Secondary effects of an opioid-focused academic detailing program on non-opioid controlled substance prescribing in primary care

Abstract

Background: Educational outreach programs that focus on safe opioid prescribing and awareness of state prescription monitoring programs may modify clinicians’ prescribing behavior. The objective of this study was to evaluate the secondary effects of an opioid-focused academic detailing (AD) program on non-opioid controlled substance prescribing in primary care. Methods: A quasi-experimental pre-post study of primary care clinicians exposed and unexposed to the AD program was conducted using data from the Illinois Prescription Monitoring Program from December 2017 to February 2019. Outcomes were mean monthly prescriptions for benzodiazepines (BZD), non-BZD sedative-hypnotics, and carisoprodol, per clinician. A difference-in-differences (DID) approach utilizing repeated-measures mixed-effects linear regression models was used to compare changes in outcomes six-months before and after the program. Results: Mean monthly BZD prescriptions declined in both groups of clinicians (AD-exposed n = 151; controls n = 399) after implementation of the AD program. Although the mean monthly number of BZD prescriptions decreased in both groups after the AD program, BZD prescribing in the AD-exposed group declined at a slower rate following the AD program (DID = 0.73; 95% CI: 0.14, 1.31). The AD-exposed group had a 0.06 (95% CI: −0.11, −0.01) lower rate of mean monthly carisoprodol prescriptions compared to the control group following the AD program. There was no change in the rate of mean monthly non-BZD sedative-hypnotic prescriptions between the two groups. Conclusions: The higher relative rate of BZD prescribing in the AD-exposed group compared to the control group following the AD program may be reflective of an unintended consequence of opioid-focused AD programs as clinicians learn to be cautious about opioid prescribing. Our findings may suggest the need for incorporation of targeted education on appropriate BZD prescribing into opioid-focused AD programs as a featured component. These findings warrant further consideration and investigation before large-scale implementation of opioid-focused educational outreach programs.

Keywords:

• Opioids
• academic detailing
• primary care
• benzodiazepines

Acknowledgments

The authors thank and acknowledge the clinicians who participated in this study and the following individuals for their contributions: Mary Smart, Sarette Tilton, Aleksandrina Ruseva, Dayna Redini, Esther Lee, Nevena Varagic, Shannon Menard, Victoria Kulbokas, Ammarah Nadeem who participated as academic detailers from the University of Illinois at Chicago College of Pharmacy; Darin Jordan, MD, Ankur Dave, MD, Reinhold Llerena, MD from AMITA Health; Craig Berberet, Stanley Murzynski, Edward Dowllar, Andrew Hollo from the Illinois Prescription Monitoring Program; Dejan Jovanov from the Illinois Department of Public Health; Jamie Mells, PhD, Wes Sargent, EdD from the Centers for Disease Control and Prevention.

Authors’ contributions

C.D.S., A.S.P., and T.A.L. contributed to the research conception and design; C.D.S., A.S.P., S.P., and T.A.L. contributed to the acquisition of data; C.D.S. contributed to the analysis of data; C.D.S., S.Y.C., M.A.F., A.S.P., L.K.S., and T.A.L. contributed to the interpretation of results; C.D.S., S.Y.C., M.A.F., A.S.P., L.K.S., and T.A.L. contributed to the writing/revisions of the manuscript.

Additional information

Funding

This research was funded in part by the Centers for Disease Control and Prevention [Grant #1U17CE002739-01]. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.