, and curriculum development within and between models. Despite these differences, common themes included the need to use data to focus academic detailing and the importance of partnerships. CONCLUSIONS Adoption of academic detailing as a strategy for improving opioid prescribing behaviors has increased. However, there is limited guidance and standardization to guide and evaluate implementation and outcomes.
Collapse
Affiliation(s)
- Natasha L. Underwood
- Division of Overdose Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Heather Kane
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Aleta Christensen
- Division of Overdose Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cherie Rooks-Peck
- Division of Overdose Prevention, National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Impact evaluation of a brief online training module on physician use of the Maryland, USA, Prescription Drug Monitoring Program. PLoS One 2022; 17:e0272217. [PMID: 35944051 PMCID: PMC9362906 DOI: 10.1371/journal.pone.0272217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 07/11/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Prescription Drug Monitoring Programs (PDMPs) are electronic databases that track controlled substance prescriptions in a state. They are underused tools in preventing opioid abuse. Most PDMP education research measures changes in knowledge or confidence rather than behavior.
Objective
To evaluate the impact of online case-based training on healthcare provider use of the Maryland (USA) PDMP.
Methods
We used e-mail distribution lists to recruit providers to complete a brief educational module. Using a pre-training and post-training survey in the module, we measured self-reported PDMP use patterns and perceived PDMP value in specific clinical situations and compared pre- and post-training responses. Within the module, we presented three fictional pain cases and asked participants how they would manage each, both before, and then after presenting prescription drug history simulating a PDMP report. We measured changes in the fictional case treatment plans before and after seeing prescription history. Finally, we measured and compared how often each participant accessed the Maryland PDMP database before and after completing the educational module. We used multivariate logistic regression to measure the effect of the intervention on actual PDMP use frequency.
Results
One hundred and fifty participants enrolled and completed the training module, and we successfully retrieved real-world PDMP use data of 137 of them. Participants’ decisions to prescribe opioids changed significantly after reviewing PDMP data in each of the fictional cases provided in the module. In the months following the training, the rate of PDMP use increased by a median of four use-cases per month among providers in practice for less than 20 years (p = 0.039) and two use-cases per month among infrequent opioid prescribers (p = 0.014).
Conclusion
A brief online case-based educational intervention was associated with a significant increase in the rate of PDMP use among infrequent opioid prescribers and those in practice less than 20 years.
Collapse
|
5
|
Mishra M, Pickett M, Weiskopf NG. The Role of Informatics in Implementing Guidelines for Chronic Opioid Therapy Risk Assessment in Primary Care: A Narrative Review Informed by the Socio-Technical Model. Stud Health Technol Inform 2022; 290:447-451. [PMID: 35673054 PMCID: PMC10128894 DOI: 10.3233/shti220115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Approximately 2 million Americans live with opioid use disorder (OUD), most of whom also have chronic pain. The economic burden of chronic pain and prescription opioid misuse runs into billions of dollars. Patients on prescription opioids for chronic non-cancer pain (CNCP) are at increased risk for OUD and overdose. By adhering to the Center for Disease Control and Prevention (CDC) opioid prescribing guidelines, primary care providers (PCPs) have the potential to improve patient outcomes. But numerous provider, patient, and practice-specific factors challenge adherence to guidelines in primary care. Many of the barriers may be mediated by informatics interventions, but gaps in knowledge and unmet needs exist. This narrative review examines the risk assessment and harm reduction process in a socio-technical context to highlight the gaps in knowledge and unmet needs that can be mediated through informatics intervention.
Collapse
Affiliation(s)
- Meenakshi Mishra
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
| | - Mary Pickett
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR, USA
| | - Nicole G. Weiskopf
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
6
|
Hoppe D, Karimi L, Khalil H. Mapping the research addressing prescription drug monitoring programs: A scoping review. Drug Alcohol Rev 2022; 41:803-817. [PMID: 35106867 DOI: 10.1111/dar.13431] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/19/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022]
Abstract
ISSUES Prescription drug monitoring programs are a harm minimisation intervention and clinical decision support tool that address the public health concern surrounding prescription drug misuse. Given the large number of studies published to date and the ongoing implementation of these programs, it is important to map the literature and identify areas for further research to improve practice. APPROACH A scoping review was undertaken to identify the research on prescription drug monitoring programs published between January 2015 and April 2021. KEY FINDINGS A total of 153 citations were included in this scoping review. The majority of the studies originated from the USA and were quantitative. Results on program effectiveness are mixed and mainly examine their association with opioid-related outcomes. Unintended consequences are revealed in the literature and this review also highlights barriers to program use. IMPLICATIONS Overall, findings are mixed despite the large number of studies published to date. Mapping the literature identifies priority areas for further research that can advise policymakers and clinicians on practice improvement. CONCLUSION Results on prescription drug monitoring program effectiveness are mixed and mainly examine their association with opioid-related outcomes. This review highlights barriers to prescription drug monitoring program effectiveness related to program use and system integration. Further research is needed in these areas to improve prescription drug monitoring program use and patient outcomes.
