Kithulegoda Natasha, Chu Cherry, Tadrous Mina, Bean Tupper, Salach Lena, Regier Loren, Bevan Lindsay, Burton Victoria, Price David, Ivers Noah, Desveaux Laura
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.
CMAJ Open. 2023 Oct 17;11(5):E932-E941. doi: 10.9778/cmajo.20210050. Print 2023 Sep-Oct.
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.
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.
Physicians receiving academic detailing ( = 238) achieved a greater reduction in opioid prescribing than matched controls ( = 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.
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.
学术推广是一项面向家庭医生的教育外展服务，由安大略省政府资助，旨在解决阿片类药物处方和疼痛管理方面的差距。我们试图评估学术推广对阿片类药物处方的影响，并了解学术推广如何以及为何可能影响阿片类药物处方。
在这项混合方法研究中，我们于2017年至2019年在加拿大安大略省同时收集了定量和定性数据。我们对参与研究的医生样本的处方结果进行了描述性分析，并将其与匹配的对照组进行了比较。我们邀请医生参与定性访谈，以讨论他们在学术推广方面的经历。定性访谈的开展和分析以理论领域框架为依据。我们对定性和定量研究结果进行三角互证，以了解推动阿片类药物处方变化的机制。
接受学术推广的医生（n = 238）在阿片类药物处方减少方面比匹配的对照组（n = 238）更为显著。17名医生完成了访谈，并报告说学术推广解决了疼痛护理方面的障碍，包括缺乏信心、与患者的艰难互动以及处方和逐渐减量的决定。学术推广强化了有关阿片类药物处方和疼痛管理的知识。对复杂患者的讨论以及在具有挑战性的对话中使用的谈话要点被描述为实践改变的关键驱动因素。
这项现实世界的混合方法评估结果解释了学术推广服务如何解决基层医疗中限制高风险阿片类药物处方的关键障碍和促进因素。这种细致入微的理解将用于为学术推广提供信息、传播和扩大规模。
