South Carolina (SC) ranks 10th in opioid prescriptions per capita—33% higher than the national average. SC is also home to a large military and veteran population, and prescription opioid use for chronic pain is alarmingly common among veterans, especially those returning from Afghanistan and Iraq. This article describes the background and development of an academic detailing (AD) educational intervention to improve use of a Prescription Drug Monitoring Program among SC physicians who serve military members and veterans. The aim of this intervention was to improve safe opioid prescribing practices and prevent prescription opioid misuse among this high-risk population.
A multidisciplinary study team of physicians, pharmacists, psychologists, epidemiologists, and representatives from the SC's Prescription Monitoring Program used the Medical Research Council complex interventions framework to guide the development of the educational intervention. The theoretical and modeling phases of the AD intervention development are described and preliminary evidence of feasibility and acceptability is provided.
Ninety-three physicians consented to the study from 2 practice sites. Eighty-seven AD visits were completed, and 59 one-month follow-up surveys were received. Participants rated the AD intervention high in helpfulness of information, intention to use information, and overall satisfaction with the intervention. The component of the intervention felt to be most helpful was the AD visit itself. Characteristics of the participants and the intervention, as well as anticipated barriers to behavior change are detailed.
Preliminary results support the feasibility of AD delivery to veteran and community patient settings, the feasibility of facilitating Prescription Drug Monitoring Program registration during an AD visit, and that AD visits were generally found satisfying to participants and helpful in improving knowledge and confidence about safe opioid prescribing practices. The component of the intervention felt to be most helpful to the participants was the actual AD visit, and most participants rated their intentions high to use the information and tools from the visit. Intervention key messages, preliminary outcome measures, and successes and challenges in developing and delivering this intervention are discussed to advance best practices in developing educational interventions in this important area of public health.
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Barth: Associate Professor, Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC. Ball: Research Assistant Professor, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC. Adams: Scientist, Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Nikitin: Research Associate, Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA. Wooten: Assistant Professor, College of Social Work, University of South Carolina, and Chair, Military Specialization, Lieutenant Colonel, Army National Guard. Qureshi: Assistant Professor, Department of Health Services Policy and Management, University of South Carolina, Columbia, SC, and Adjunct Professor, Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, Columbia, SC. Larson: Senior Scientist and Lecturer, Heller School for Social Policy and Management, Brandeis University, Waltham, MA.
Correspondence: Kelly S. Barth, DO, Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 67 President Street, Charleston, SC 29425; e-mail: Stephen@musc.edu.
Disclosures: The authors declare no conflict of interest. M.J.L., K.S.B., and S.B. contributed to study design. All authors interpreted the data and contributed in manuscript writing. K.S.B., R.S.A., R.N., S.B., and M.J.L. wrote the iterative drafts of the manuscripts. All authors read, contributed to, and approved the final manuscript. N.R.W.'s effort is funded by the National Institute on Drug Abuse (K01DA037412). M.J.L., R.S.A., and R.N.'s effort is funded in part National Institute on Drug Abuse (R34 DA037039). K.S.B. served as a consultant for the R34 (DA037039).
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