Understanding State-Level Variations in Implementing Academic Detailing for Prescribing Opioids: Findings from 11 States Within the United States

摘要

Objective. Academic detailing is a clinical education technique characterized by targeted, one-on-one, interactive conversations between trained staff and the clinician. This study describes variations in implementing academic detailing among jurisdictions receiving funding from the U.S. Centers for Disease Control and Prevention (CDC) to prevent prescription drug overdoses. Design. In 2015, CDC started the Prescription Drug Overdose Prevention for States (PfS) program. Subjects. This study focuses on 11 of the 29 funded jurisdictions that implemented academic detailing as part of their PfS efforts. Methods. Jurisdictions provided annual progress reports from 2016 to 2019. We conducted semistructured interviews in 2017 and 2018 with all funded jurisdictions and conducted follow-up interviews with three jurisdictions in 2020 to obtain additional context. We used an analytic matrix display to identify themes from annual progress report data, the coding report from the 2017/2018 interviews, and the three follow-up interviews from 2020. Results. Two academic detailing models emerged: 1) one-on-one detailing, where centrally trained staff conducted all visits, and 2) a train-the-trainer model. Jurisdictions also described a hybrid model, which they referred to as academic detailing despite not meeting the definition of academic detailing. We identified variations in delivery strategies, staffing, and curriculum development within and between models. Despite these differences, common themes included the need to use data to focus academic detailing and the importance of partnerships. Conclusions. Adoption of academic detailing as a strategy for improving opioid prescribing behaviors has increased. However, there is limited guidance and standardization to guide and evaluate implementation and outcomes.