Collapse
Affiliation(s)
- Dimi Hoppe
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Leila Karimi
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Hanan Khalil
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| |
Collapse
|
7
|
Sud A, Buchman DZ, Furlan AD, Selby P, Spithoff SM, Upshur REG. Chronic Pain and Opioid Prescribing: Three Ways for Navigating Complexity at the Clinical‒Population Health Interface. Am J Public Health 2022; 112:S56-S65. [PMID: 35143271 PMCID: PMC8842204 DOI: 10.2105/ajph.2021.306500] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/04/2022]
Abstract
Clinically focused interventions for people living with pain, such as health professional education, clinical decision support systems, prescription drug monitoring programs, and multidisciplinary care to support opioid tapering, have all been promoted as important solutions to the North American opioid crisis. Yet none have so far delivered substantive beneficial opioid-related population health outcomes. In fact, while total opioid prescribing has leveled off or reduced in many jurisdictions, population-level harms from opioids have continued to increase dramatically. We attribute this failure partly to a poor recognition of the epistemic and ethical complexities at the interface of clinical and population health. We draw on a framework of knowledge networks in wicked problems to identify 3 strategies to help navigate these complexities: (1) designing and evaluating clinically focused interventions as complex interventions, (2) reformulating evidence to make population health dynamics apparent, and (3) appealing to the inseparability of facts and values to support decision-making in uncertainty. We advocate that applying these strategies will better equip clinically focused interventions as complements to structural and public health interventions to achieve the desired beneficial population health effects. (Am J Public Health. 2022;112(S1):S56-S65. https://doi.org/10.2105/AJPH.2021.306500).
Collapse
Affiliation(s)
- Abhimanyu Sud
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Daniel Z Buchman
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Andrea D Furlan
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Peter Selby
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Sheryl M Spithoff
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| | - Ross E G Upshur
- Abhimanyu Sud is with the Department of Family and Community Medicine and Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada. Daniel Z. Buchman is with Centre for Addiction and Mental Health and Dalla Lana School of Public Health, Toronto. Andrea D. Furlan is with the Institute for Work and Health and Department of Medicine, University of Toronto. Peter Selby is with the Centre for Addiction and Mental Health and Department of Family and Community Medicine, Department of Psychiatry, University of Toronto. Sheryl M. Spithoff is with Department of Family and Community Medicine, University of Toronto. Ross E. G. Upshur is with the Bridgepoint Collaboratory for Research and Innovation, Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto
| |
Collapse
|
8
|
Sud A, Molska GR, Salamanca-Buentello F. Evaluations of Continuing Health Provider Education Focused on Opioid Prescribing: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:286-299. [PMID: 34074902 PMCID: PMC8781229 DOI: 10.1097/acm.0000000000004186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE Continuing health provider education (HPE) is an important intervention supported by health policy to counter the opioid epidemic; knowledge regarding appropriate program design and evaluation is lacking. The authors aim to provide a comprehensive understanding of evaluations of opioid-related continuing HPE programs and their appropriateness as interventions to improve population health. METHOD In January 2020, the authors conducted a systematic search of 7 databases, seeking studies of HPE programs on opioid analgesic prescribing and overdose prevention. Reviewers independently screened the titles and abstracts of all studies and then assessed the full texts of all studies potentially eligible for inclusion. The authors extracted a range of data using categories for evaluating complex programs: the use of theory, program purpose, inputs, activities, outputs, outcomes, and industry involvement. Results were reported in a narrative synthesis. RESULTS Thirty-nine reports on 32 distinct HPE programs met inclusion criteria. Of these 32, 31 (97%) were U.S./Canadian programs and 28 (88%) were reported after 2010. Measurements of changes in knowledge and confidence were common. Performance outcomes were less common and typically self-reported. Most studies (n = 27 [84%]) used concerns of opioid-related harms at the population health level to justify the educational intervention, but only 5 (16%) measured patient- or population-level outcomes directly related to the educational programs. Six programs (19%) had direct or indirect opioid manufacturer involvement. CONCLUSIONS Continuing HPE has been promoted as an important means of addressing population-level opioid-related harms by policymakers and educators, yet published evaluations of HPE programs focusing on opioid analgesics inadequately evaluate patient- or population-level outcomes. Instead, they primarily focus on self-reported performance outcomes. Conceptual models are needed to guide the development and evaluation of continuing HPE programs intended to have population health benefits.
Collapse
Affiliation(s)
- Abhimanyu Sud
- A. Sud is assistant professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-8354-6153
| | - Graziella R. Molska
- G.R. Molska was research coordinator, Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada at the time this work was completed
| | - Fabio Salamanca-Buentello
- F. Salamanca-Buentello is a postdoctoral fellow, Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-3666-7785
| |
Collapse
|
9
|
Kulbokas V, Hanson KA, Smart MH, Mandava MR, Lee TA, Pickard AS. Academic detailing interventions for opioid-related outcomes: a scoping review. Drugs Context 2021; 10:2021-7-7. [PMID: 34970320 PMCID: PMC8687092 DOI: 10.7573/dic.2021-7-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/01/2021] [Indexed: 11/24/2022] Open
Abstract
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 interventions and describe their findings. METHODS A scoping review focused on AD interventions for opioids was conducted in PubMed, EMBASE and CINAHL databases through July 1, 2021. Studies were eligible for inclusion if written in English, included interactive opioid-focused educational interventions, and were conducted either in person, virtually or via telephone. Four independent reviewers reviewed titles and abstracts. Data extraction from full-text publications was completed using a standardized form. RESULTS Of 6086 articles initially identified, 22 articles met the inclusion criteria and 20 unique interventions were identified. The AD intervention was either delivered one-on-one (n=16) or in a small, interactive group setting (n=4). AD interventions varied in design. Effectiveness was evaluated in terms of opioid and naloxone prescribing rates, provider knowledge gaps, provider adherence to guidelines, and intervention feasibility. Sixteen (80%) interventions resulted in statistically significant improvement in one or more outcomes. CONCLUSION Generally, opioid-related AD was effective and programmes were primarily conducted one-on-one between pharmacists and primary care providers for 16-30 minutes. A variety of metrics and outcomes were used to assess the success/effectiveness of AD interventions, which is an important consideration in future studies as no single metric captures the effectiveness of an educational outreach-based intervention for pain management.
Collapse
Affiliation(s)
- Victoria Kulbokas
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Kent A Hanson
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Mary H Smart
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Monika Rao Mandava
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| |
Collapse
|
10
|
Gondora N, Versteeg SG, Carter C, Bishop LD, Sproule B, Turcotte D, Halpape K, Beazely MA, Dattani S, Kwong M, Nissen L, Chang F. The role of pharmacists in opioid stewardship: A scoping review. Res Social Adm Pharm 2021; 18:2714-2747. [PMID: 34261590 DOI: 10.1016/j.sapharm.2021.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/26/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The opioid epidemic is an international public health concern. Pharmacists are in a strategic position to promote and implement effective opioid stewardship due to both their central role on health care teams and frequent interaction with patients. Despite this integral role, pharmacists do not have harmonized scopes of practice in opioid stewardship. OBJECTIVES This scoping review was conducted to identify and critically review the role of pharmacists in opioid stewardship and identify future areas of study. METHODS The scoping review was conducted according to the methodological framework proposed by Arksey and O'Malley, which was further modified by the Joanna Briggs Institute. Six databases were searched for original, peer-reviewed research; PubMed (MEDLINE), Ovid Embase, Ovid International Pharmaceutical Abstracts, Scopus, Cochrane Library, and APA PsycInfo. RESULTS In 92% of the included studies (n = 77), opioid stewardship interventions led by either a pharmacist or in an interdisciplinary team resulted in improvements in at least one outcome measure, with education and medication therapy adjustments being the most predominant activities. Other areas supported by evidence include community stakeholder education, policy and guideline setting, and risk assessment. CONCLUSION This scoping review provides valuable insight into the various roles pharmacists can have in opioid stewardship. The findings from this review identified opioid stewardship activities that can make significant contributions towards reducing the impact of the opioid crisis. This review informs future research and has the potential to influence pharmacy practice on a national and international scale.
