title: Academic Detailing Pilot for Naloxone Prescribing Among Primary Care Providers in San Francisco.
abstract: BACKGROUND
  Improving the safety of prescribed opioids in clinical settings is a national priority. While co-prescribing naloxone is increasingly recommended, there is little understanding of the optimal way to implement this practice.
  
  
  METHODS
  We developed and delivered an academic detailing intervention to 40 randomly selected opioid-prescribing primary care providers in San Francisco from February to May 2015. Process outcomes were tracked and included provider demographics, number and type of contact attempts, reason for refusal (if applicable), name of detailer, duration of intervention, topics covered, provider concerns, and follow-up plan. Outcome evaluation included changes in the rate of naloxone prescriptions 4 months before and after academic detailing by provider based on de-identified Medi-Cal claims data. Using a difference-in-differences approach, we developed a negative binomial regression model to compare changes in naloxone prescribing to Medi-Cal patients between providers that did and did not receive the intervention.
  
  
  RESULTS
  Eighty-three percent of 48 providers contacted accepted the intervention after a mean of 2.6 contacts. Detailing lasted a mean of 28 minutes (range 5-60 minutes) and most frequently covered indications for naloxone, examples of naloxone prescriptions, language to use with patients, and pharmacy outreach. Those who received the academic detailing had a significantly greater increase in naloxone prescriptions compared to those who did not receive the intervention (IRR=11.0, 95%CI=1.8-67.8, P=.010).
  
  
  CONCLUSIONS
  Academic detailing addressing opioid safety and naloxone prescribing was well-received by primary care providers and associated with an increase in naloxone prescriptions filled by Medi-Cal patients.
authors.affiliation: San Francisco Department of Public Health.
authors.forename: Emily
authors.initials: E
authors.lastname: Behar
authors.forename: Christopher
authors.initials: C
authors.lastname: Rowe
authors.forename: Glenn-Milo
authors.initials: GM
authors.lastname: Santos
authors.forename: Nina
authors.initials: N
authors.lastname: Santos
authors.forename: Phillip O
authors.initials: PO
authors.lastname: Coffin
mesh_terms: D011307:Drug Prescriptions; D004502:Education, Medical, Continuing / Q000379:methods*; D006801:Humans; D009270:Naloxone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012495:San Francisco
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone