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.