Collapse
Affiliation(s)
- Nyasha Gondora
- School of Pharmacy, University of Waterloo, Ontario, Canada
| | | | - Caitlin Carter
- School of Pharmacy, University of Waterloo, Ontario, Canada
| | - Lisa D Bishop
- School of Pharmacy, Memorial University, Newfoundland and Labrador, Canada
| | - Beth Sproule
- Centre for Addiction and Mental Health & Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada
| | - Dana Turcotte
- College of Pharmacy, University of Manitoba, Manitoba, Canada
| | - Katelyn Halpape
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatchewan, Canada
| | | | - Shelita Dattani
- Neighborhood Pharmacy Association of Canada, Ottawa, Ontario, Canada
| | - Mona Kwong
- British Columbia Centre on Substance Use, British Columbia, Canada
| | - Lisa Nissen
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Feng Chang
- School of Pharmacy, University of Waterloo, Ontario, Canada.
| |
Collapse
|
11
|
Ball SJ, McCauley JA, Pruitt M, Zhang J, Marsden J, Barth KS, Mauldin PD, Gebregziabher M, Moran WP. Academic detailing increases prescription drug monitoring program use among primary care practices. J Am Pharm Assoc (2003) 2021; 61:418-424.e2. [PMID: 33812783 PMCID: PMC8273068 DOI: 10.1016/j.japh.2021.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/10/2021] [Accepted: 02/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Clinical review of a prescription drug monitoring program (PDMP) is considered a valuable tool for opioid prescribing risk mitigation; however, PDMP use is often low, even in states with mandatory registration and use policies. The objective was to evaluate the impact of an academic detailing (AD) outreach intervention on PDMP use among primary care prescribers. METHODS AD intervention was delivered to primary care based controlled substance prescribers (N = 87) and their associated PDMP delegates (n = 42) by a clinical pharmacist as 1 component of a large-scale, statewide initiative to improve opioid prescribing safety. Prescriber PDMP use behavior was assessed by prescriber self-report and analysis of objective 2016-2018 PDMP data regarding the number of monthly report requests. We compared means between pre- and postintervention using a paired t test and plotted the monthly average reports over time to assess the trend of mean reports over time. Generalized linear mixed model with a negative binomial distribution was used to assess the difference in the trend and magnitude of the combined count of reports for the entire sample and prescriber subsets that were segmented on the basis of the adoption status of PDMP. RESULTS The monthly mean of reports by combined prescribers and delegates significantly increased after the AD intervention (mean 28.1 pre vs. 53.0 post; P < 0.001), with the increase in delegate reports (mean 17.1 pre vs. 60.0 post; P < 0.001) driving the overall increase. Reports were requested 40.4 times more often than in the preintervention period (P < 0.001). Patterns of pre- to postchanges in mean monthly report requests differed by baseline PDMP adoption status. CONCLUSION The AD intervention was transformative in facilitating practice change to use delegates to run reports. Visits with both prescribers and delegates, including hands-on PDMP training and registration assistance, can be viewed as beneficial for practice facilitation.
Collapse
Affiliation(s)
- Sarah J. Ball
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jenna A. McCauley
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Megan Pruitt
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, Medical University of South Carolina, USA
| | - Jingwen Zhang
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Justin Marsden
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kelly S. Barth
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Patrick D. Mauldin
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, USA
| | - William P. Moran
- Division of General Internal Medicine, Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
12
|
Saffore CD, Pickard AS, Crawford SY, Fischer MA, Sharp LK, Pointer S, Lee TA. Secondary effects of an opioid-focused academic detailing program on non-opioid controlled substance prescribing in primary care. Subst Abus 2021; 42:962-967. [PMID: 33750286 DOI: 10.1080/08897077.2021.1900989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Educational outreach programs that focus on safe opioid prescribing and awareness of state prescription monitoring programs may modify clinicians' prescribing behavior. The objective of this study was to evaluate the secondary effects of an opioid-focused academic detailing (AD) program on non-opioid controlled substance prescribing in primary care. Methods: A quasi-experimental pre-post study of primary care clinicians exposed and unexposed to the AD program was conducted using data from the Illinois Prescription Monitoring Program from December 2017 to February 2019. Outcomes were mean monthly prescriptions for benzodiazepines (BZD), non-BZD sedative-hypnotics, and carisoprodol, per clinician. A difference-in-differences (DID) approach utilizing repeated-measures mixed-effects linear regression models was used to compare changes in outcomes six-months before and after the program. Results: Mean monthly BZD prescriptions declined in both groups of clinicians (AD-exposed n = 151; controls n = 399) after implementation of the AD program. Although the mean monthly number of BZD prescriptions decreased in both groups after the AD program, BZD prescribing in the AD-exposed group declined at a slower rate following the AD program (DID = 0.73; 95% CI: 0.14, 1.31). The AD-exposed group had a 0.06 (95% CI: -0.11, -0.01) lower rate of mean monthly carisoprodol prescriptions compared to the control group following the AD program. There was no change in the rate of mean monthly non-BZD sedative-hypnotic prescriptions between the two groups. Conclusions: The higher relative rate of BZD prescribing in the AD-exposed group compared to the control group following the AD program may be reflective of an unintended consequence of opioid-focused AD programs as clinicians learn to be cautious about opioid prescribing. Our findings may suggest the need for incorporation of targeted education on appropriate BZD prescribing into opioid-focused AD programs as a featured component. These findings warrant further consideration and investigation before large-scale implementation of opioid-focused educational outreach programs.
