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A randomized matched-pairs study of feasibility, acceptability, and effectiveness of systems consultation: a novel implementation strategy for adopting clinical guidelines for Opioid prescribing in primary care.
Implement Sci. 2018 01 25; 13(1):21.IS

Abstract

BACKGROUND

This paper reports on the feasibility, acceptability, and effectiveness of an innovative implementation strategy named "systems consultation" aimed at improving adherence to clinical guidelines for opioid prescribing in primary care. While clinical guidelines for opioid prescribing have been developed, they have not been widely implemented, even as opioid abuse reaches epidemic levels.

METHODS

We tested a blended implementation strategy consisting of several discrete implementation strategies, including audit and feedback, academic detailing, and external facilitation. The study compares four intervention clinics to four control clinics in a randomized matched-pairs design. Each systems consultant aided clinics on implementing the guidelines during a 6-month intervention consisting of monthly site visits and teleconferences/videoconferences. The mixed-methods evaluation employs the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Quantitative outcomes are compared using time series analysis. Qualitative methods included focus groups, structured interviews, and ethnographic field techniques.

RESULTS

Seven clinics were randomly approached to recruit four intervention clinics. Each clinic designated a project team consisting of six to eight staff members, each with at least one prescriber. Attendance at intervention meetings was 83%. More than 80% of staff respondents agreed or strongly agreed with the statements: "I am more familiar with guidelines for safe opioid prescribing" and "My clinic's workflow for opioid prescribing is easier." At 6 months, statistically significant improvements were noted in intervention clinics in the percentage of patients with mental health screens, treatment agreements, urine drug tests, and opioid-benzodiazepine co-prescribing. At 12 months, morphine-equivalent daily dose was significantly reduced in intervention clinics compared to controls. The cost to deliver the strategy was $7345 per clinic. Adaptations were required to make the strategy more acceptable for primary care. Qualitatively, intervention clinics reported that chronic pain was now treated using approaches similar to those employed for other chronic conditions, such as hypertension and diabetes.

CONCLUSIONS

The systems consultation implementation strategy demonstrated feasibility, acceptability, and effectiveness in a study involving eight primary care clinics. This multi-disciplinary strategy holds potential to mitigate the prevalence of opioid addiction and ultimately may help to improve implementation of clinical guidelines across healthcare.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02433496). https://clinicaltrials.gov/ct2/show/NCT02433496 Registered May 5, 2015.

Links

PMC Free PDF

Authors+Show Affiliations

Quanbeck A
University of Wisconsin Department of Family Medicine and Community Health, Madison, WI, USA. arquanbe@wisc.edu. University of Wisconsin Center for Health Enhancement Systems Studies, Madison, WI, USA. arquanbe@wisc.edu.
Brown RT
University of Wisconsin Department of Family Medicine and Community Health, Madison, WI, USA.
Zgierska AE
University of Wisconsin Department of Family Medicine and Community Health, Madison, WI, USA.
Jacobson N
University of Wisconsin - Madison School of Nursing, Madison, WI, USA.
Robinson JM
University of Wisconsin Center for Health Systems Research and Analysis, Madison, WI, USA.
Johnson RA
University of Wisconsin Department of Family Medicine and Community Health, Madison, WI, USA.
Deyo BM
University of Wisconsin Department of Family Medicine and Community Health, Madison, WI, USA.
Madden L
APT Foundation, New Haven, CT, USA.
Tuan WJ
University of Wisconsin Department of Family Medicine and Community Health, Madison, WI, USA.
Alagoz E
University of Wisconsin Center for Health Enhancement Systems Studies, Madison, WI, USA.

MeSH

Analgesics, OpioidChronic PainDelivery of Health CareEvidence-Based PracticeFemaleFocus GroupsGuideline AdherenceHumansInterviews as TopicMaleOpioid-Related DisordersPractice Guidelines as TopicPractice Patterns, Physicians'Primary Health CareQualitative ResearchReferral and ConsultationResearch Design

