Brandeis University and University of South Carolina (SC) are proposing a pilot study, the SC Opioid Safety Initiative - Military (SCOSI-M) study, that will focus on increasing the use of safe prescribing and prescription monitoring practices among primary care physicians. We will design an innovative educational intervention using an academic detailing approach that has military/veteran-specific content and is targeted to physicians treating military personnel and veterans. This project fills a gap because currently, no academic detailing programs specific to controlled substances are in the literature. A second innovation is that we will promote the use of the SC prescription drug monitoring program (PDMP) as one of the educational objectives. This increases the study's significance and potential generalizability, as state PDMP programs are widespread and have been shown to reduce diversion of controlled substances. Their effectiveness in improving quality of health care is hindered;however, as very few prescribers use them. The overall aim of SCOSI-M is to prevent the onset or progression of prescription drug problems among Iraq and Afghanistan veterans, military members, and their families who are at high risk for developing problems if their treatment involves long-term use of an opioid.
The specific aims are to:
Aim 1. Design an educational outreach intervention based on academic detailing (i.e., SCOSI-M) for physicians with content specific to prescription drug problems among veterans, military members, and their families.
Aim 2. Enroll in SCOSI-M 112 physicians from 3 environments who currently serve veterans, military members, and their families and who also routinely prescribe Schedule II opioids, and engage them in a 2-visit intervention.
Aim 3. To evaluate the feasibility and effectiveness of the SCOSI-M intervention. Feasibility relates to reaching targeted physicians and engaging them in SCOSI-M. Effectiveness is measured by physicians registering for and use of the South Carolina Reporting &Identification Prescription Tracking System (SCRIPTS) when prescribing opioids (e.g., % of new patients the physician queried). Secondary outcomes are measures of safer prescribing practices (% of patients prescribed 100 morphine milligram equivalents or more per day), adoption of other prescription management practices (administer alcohol/drug screen, order drug tests). Exploratory outcomes are the association of the intervention with prescription drug misuse or abuse measures for the military population and overall adult population of Richland County, SC. A successful R34 pilot study will inform the design of a future large-scale randomized trial to assess the effectiveness of academic detailing combined with increased PDMP use in reducing prescription drug misuse.
The proposed project is a pilot test of medical education visits (academic detailing) that is focused on physicians serving military personnel, veterans and their family members. This innovative outreach is designed to increase safe prescribing of opioid medications by increasing the physicians'use of a state's prescription monitoring program and increasing the adoption of other clinical practices associated with safe prescribing (screen for substance misuse, safe doses).