Academic Detailing for Postpartum Opioid Prescribing

Abstract

Overprescribing opioid pain medications has become a major concern in our society due to the increasing rates of substance use disorders and the rate of accidental overdoses. The widespread availability of opioid medications suggests that patients are being prescribed opioids in amounts larger than they require for pain control. Efforts are now being made on a variety of fronts to decrease overprescribing. Material and Methods: A quality-improvement model was applied to address this concern at one medical center in women being discharged from the hospital following childbirth. The rates and amounts at which opioids were prescribed to this population before and after an academic detailing intervention were compared. Results: The overall percentage of women who received prescriptions for opioid medications decreased from 100% to 93% in cesarean sections (P ‫؍‬ .054) and 15% to 9% in vaginal deliveries (P ‫؍‬ .03). The average prescription size decreased by 5 tablets (P < .0001). Implications: Simple quality-improvement methods may have a positive impact on opioid prescribing patterns, including decreasing the percentage of opioids postdelivery or the quantity of opioids per prescription.

Academic detailing interventions for opioid-related outcomes: a scoping review

“…Of the 22 full-text articles included, we identified 20 unique interventions ( Tables 1 and 2 ). 6 , 7 , 17 – 35 Sixteen (80%) of the interventions were published in the last 5 years. Interventions were carried out in two countries, the United States ( n =17) and Australia ( n =3).…”

The Opioid-overdose Reduction Continuum of Care Approach (ORCCA): Evidence-based practices in the HEALing Communities Study

“…Online and in-person continuing education has been shown to improve knowledge, attitudes, confidence and self-reported clinical practice in safer opioid prescribing ( Alford et al, 2016 ). Academic detailing, an interactive one-on-one educational outreach by a healthcare provider to a prescriber to provide unbiased, evidence-based information to improve patient care, has been applied successfully to improve opioid prescribing behavior ( Larson et al, 2018 ; Voelker and Schauberger, 2018 ). The utilization of state Prescription Drug Monitoring Programs to assess patients’ controlled substance prescription histories and identify potential risky patterns of opioid use or drug combinations has resulted in reduced multiple-provider episodes (i.e., “doctor shopping”) ( Strickler et al, 2020 ), reduced high-risk opioid prescribing ( Strickler et al, 2019 ), and reduced prescription opioid poisonings ( Pauly et al, 2018 ).…”

Practice-based Research Network (PBRN) Engagement: 20+ Years and Counting

“…They surveyed family physicians in Colorado and had a low response rate, but, nonetheless, their results generate the hypothesis that the use of patient satisfaction surveys to affect salary may increase opioid prescribing, presumably to affect satisfaction ratings. In addition, addressing the prescription opioid problem, Voelker and Schauberger 22 , in their research letter, report that a QI process of providing performance reports plus academic detailing to clinicians practicing obstetrics in 1 hospital system led to decreased opioid prescriptions for mothers postdelivery.…”

“…Results show a modest effort to supply continuing medical education for PBRN activities, show a low level of addressing health policy issues, and suggest an urgent need to train the future generation of primary care researchers. Voelker and Schauberger 22 illustrate how QI can use evidence-based academic detailing to educate clinicians. We already know that PBRN participation changes clinical behavior through education and experience.…”