Collapse
Affiliation(s)
- Christopher D Saffore
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Stephanie Y Crawford
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Michael A Fischer
- Division of Pharmacoepidemiology and Pharmacoeconomics, National Resource Center for Academic Detailing, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Sarah Pointer
- Illinois Prescription Monitoring Program, Bureau of Pharmacy and Clinical Support Services, Springfield, IL, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
13
|
Sud A, Doukas K, Hodgson K, Hsu J, Miatello A, Moineddin R, Paton M. A retrospective quantitative implementation evaluation of Safer Opioid Prescribing, a Canadian continuing education program. BMC MEDICAL EDUCATION 2021; 21:101. [PMID: 33579258 PMCID: PMC7880212 DOI: 10.1186/s12909-021-02529-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 02/02/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND Continuing health professions education (CHPE) is an important policy intervention for the opioid epidemic. Besides effectiveness or impact, health policy implementation should be studied to understand how an intervention was delivered within complex environments. Implementation outcomes can be used to help interpret CHPE effects and impacts, help answer questions of "how" and "why" programs work, and inform transferability. We evaluated Safer Opioid Prescribing (SOP), a national CHPE program, using implementation outcomes of reach, dose, fidelity, and participant responsiveness. METHODS We conducted a retrospective quantitative implementation evaluation of the 2014-2017 cohorts of SOP. To measure reach and dose, we examined participation and completion data. We used Ontario physician demographic data, including regulatory status with respect to controlled substances, to examine relevant trends. To measure fidelity and participant responsiveness, we analyzed participant-provided evaluations of bias, active learning, and relevance to practice. We used descriptive statistics and measures of association for both continuous and categorical variables. We used logistic regression to determine predictors of workshop participation and analysis of covariance to examine variation in satisfaction across different-sized sessions. RESULTS Reach: In total, there were 472 unique participants, 84.0% of whom were family physicians. Among Ontario physician participants, 90.0% were family physicians with characteristics representative of province-wide demographics. Dose: Webinar completion rate was 86.2% with no differences in completion based on rurality, gender, or controlled substance prescribing status with medical regulatory authorities. Fidelity and participant responsiveness: Nearly all participants rated the three webinars and workshop as balanced, and each element of SOP was also rated as highly relevant to clinical practice. CONCLUSIONS This evaluation demonstrates that Safer Opioid Prescribing was implemented as intended. Over a short period and without any external funding, the program reached more than 1% of the Ontario physician workforce. This suggests that the program may be a good model for using virtual CHPE to reach a critical mass of prescribers. This study represents a methodological advance of adapting evaluation methods from health policy and complex interventions for continuing health professions education. Future studies will assess effectiveness and impact on opioid prescribing and utilization within evaluation models of complex interventions.