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29370813

Clinical Trial Links

Clinical trial which this article describes

Citation

Quanbeck, Andrew, et al. "A Randomized Matched-pairs Study of Feasibility, Acceptability, and Effectiveness of Systems Consultation: a Novel Implementation Strategy for Adopting Clinical Guidelines for Opioid Prescribing in Primary Care." Implementation Science : IS, vol. 13, no. 1, 2018, p. 21.
Quanbeck A, Brown RT, Zgierska AE, et al. A randomized matched-pairs study of feasibility, acceptability, and effectiveness of systems consultation: a novel implementation strategy for adopting clinical guidelines for Opioid prescribing in primary care. Implement Sci. 2018;13(1):21.
Quanbeck, A., Brown, R. T., Zgierska, A. E., Jacobson, N., Robinson, J. M., Johnson, R. A., Deyo, B. M., Madden, L., Tuan, W. J., & Alagoz, E. (2018). A randomized matched-pairs study of feasibility, acceptability, and effectiveness of systems consultation: a novel implementation strategy for adopting clinical guidelines for Opioid prescribing in primary care. Implementation Science : IS, 13(1), 21. https://doi.org/10.1186/s13012-018-0713-1
Quanbeck A, et al. A Randomized Matched-pairs Study of Feasibility, Acceptability, and Effectiveness of Systems Consultation: a Novel Implementation Strategy for Adopting Clinical Guidelines for Opioid Prescribing in Primary Care. Implement Sci. 2018 01 25;13(1):21. PubMed PMID: 29370813.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A randomized matched-pairs study of feasibility, acceptability, and effectiveness of systems consultation: a novel implementation strategy for adopting clinical guidelines for Opioid prescribing in primary care. AU - Quanbeck,Andrew, AU - Brown,Randall T, AU - Zgierska,Aleksandra E, AU - Jacobson,Nora, AU - Robinson,James M, AU - Johnson,Roberta A, AU - Deyo,Brienna M, AU - Madden,Lynn, AU - Tuan,Wen-Jan, AU - Alagoz,Esra, Y1 - 2018/01/25/ PY - 2017/09/25/received PY - 2018/01/16/accepted PY - 2018/1/27/entrez PY - 2018/1/27/pubmed PY - 2018/12/28/medline KW - Clinical practice guidelines KW - Evidence-based practice KW - Opioid prescribing KW - Organizational coaching KW - Organizational implementation strategies KW - Primary care SP - 21 EP - 21 JF - Implementation science : IS JO - Implement Sci VL - 13 IS - 1 N2 - BACKGROUND: This paper reports on the feasibility, acceptability, and effectiveness of an innovative implementation strategy named "systems consultation" aimed at improving adherence to clinical guidelines for opioid prescribing in primary care. While clinical guidelines for opioid prescribing have been developed, they have not been widely implemented, even as opioid abuse reaches epidemic levels. METHODS: We tested a blended implementation strategy consisting of several discrete implementation strategies, including audit and feedback, academic detailing, and external facilitation. The study compares four intervention clinics to four control clinics in a randomized matched-pairs design. Each systems consultant aided clinics on implementing the guidelines during a 6-month intervention consisting of monthly site visits and teleconferences/videoconferences. The mixed-methods evaluation employs the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Quantitative outcomes are compared using time series analysis. Qualitative methods included focus groups, structured interviews, and ethnographic field techniques. RESULTS: Seven clinics were randomly approached to recruit four intervention clinics. Each clinic designated a project team consisting of six to eight staff members, each with at least one prescriber. Attendance at intervention meetings was 83%. More than 80% of staff respondents agreed or strongly agreed with the statements: "I am more familiar with guidelines for safe opioid prescribing" and "My clinic's workflow for opioid prescribing is easier." At 6 months, statistically significant improvements were noted in intervention clinics in the percentage of patients with mental health screens, treatment agreements, urine drug tests, and opioid-benzodiazepine co-prescribing. At 12 months, morphine-equivalent daily dose was significantly reduced in intervention clinics compared to controls. The cost to deliver the strategy was $7345 per clinic. Adaptations were required to make the strategy more acceptable for primary care. Qualitatively, intervention clinics reported that chronic pain was now treated using approaches similar to those employed for other chronic conditions, such as hypertension and diabetes. CONCLUSIONS: The systems consultation implementation strategy demonstrated feasibility, acceptability, and effectiveness in a study involving eight primary care clinics. This multi-disciplinary strategy holds potential to mitigate the prevalence of opioid addiction and ultimately may help to improve implementation of clinical guidelines across healthcare. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02433496). https://clinicaltrials.gov/ct2/show/NCT02433496 Registered May 5, 2015. SN - 1748-5908 UR - https://www.unboundmedicine.com/medline/citation/29370813/A_randomized_matched_pairs_study_of_feasibility_acceptability_and_effectiveness_of_systems_consultation:_a_novel_implementation_strategy_for_adopting_clinical_guidelines_for_Opioid_prescribing_in_primary_care_ DB - PRIME DP - Unbound Medicine ER -