TY - JOUR
T1 - A randomized matched-pairs study of feasibility, acceptability, and effectiveness of systems consultation
T2 - A novel implementation strategy for adopting clinical guidelines for Opioid prescribing in primary care
AU - Quanbeck, Andrew
AU - Brown, Randall T.
AU - Zgierska, Aleksandra E.
AU - Jacobson, Nora
AU - Robinson, James M.
AU - Johnson, Roberta A.
AU - Deyo, Brienna M.
AU - Madden, Lynn
AU - Tuan, Wen Jan
AU - Alagoz, Esra
N1 - Funding Information:
The authors thank the distinguished experts who served on the advisory panel for the study and took part in translating the clinical guideline for opioid prescribing: from pain management, the experts who developed the guideline for opioid prescribing, Jane Ballantyne, MD, Roger Chou, MD, and Perry Fine, MD; from healthcare quality improvement and implementation, David H. Gustafson, PhD, Dennis McCarty, PhD, and Paul Batalden, MD; and from community-based family medicine, Jonas Lee, MD, Beth Potter, MD, and John Frey, MD. The authors also thank Richard O. Welnick, MD, from UWHealth for his support of the project and staff members Judith Ganch and Nicholas Schumacher for their editorial assistance. Funding The National Institute on Drug Abuse (NIDA) is the primary funder of the study (R34-DA-036720-01 and 1K01DA039336-01). The funder had no role in study design, the collection or interpretation of data, or the publication of results.
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/1/25
Y1 - 2018/1/25
N2 - Background: This paper reports on the feasibility, acceptability, and effectiveness of an innovative implementation strategy named "systems consultation" aimed at improving adherence to clinical guidelines for opioid prescribing in primary care. While clinical guidelines for opioid prescribing have been developed, they have not been widely implemented, even as opioid abuse reaches epidemic levels. Methods: We tested a blended implementation strategy consisting of several discrete implementation strategies, including audit and feedback, academic detailing, and external facilitation. The study compares four intervention clinics to four control clinics in a randomized matched-pairs design. Each systems consultant aided clinics on implementing the guidelines during a 6-month intervention consisting of monthly site visits and teleconferences/videoconferences. The mixed-methods evaluation employs the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Quantitative outcomes are compared using time series analysis. Qualitative methods included focus groups, structured interviews, and ethnographic field techniques. Results: Seven clinics were randomly approached to recruit four intervention clinics. Each clinic designated a project team consisting of six to eight staff members, each with at least one prescriber. Attendance at intervention meetings was 83%. More than 80% of staff respondents agreed or strongly agreed with the statements: "I am more familiar with guidelines for safe opioid prescribing" and "My clinic's workflow for opioid prescribing is easier." At 6 months, statistically significant improvements were noted in intervention clinics in the percentage of patients with mental health screens, treatment agreements, urine drug tests, and opioid-benzodiazepine co-prescribing. At 12 months, morphine-equivalent daily dose was significantly reduced in intervention clinics compared to controls. The cost to deliver the strategy was $7345 per clinic. Adaptations were required to make the strategy more acceptable for primary care. Qualitatively, intervention clinics reported that chronic pain was now treated using approaches similar to those employed for other chronic conditions, such as hypertension and diabetes. Conclusions: The systems consultation implementation strategy demonstrated feasibility, acceptability, and effectiveness in a study involving eight primary care clinics. This multi-disciplinary strategy holds potential to mitigate the prevalence of opioid addiction and ultimately may help to improve implementation of clinical guidelines across healthcare.
AB - Background: This paper reports on the feasibility, acceptability, and effectiveness of an innovative implementation strategy named "systems consultation" aimed at improving adherence to clinical guidelines for opioid prescribing in primary care. While clinical guidelines for opioid prescribing have been developed, they have not been widely implemented, even as opioid abuse reaches epidemic levels. Methods: We tested a blended implementation strategy consisting of several discrete implementation strategies, including audit and feedback, academic detailing, and external facilitation. The study compares four intervention clinics to four control clinics in a randomized matched-pairs design. Each systems consultant aided clinics on implementing the guidelines during a 6-month intervention consisting of monthly site visits and teleconferences/videoconferences. The mixed-methods evaluation employs the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Quantitative outcomes are compared using time series analysis. Qualitative methods included focus groups, structured interviews, and ethnographic field techniques. Results: Seven clinics were randomly approached to recruit four intervention clinics. Each clinic designated a project team consisting of six to eight staff members, each with at least one prescriber. Attendance at intervention meetings was 83%. More than 80% of staff respondents agreed or strongly agreed with the statements: "I am more familiar with guidelines for safe opioid prescribing" and "My clinic's workflow for opioid prescribing is easier." At 6 months, statistically significant improvements were noted in intervention clinics in the percentage of patients with mental health screens, treatment agreements, urine drug tests, and opioid-benzodiazepine co-prescribing. At 12 months, morphine-equivalent daily dose was significantly reduced in intervention clinics compared to controls. The cost to deliver the strategy was $7345 per clinic. Adaptations were required to make the strategy more acceptable for primary care. Qualitatively, intervention clinics reported that chronic pain was now treated using approaches similar to those employed for other chronic conditions, such as hypertension and diabetes. Conclusions: The systems consultation implementation strategy demonstrated feasibility, acceptability, and effectiveness in a study involving eight primary care clinics. This multi-disciplinary strategy holds potential to mitigate the prevalence of opioid addiction and ultimately may help to improve implementation of clinical guidelines across healthcare.
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U2 - 10.1186/s13012-018-0713-1
DO - 10.1186/s13012-018-0713-1
M3 - Article
C2 - 29370813
AN - SCOPUS:85041570226
VL - 13
JO - Implementation Science
JF - Implementation Science
SN - 1748-5908
IS - 1
M1 - 21
ER -