Collapse
Affiliation(s)
- Abhimanyu Sud
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada.
| | - Kathleen Doukas
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Katherine Hodgson
- Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Justin Hsu
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Amber Miatello
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Rahim Moineddin
- Department of Family & Community Medicine, University of Toronto, Toronto, Canada
| | - Morag Paton
- Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
14
|
Martin HD, Modi SS, Feldman SS. Barriers and facilitators to PDMP IS Success in the US: A systematic review. Drug Alcohol Depend 2021; 219:108460. [PMID: 33387937 DOI: 10.1016/j.drugalcdep.2020.108460] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Prescription Drug Monitoring Programs (PDMP) help prevent prescription drug misuse and promote appropriate pain management. Despite these benefits and PDMP mandates in most states, PDMPs face challenges that hinder their success. This paper uses the Delone and McLean Information Success (IS) Model to review the current literature for barriers and facilitators to PDMP quality, use, intention to use and user satisfaction in the United States (U.S.). MATERIAL AND METHODS Scopus, PubMed and Embase databases were searched due to their relevance to information technology, education and research. RESULTS There were 142 and 183 barriers and facilitators, respectively, found in 44 peer reviewed articles. Barriers to PDMP quality, use and user satisfaction include lack of interstate data sharing, access difficulties, lack of time, inability to delegate access, lack of knowledge or awareness of the PMDP, and lack of EHR integration. Facilitators to PDMP quality, use and user satisfaction include interstate data connections, real-time data updates, EHR integration, and access delegation. DISCUSSION Interstate data sharing, EHR integration and expanding access to delegates were common themes found. Some results were found to be contradictory such as mandating use. CONCLUSION PDMP users can use these findings to assess current barriers to PDMP success in the U.S. and draw possible solutions from the list of facilitators. Practitioners should consider the context of their state and organization when determining which facilitators would most promote PDMP IS success. Combining facilitators may be the best route to PDMP IS success in certain situations.
Collapse
Affiliation(s)
- Heather D Martin
- School of Health Professions, The University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35233, United States.
| | - Shikha S Modi
- School of Health Professions, The University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35233, United States
| | - Sue S Feldman
- School of Health Professions, The University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35233, United States
| |
Collapse
|
15
|
Richard P, Bauer MR, Moresco N, Walker R, Bowser D, Reed D, Larson MJ. Opioid prescribing for surgical dental procedures in dental clinics of military treatment facilities. J Am Dent Assoc 2020; 152:94-104.e18. [PMID: 33358238 DOI: 10.1016/j.adaj.2020.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 09/04/2020] [Accepted: 09/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Variation in opioid prescribing rates among geographic regions is well known and, to the authors' knowledge, there have been no studies of variation from 1 dental clinic to another, and such variation might suggest an excess of opioid prescriptions. METHODS The authors used a retrospective cohort design study of all dental encounter records for 819,453 soldiers in the dental clinics (n = 250) of the US Military Health System during the period from 2008 through 2017. RESULTS There were 743,459 dental surgical encounters. Opioid prescriptions were filled for 36.7% of these encounters. Multinomial multilevel regression found statistically significant between-facility variance in opioid prescribing, which was partially explained via facility-level characteristics (region, type, and percentage of surgeries for young patients), and practice variables (mean percentage extractions, percentage periodontic surgery, and percentage specialists). CONCLUSIONS The authors found a substantial variation in opioid prescribing among dental clinics in the US Military Health System. Dentists at 11 of the 30 largest military treatment facilities prescribed at a rate 4 percentage points higher than expected, and dentists at 9 of these military treatment facilities had a rate of 4 percentage points lower than expected. Additional study of the factors allowing the low-prescribing facilities to achieve these rates might lead to an overall decrease in opioid prescribing. PRACTICAL IMPLICATIONS The authors' findings of dental opioid prescribing in the military can lead to appreciation of the guidelines from the American Dental Association and the American Association of Oral and Maxillofacial Surgeons, which suggest alternatives to opioid prescribing for surgical procedures, particularly for tooth extractions.
Collapse
|
16
|
Practice change intentions after academic detailing align with subsequent opioid prescribing. J Am Pharm Assoc (2003) 2020; 60:1001-1008. [DOI: 10.1016/j.japh.2020.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/21/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022]
|
17
|
Identification of barriers to safe opioid prescribing in primary care: a qualitative analysis of field notes collected through academic detailing. Br J Gen Pract 2020; 70:e589-e597. [PMID: 32540873 DOI: 10.3399/bjgp20x711737] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Understanding barriers to safe opioid prescribing in primary care is critical amid the epidemic of prescription opioid abuse, misuse, and overdose in the US. Educational outreach strategies, such as academic detailing (AD), provide a forum for identification of barriers to, and strategies to facilitate, safe opioid prescribing in primary care. AIM To identify barriers to safe opioid prescribing among primary care providers (PCPs) through AD. DESIGN AND SETTING Qualitative analysis of data was collected through an existing AD intervention to improve safe opioid prescribing in primary care. The AD intervention was delivered from June 2018 to August 2018 to licensed PCPs with prescriptive authority within a large independent health system in the metropolitan Chicagoland area. METHOD The AD intervention involved visits by trained detailers to PCPs who contemporaneously documented details from each visit via field notes. Using qualitative analysis, field notes were analysed to identify recurring themes related to opioid prescribing barriers. RESULTS Detailer-entered field notes from 186 AD visits with PCPs were analysed. Barriers to safe opioid prescribing were organised into six themes: 1) gaps in knowledge; 2) lack of prescription monitoring programme (PMP) utilisation; 3) patient pressures to prescribe opioids; 4) insurance coverage policies; 5) provider beliefs; and 6) health system pain management practices. CONCLUSION Barriers to safe opioid prescribing in primary care, identified through AD visits among this large group of PCPs, support the need for continued efforts to enhance pain-management education, maximise PMP utilisation, and increase access to, and affordability of, non-opioid treatments.
