Changing or validating physician opioid prescribing behaviors through audit and feedback and academic detailing interventions in primary care
Background In Ontario, Canada, province-wide initiatives supporting safer opioid prescribing in primary care include voluntary audit and feedback reports and academic detailing. In this process evaluation, we aimed to determine the fidelity of delivery and receipt of the interventions, the observed...
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SAGE Publishing
2025-01-01
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| Series: | Implementation Research and Practice |
| Online Access: | https://doi.org/10.1177/26334895241307638 |
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| author | Celia Laur Natasha Kithulegoda Nicola McCleary Emily Nicholas Angl Michael Strange Barbara Sklar Thivja Sribaskaran Gail Dobell Sharon Gushue Jonathan M. C. Lam Lindsay Bevan Victoria Burton Lena Salach Justin Presseau Laura Desveaux Noah Ivers |
| author_facet | Celia Laur Natasha Kithulegoda Nicola McCleary Emily Nicholas Angl Michael Strange Barbara Sklar Thivja Sribaskaran Gail Dobell Sharon Gushue Jonathan M. C. Lam Lindsay Bevan Victoria Burton Lena Salach Justin Presseau Laura Desveaux Noah Ivers |
| author_sort | Celia Laur |
| collection | DOAJ |
| description | Background In Ontario, Canada, province-wide initiatives supporting safer opioid prescribing in primary care include voluntary audit and feedback reports and academic detailing. In this process evaluation, we aimed to determine the fidelity of delivery and receipt of the interventions, the observed change strategies used by physicians, potential mechanisms of action, and how complementary the initiatives can be to each other. Method Semi-structured interviews were conducted with academic detailers and with physicians who received both interventions. Academic detailer interviews were coded using the Behavior Change Technique Taxonomy; physician interviews were coded to the Theoretical Domain Framework. Change strategies were summarized based on academic detailer intentions and physician-reported practice changes. Potential mechanisms of action were identified using the Theories and Techniques Tool and the literature. Patient partners informed the interpretation of results through ongoing group discussions of preliminary findings. Results Interviews were conducted with eight academic detailers and 12 physicians. Change strategies described by academic detailers to support physicians’ opioid prescribing included problem solving , instructions on how to perform the behavior , adding objects to the environment , credible source , shaping knowledge , and social support. Physicians mentioned that academic detailing validated current opioid practices or increased their belief about capabilities and their intentions , mediated by increased skills and the impact of environmental context and resources . Potential mechanisms of action included behavioral regulation , behavioral cueing , and general attitudes/beliefs. On its own, receiving the audit and feedback report did not lead to changes in beliefs about prescribing practices; however, for some physicians, it provided validation and reassurance. Physicians saw unrealized potential for complementarity. Conclusions New interventions are often implemented in a complex ecosystem with other competing interventions. In this study, we show how examining the fidelity of the intervention from initial design through to delivery can identify opportunities for potential optimization. |
| format | Article |
| id | doaj-art-04c775e2c7cd4ad3b15cac0b9d4e740a |
| institution | Kabale University |
| issn | 2633-4895 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Implementation Research and Practice |
| spelling | doaj-art-04c775e2c7cd4ad3b15cac0b9d4e740a2025-01-07T10:03:19ZengSAGE PublishingImplementation Research and Practice2633-48952025-01-01610.1177/26334895241307638Changing or validating physician opioid prescribing behaviors through audit and feedback and academic detailing interventions in primary careCelia Laur0Natasha Kithulegoda1Nicola McCleary2Emily Nicholas Angl3Michael Strange4Barbara Sklar5Thivja Sribaskaran6Gail Dobell7Sharon Gushue8Jonathan M. C. Lam9Lindsay Bevan10Victoria Burton11Lena Salach12Justin Presseau13Laura Desveaux14Noah Ivers15 Institute of Health Policy, Management and Evaluation, , Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, , Toronto, ON, Canada School of Epidemiology and Public Health, , Ottawa, ON, Canada ENA Consulting, Toronto, ON, Canada Lived Experience Advisor, Toronto, ON, Canada Lived Experience Advisor, Toronto, ON, Canada Institute for Health System Solutions and Virtual Care, Women's College Research and Innovation Institute, Women's College Hospital, Toronto, ON, Canada , Toronto, ON, Canada , Toronto, ON, Canada , Toronto, ON, Canada , Toronto, ON, Canada , Toronto, ON, Canada , Toronto, ON, Canada School of Psychology, , Ottawa, ON, Canada Institute for Better Health, , Mississauga, ON, Canada Department of Family and Community Medicine, , Toronto, ON, CanadaBackground In Ontario, Canada, province-wide initiatives supporting safer opioid prescribing in primary care include voluntary audit and feedback reports and academic detailing. In this process evaluation, we aimed to determine the fidelity of delivery and receipt of the interventions, the observed change strategies used by physicians, potential mechanisms of action, and how complementary the initiatives can be to each other. Method Semi-structured interviews were conducted with academic detailers and with physicians who received both interventions. Academic detailer interviews were coded using the Behavior Change Technique Taxonomy; physician interviews were coded to the Theoretical Domain Framework. Change strategies were summarized based on academic detailer intentions and physician-reported practice changes. Potential mechanisms of action were identified using the Theories and Techniques Tool and the literature. Patient partners informed the interpretation of results through ongoing group discussions of preliminary findings. Results Interviews were conducted with eight academic detailers and 12 physicians. Change strategies described by academic detailers to support physicians’ opioid prescribing included problem solving , instructions on how to perform the behavior , adding objects to the environment , credible source , shaping knowledge , and social support. Physicians mentioned that academic detailing validated current opioid practices or increased their belief about capabilities and their intentions , mediated by increased skills and the impact of environmental context and resources . Potential mechanisms of action included behavioral regulation , behavioral cueing , and general attitudes/beliefs. On its own, receiving the audit and feedback report did not lead to changes in beliefs about prescribing practices; however, for some physicians, it provided validation and reassurance. Physicians saw unrealized potential for complementarity. Conclusions New interventions are often implemented in a complex ecosystem with other competing interventions. In this study, we show how examining the fidelity of the intervention from initial design through to delivery can identify opportunities for potential optimization.https://doi.org/10.1177/26334895241307638 |
| spellingShingle | Celia Laur Natasha Kithulegoda Nicola McCleary Emily Nicholas Angl Michael Strange Barbara Sklar Thivja Sribaskaran Gail Dobell Sharon Gushue Jonathan M. C. Lam Lindsay Bevan Victoria Burton Lena Salach Justin Presseau Laura Desveaux Noah Ivers Changing or validating physician opioid prescribing behaviors through audit and feedback and academic detailing interventions in primary care Implementation Research and Practice |
| title | Changing or validating physician opioid prescribing behaviors through audit and feedback and academic detailing interventions in primary care |
| title_full | Changing or validating physician opioid prescribing behaviors through audit and feedback and academic detailing interventions in primary care |
| title_fullStr | Changing or validating physician opioid prescribing behaviors through audit and feedback and academic detailing interventions in primary care |
| title_full_unstemmed | Changing or validating physician opioid prescribing behaviors through audit and feedback and academic detailing interventions in primary care |
| title_short | Changing or validating physician opioid prescribing behaviors through audit and feedback and academic detailing interventions in primary care |
| title_sort | changing or validating physician opioid prescribing behaviors through audit and feedback and academic detailing interventions in primary care |
| url | https://doi.org/10.1177/26334895241307638 |
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