Academic Detailing to Improve Opioid Safety: Implementation Lessons from a Qualitative Evaluation
Academic Detailing to Improve Opioid Safety: Implementation Lessons from a Qualitative Evaluation
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DOI：
10.1093/pm/pny085
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发表时间：
2018-09-01
期刊：
影响因子：
3.1
通讯作者：
Gale, Randall C.
中科院分区：
文献类型：
--
作者：
Midboe, Amanda M.;Wu, Justina;Gale, Randall C.
客观的。学术细节 (AD) 是一种很有前途的干预措施，可以解决与阿片类药物相关的日益增长的发病率和死亡率。虽然 AD 已被证明可以有效改善提供者在多种情况下的处方实践，但目前尚不清楚如何最好地实施 AD。本研究旨在根据退伍军人健康管理局 (VA) 的 AD 计划模型确定实施的关键经验教训。设计。使用半结构化访谈进行定性过程评估。环境。塞拉太平洋地区有七个退伍军人管理局医疗保健系统。科目。现任和前任学术详细信息提供者 (N = 10) 以及 VA 提供者对 AD 的暴露程度不同（高、低或无；N = 20）。方法。半结构化访谈被录音并转录。我们使用了基于团队的、混合归纳和演绎的方法，以实施研究综合框架为指导。结果。学术细节制定者和提供者围绕关键主题总结出的主要经验教训：1）针对提供者的患者群体定制的一对一会议最有用； 2) 领导力在支持提供者参与 AD 计划方面发挥着关键作用； 3) 跟踪学术细节提供者和提供者的表现对于提高这两个群体的表现非常重要； 4) 学术细节人员在激励提供者行为改变方面发挥着关键作用，因此动机访谈培训非常有价值； 5) 学术细节专家指出，网络对于共享实施策略和资源非常重要。结论。确定这些重要经验教训并将其纳入 AD 等复杂干预措施的实施中，对于促进采用基于证据的干预措施来应对阿片类药物流行病至关重要。
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.