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Research

Identification of barriers to safe opioid prescribing in primary care: a qualitative analysis of field notes collected through academic detailing

Christopher D Saffore, Sarette T Tilton, Stephanie Y Crawford, Michael A Fischer, Todd A Lee, A Simon Pickard and Lisa K Sharp
British Journal of General Practice 2020; 70 (697): e589-e597. DOI: https://doi.org/10.3399/bjgp20X711737
Christopher D Saffore
Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago.
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Sarette T Tilton
University of Illinois at Chicago College of Pharmacy, Chicago.
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Stephanie Y Crawford
Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago.
Roles: Professor
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Michael A Fischer
National Resource Center for Academic Detailing, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston.
Roles: Director
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Todd A Lee
Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago.
Roles: Professor and head
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A Simon Pickard
Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago.
Roles: Professor
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Lisa K Sharp
Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago, Chicago.
Roles: Professor
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Abstract

Background Understanding barriers to safe opioid prescribing in primary care is critical amid the epidemic of prescription opioid abuse, misuse, and overdose in the US. Educational outreach strategies, such as academic detailing (AD), provide a forum for identification of barriers to, and strategies to facilitate, safe opioid prescribing in primary care.

Aim To identify barriers to safe opioid prescribing among primary care providers (PCPs) through AD.

Design and setting Qualitative analysis of data was collected through an existing AD intervention to improve safe opioid prescribing in primary care. The AD intervention was delivered from June 2018 to August 2018 to licensed PCPs with prescriptive authority within a large independent health system in the metropolitan Chicagoland area.

Method The AD intervention involved visits by trained detailers to PCPs who contemporaneously documented details from each visit via field notes. Using qualitative analysis, field notes were analysed to identify recurring themes related to opioid prescribing barriers.

Results Detailer-entered field notes from 186 AD visits with PCPs were analysed. Barriers to safe opioid prescribing were organised into six themes: 1) gaps in knowledge; 2) lack of prescription monitoring programme (PMP) utilisation; 3) patient pressures to prescribe opioids; 4) insurance coverage policies; 5) provider beliefs; and 6) health system pain management practices.

Conclusion Barriers to safe opioid prescribing in primary care, identified through AD visits among this large group of PCPs, support the need for continued efforts to enhance pain-management education, maximise PMP utilisation, and increase access to, and affordability of, non-opioid treatments.

  • academic detailing
  • opioids
  • primary health care
  • qualitative research
  • Received November 20, 2019.
  • Revision requested December 8, 2019.
  • Accepted December 17, 2019.
  • © British Journal of General Practice 2020
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British Journal of General Practice: 70 (697)
British Journal of General Practice
Vol. 70, Issue 697
August 2020
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Identification of barriers to safe opioid prescribing in primary care: a qualitative analysis of field notes collected through academic detailing
Christopher D Saffore, Sarette T Tilton, Stephanie Y Crawford, Michael A Fischer, Todd A Lee, A Simon Pickard, Lisa K Sharp
British Journal of General Practice 2020; 70 (697): e589-e597. DOI: 10.3399/bjgp20X711737

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Identification of barriers to safe opioid prescribing in primary care: a qualitative analysis of field notes collected through academic detailing
Christopher D Saffore, Sarette T Tilton, Stephanie Y Crawford, Michael A Fischer, Todd A Lee, A Simon Pickard, Lisa K Sharp
British Journal of General Practice 2020; 70 (697): e589-e597. DOI: 10.3399/bjgp20X711737
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Keywords

  • academic detailing
  • opioids
  • primary health care
  • qualitative research

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