Academic Detailing to Advance Naloxone Prescribing in Rural Primary Care: A 2-Year Pilot Study

Abstract

Background: Opioid-related overdoses remain a critical concern in Arkansas, where Primary Care Providers (PCPs) play a key role in overdose prevention through naloxone education and prescribing. Academic Detailing (AD) is a promising strategy to improve provider knowledge, confidence, and adoption of naloxone-related practices, yet feasibility in rural primary care remains underexplored. Aim: To evaluate the feasibility and impact of a brief, continuing education (CE)-accredited AD intervention on naloxone prescribing confidence and behavior among rural PCPs over 2 years. Methodology: The University of Arkansas for Medical Sciences (UAMS) delivered a 30-minute virtual AD session, “Preventing Opioid Overdose with Naloxone,” to 15 PCPs within a large Federally Qualified Health Center network. A matched control group of 15 PCPs was included. Implementation service outcomes (via prescribing) were assessed using repeated measures multivariate analysis of variance (MANOVA). Immediate post-session and 2-year follow-up surveys examined confidence, practice changes, and implementation experiences. Results: Naloxone prescribing increased in both groups; however, there was no significant group-by-time interaction. All post-session respondents reported increased confidence. At 2 years, 92% indicated the AD session continued to influence their practice. Qualitative feedback identified barriers (stigma, cost, and limited patient update) and facilitators (peer support and institutional policies) shaping prescribing. Conclusion: This pilot demonstrates the feasibility of delivering AD in rural primary care and provides evidence of early penetration within an FQHC network. While prescribing increases could not be attributed solely to the intervention, AD was associated with sustained improvements in provider knowledge, confidence, and perceived relevance of naloxone prescribing. These findings highlight the limitations of brief educational sessions when implemented without complementary system-level supports, underscoring the need for multilevel approaches to expand naloxone access in underserved communities.