Academic detailing to improve opioid safety: Implementation lessons from a qualitative evaluation

Abstract

Objective. Academic detailing (AD) is a promising intervention to address the growing morbidity and mortality associated with opioids. While AD has been shown to be effective in improving provider prescribing practices across a range of conditions, it is unclear how best to implement AD. The present study was designed to identify key lessons for implementation based on a model AD program in the Veterans Health Administration (VA). Design. Qualitative process evaluation using semistructured interviews. Setting. Seven VA health care systems in the Sierra Pacific region. Subjects. Current and former academic detailers (N=10) and VA providers with varying exposure to AD (high, low, or no; N=20). Methods. Semistructured interviews were audio-recorded and transcribed. We used a teambased, mixed inductive and deductive approach guided by the Consolidated Framework for Implementation Research. Results. Key lessons identified by academic detailers and providers coalesced around key themes: 1) one-onone sessions customized to the providers patient population are most useful; 2) leadership plays a critical role in supporting providers participation in AD programs; 3) tracking academic detailer and provider performance is important for improving performance for both groups; 4) academic detailers play a key role in motivating provider behavior change and thus training in Motivational Interviewing is highly valuable; and 5) academic detailers noted that networking is important for sharing implementation strategies and resources. Conclusions. Identifying and incorporating these key lessons into the implementation of complex interventions like AD are critical to facilitating uptake of evidencebased interventions addressing the opioid epidemic.