Collapse
|
18
|
Alogaili F, Abdul Ghani N, Ahmad Kharman Shah N. Prescription drug monitoring programs in the US: A systematic literature review on its strength and weakness. J Infect Public Health 2020; 13:1456-1461. [PMID: 32694082 DOI: 10.1016/j.jiph.2020.06.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/02/2020] [Accepted: 06/29/2020] [Indexed: 11/17/2022] Open
Abstract
Prescription Drug Monitoring Program (PDMP) is an electronic database that tracks the prescriptions of controlled drugs with its aims to combat the incidence of drug abuse. Although the establishment of PDMP in the US was since 2003, evidence of the impact of PDMP's strength and weakness towards its implementation is still scarce. A systematic literature review according to Preferred Reporting Items for Systematic Review (PRISMA) standard was conducted to investigate the influence of PDMP's strength in combating the incidence of drug abuse and also to review the weaknesses of PDMP that prohibit its implementation. Results from this study reveal that the implementation of PDMP has mitigated the issue of drug abuse and has increased work efficiency among healthcare practitioners. However, the implementation rate of this system is low due to its weaknesses such as limited internet access and limited access to the PDMP system. Therefore, efforts to overcome the weaknesses of PDMP need to be instituted to ensure the healthcare system could fully optimize PDMP's benefits.
Collapse
Affiliation(s)
- Fahd Alogaili
- Department of Information System, Faculty of Computer Science and Technology, University of Malaya, Malaysia.
| | - Norjihan Abdul Ghani
- Department of Information System, Faculty of Computer Science and Technology, University of Malaya, Malaysia
| | - Nordiana Ahmad Kharman Shah
- Department of Library & Information Science, Faculty of Computer Science and Technology, University of Malaya, Malaysia
| |
Collapse
|
19
|
Mastarone GL, Wyse JJ, Wilbur ER, Morasco BJ, Saha S, Carlson KF. Barriers to Utilization of Prescription Drug Monitoring Programs Among Prescribing Physicians and Advanced Practice Registered Nurses at Veterans Health Administration Facilities in Oregon. PAIN MEDICINE 2019; 21:695-703. [DOI: 10.1093/pm/pnz289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AbstractObjectiveTo identify barriers to using state prescription drug monitoring programs (PDMPs) among prescribing physicians and advanced practice registered nurses across a variety of Veterans Health Administration (VA) settings in Oregon.DesignIn-person and telephone-based qualitative interviews and user experience assessments conducted with 25 VA prescribers in 2018 probed barriers to use of state PDMPs.SettingVA health care facilities in Oregon.SubjectsPhysicians (N = 11) and advanced practice registered nurses (N = 14) who prescribed scheduled medications, provided care to patients receiving opioids, and used PDMPs in their clinical practice. Prescribers were stationed at VA medical centers (N = 10) and community-based outpatient clinics (N = 15); medical specialties included primary care (N = 10), mental health (N = 9), and emergency medicine (N = 6).MethodsUser experience was analyzed using descriptive statistics. Qualitative interviews were analyzed using conventional content analysis methodology.ResultsThe majority of physicians (64%) and advanced practice registered nurses (79%) rated PDMPs as “useful.” However, participants identified both organizational and software design issues as barriers to their efficient use of PDMPs. Organizational barriers included time constraints, clinical team members without access, and lack of clarity regarding the priority of querying PDMPs relative to other pressing clinical tasks. Design barriers included difficulties entering or remembering passwords, unreadable data formats, time-consuming program navigation, and inability to access patient information across state lines.ConclusionsPhysicians and advanced practice registered nurses across diverse VA settings reported that PDMPs are an important tool and contribute to patient safety. However, issues regarding organizational processes and software design impede optimal use of these resources.
