Impacting the Prescribing of Opioids through Academic Detailing

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1 Academic detailing (AD) programs that educate providers on the appropriate prescribing of opioids have the 2 potential to improve health outcomes and patient care, but the extent to which AD is effective for this purpose 3 is not well established. The long-term goal of the proposed research is to improve the management of 4 patients with chronic pain while reducing fatal and non-fatal opioid overdoses. This goal will be accomplished 5 by implementing and evaluating AD programs delivered to primary care providers on the appropriate 6 management of chronic non-cancer pain. The objective is to improve appropriateness of opioid prescribing by 7 primary care providers in Illinois. The central hypothesis is that one-on-one AD visits by academic detailers 8 will improve appropriate opioid prescribing by primary care providers and enhance their use of the State 9 Prescription Drug Program (PMP). The rationale for the proposed research is rooted in the need to generate 10 evidence on the effectiveness of AD programs to improve opioid prescribing and provide resources to 11 successfully implement them. This work will be accomplished by building on pilot AD programs in the 12 Chicagoland and Southern Illinois regions that we successfully implemented in collaboration with the State of 13 Illinois PMP. The proposed research will rigorously evaluate the effectiveness of two different AD programs in 14 Illinois. The specific aims are: 1) to evaluate the short-term (6 month) impact of an AD program involving 2 15 visits on opioid prescribing patterns and PMP utilization among primary care providers; 2) to determine the 16 longer-term effectiveness (12 months) of a more sustained AD program (i.e. more than two visits); 3) to 17 develop an online toolkit of accessible resources for AD programs on the safe and appropriate management of 18 patients with chronic pain for use by health-systems and state/local health departments. The proposed 19 research is innovative in the design of the AD visit on opioid prescribing, including individualized opioid 20 metrics that compare provider prescribing to local norms using Illinois PMP data, use of validated measures to 21 assess intention to change opioid prescribing behavior as a result of the AD visit, and program evaluation 22 using a stepped-wedge cluster-randomized design. Our successful experience in implementing pilot AD 23 programs in the state as part of Illinois' CDC prevention for states activities and our established relationship 24 with the Illinois PMP and health-systems throughout Illinois make us well positioned to evaluate the impact of 25 AD on opioid prescribing activities. The proposed research is significant to combating the opioid epidemic 26 because evidence to support the effectiveness of AD programs and their design and delivery is critical to 27 identifying approaches that modify prescribing behaviors and improve the management of patients with pain. 28 The expected outcome is to positively impact clinical decision-making and patient outcomes in Illinois and 29 address evidence gaps on the effectiveness of AD programs that leverage relationships with state PMPs to 30 improve opioid prescribing and pain management by healthcare providers.