(3) Using Academic Detailing for Educational Outreach to Reduce Opioid Prescribing Rates

Background:
The opioid epidemic remains a significant public health problem in the US. More than 70,000 people died of an overdose in 2019; over two-thirds of these deaths involved an opioid. Overdoses involving opioids killed nearly 47,000 people in 2018. Arkansas (AR) is one of the highest opioid prescribing states with a rate of 108.1 prescriptions per 100 persons in 2017 and 102.1 in 2018, nearly double the US average of 51.4. Despite this slight improvement to 93.2 in 2019, only 1 county in AR was below the national average by the CDC calculation. This ongoing research uses educational interventions through an Academic Detailing (AD) Program developed by University of Arkansas for Medical Sciences and provided to rural primary care providers (PCPs) in AR counties with the highest opioid-prescribing rates and opioid-overdose deaths. Our overarching goal of the AD Program was to provide 1:1 in-person, evidence-based education to increase provider’s knowledge of opioid safety and to offer alternative multidisciplinary pain care and treatment, while reducing opioid prescribing when possible.
Methods
Our trained pharmacist delivered the AD Program education to 103 PCPs from June 21, 2019 to November 26, 2019 in 16 of 75 counties in AR. The AD Program was concentrated to reach PCPs because this area of practice accounts for the largest source of opioid prescriptions. Using data from the AR Prescription Drug Monitoring Program, counties with the highest rates of opioid prescriptions per capita were identified to receive the AD Program education. The session details, including visit duration, topics discussed, materials provided, PCP receptiveness and concerns, and requests for additional information, were tracked in Research Electronic Data Capture database.
Findings
PCPs were given the opportunity to complete a post-visit survey to evaluate the success of the educational outreach. The majority of surveyed PCPs felt that the AD Program session disseminated useful information for their primary care practice. Of the 30 PCPs who responded to the survey, 22 (73%) implemented changes to their pain management approach as a result.
Conclusions
Many PCPs reported barriers to acquiring patient resources, including financial limitations, lack of local access to multidisciplinary practitioners, and adequate transportation. PCPs in rural communities struggle to apply the evidence-based, multidisciplinary approach to pain management when access to such treatment disciplines and modalities are limited or nonexistent. In 2020, the COVID-19 pandemic halted in-person visits and the AD Program team modified their methods with alternative correspondence. This AD research will continue through November 2022.

References: -Margot Trotter Davis, Brian Bateman, and Jerry Avorn, “Educational Outreach to Opioid Prescribers: The Case for Academic Detailing,” Pain Physician, no. 2017 (n.d.): 6.
-Christopher D. Saffore et al., “Identification of Barriers to Safe Opioid Prescribing in Primary Care: A Qualitative Analysis of Field Notes Collected through Academic Detailing,” British Journal of General Practice 70, no. 697 (August 1, 2020): e589–97.
-Christopher D. Saffore et al., “Secondary Effects of an Opioid-Focused Academic Detailing Program on Non-Opioid Controlled Substance Prescribing in Primary Care,” Substance Abuse, March 22, 2021, 1–6, https://doi.org/10.1080/08897077.2021.1900989.
-“Drug Overdose Deaths | Drug Overdose | CDC Injury Center,” September 9, 2021, https://www.cdc.gov/drugoverdose/deaths/index.html.
-2019 PDMP Annual Report "https://www.healthy.arkansas.gov/images/uploads/pdf/2019_PDMP_Annual_Report-PUBLISHED.pdf"