Collapse
Affiliation(s)
- Ginnifer L Mastarone
- Center to Improve Veteran Involvement in Care (CIVIC), Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon
- Department of Communication, College of Liberal Arts & Sciences, Portland State University, Portland, Oregon
| | - Jessica J Wyse
- Center to Improve Veteran Involvement in Care (CIVIC), Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Eileen R Wilbur
- Pharmacy Services, Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon
| | - Benjamin J Morasco
- Center to Improve Veteran Involvement in Care (CIVIC), Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon
- Department of Psychiatry, School of Medicine, Oregon Health and Science University, Portland, Oregon
| | - Somnath Saha
- Center to Improve Veteran Involvement in Care (CIVIC), Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, Oregon
- Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Kathleen F Carlson
- Center to Improve Veteran Involvement in Care (CIVIC), Veterans Affairs Portland Health Care System (VAPORHCS), Portland, Oregon
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
20
|
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 2019; 19:S46-S53. [PMID: 30203010 DOI: 10.1093/pm/pny085] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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.
Collapse
Affiliation(s)
- Amanda M Midboe
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Stanford University
| | - Justina Wu
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Stanford University
| | - Taryn Erhardt
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Stanford University
| | | | - Mark Bounthavong
- Veterans Health Administration, Pharmacy Benefits Management, Academic Detailing Service
| | | | - Randall C Gale
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Stanford University
| |
Collapse
|
21
|
Larson MJ, Browne C, Nikitin RV, Wooten NR, Ball S, Adams RS, Barth K. Physicians report adopting safer opioid prescribing behaviors after academic detailing intervention. Subst Abus 2018; 39:218-224. [PMID: 29608412 DOI: 10.1080/08897077.2018.1449175] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background This study evaluated an educational intervention intended to increase physicians' use of patient prescription history information from the state prescription monitoring program (PMP) and their adoption of clinical behaviors consistent with opioid prescription guidelines to reduce patient risk. Methods Physician volunteers (n = 87) in community practices and Veterans Administration medical settings in South Carolina received an office-based, individualized, educational intervention (Academic Detailing) from a trained pharmacist who promoted three key messages about safer opioid prescribing. Physicians were registered for the state PMP, guided through retrieving patient information from the PMP, and given patient-centered materials. Physicians consented to completing web-surveys; 68 (78%) completed follow-up surveys on average 12.2 weeks post-intervention. Results Of 43 respondents who did not use the PMP before the intervention, 83% adopted PMP use. Self-reports also revealed a significant increase in frequency of the following behaviors: 1) using patient report information from the PMP, 2) using a standardized scale to monitor pain intensity and interference with daily functioning, and 3) issuing orders for urine toxicology screens for patients maintained long-term on opioids. Conclusions The intervention was effective in promoting physician adoption of prescribing behaviors intended to reduce risks associated with prescription opioids. The self-report findings of this study should be confirmed by analysis using data on the number of queries submitted to the state's PMP. The present study suggests that a single academic detailing visit may be an effective tool for increasing physician voluntary registration and utilization of data on patients' prescription history contained in a state PMP.
Collapse
Affiliation(s)
- Mary Jo Larson
- a Mary Jo Larson is senior scientist and senior lecturer, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University , Waltham MA
| | - Cheryl Browne
- b Cheryl Browne is an independent evaluation consultant in Somerville , MA
| | - Ruslan V Nikitin
- c Ruslan V. Nikitin was a research associate at Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University , Waltham MA
| | - Nikki R Wooten
- d Nikki R. Wooten is an assistant professor and chair, military specialization, College of Social Work, University of South Carolina, Columbia SC . Dr. Wooten is also a lieutenant colonel in the U. S. Army Reserve
| | - Sarah Ball
- e Sarah Ball is a research assistant professor, Division of General Internal Medicine and Geriatrics, College of Medicine, Medical University of South Carolina , Charleston, SC
| | - Rachel Sayko Adams
- f Rachel Sayko Adams is a scientist at the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University , Waltham MA
| | - Kelly Barth
- g Kelly Barth is associate professor, Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina , Charleston, SC
| |
Collapse
|
22
|
Olson CA. In This Issue: Contributions to CEHP Research and Practice. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2017; 37:67-69. [PMID: 28562493 DOI: 10.1097/ceh.0000000000000159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|