Commentary on “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”

This manuscript aims to address a critical gap between primary care physicians’ prescribing behavior and evidence based guidelines for the use of opioids to treat patients suffering from pain. Primary care providers have historically been slow to adopt guidelines and EBPs. This has also been the case for pain treatment during the opioid crisis. Prescription opioids account for more than half of overdose deaths in the US and about half of all opioid prescriptions are written by primary care providers, making them an appropriate target for this intervention. The hybrid mixed-methods study design measured the acceptability, feasibility, and effectiveness of a blended implementation intervention, Systems Consultation, that packages three discreet implementation strategies: (1) audit and feedback, which consists of providing performance baseline feedback to clinics that points to opportunities for improvement; (2) academic detailing, in which a respected physician with expertise in addiction medicine visits clinics to provide advice on how to improve clinical practice; and (3) organizational coaching, an intensive advising approach designed to tailor guidelines or policy recommendations to specific clinical contexts. After randomizing and match-pairing eight community-based primary care clinics in the greater Madison, WI area, the authors implemented their intervention in half of the sites over a six month period. Results demonstrated acceptability, feasibility, and effectiveness of the intervention. These findings imply that through systems consultation, primary care physicians may adhere more strictly to opioid prescribing guidelines. However, the study authors do not speak to the  generalizability or implications for scale-up in or outside of Madison. It would be informative to understand what, if anything, is unique with respect to opioid prescribing in the greater Madison area and how well this intervention could map onto prescribers across the country. Primary care physicians were targeted for this intervention because they prescribe about half of all opioids in the US, but what about those prescribing the other half? It would be interesting to see if this intervention (or adaptations of this intervention) could also be used to target the prescribing behavior of pharmacists, specialists, or other prescribers.

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¹A. Quanbeck, R. T. Brown, A. E. Zgierska, N. Jacobson, J. M. Robinson, R. A. Johnson, B. M. Deyo, L. Madden, W. J. Tuan and E. Alagoz. (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. Implement Sci, 13(1), 21.