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Appl Clin Inform 2025; 16(02): 393-401
DOI: 10.1055/a-2508-7086
Research Article

Academic Detailing to Enhance Adoption of Clinical Decision Support for Patients at Risk of Opioid Overdose

Sarah Hussain
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Harold Lehmann
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Megan E. Buresh
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Timothy M. Niessen
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Michael I. Fingerhood
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Nazeer Ahmed
2   Department of Pharmacy, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
,
Kelly Cavallio
3   Maryland Primary Care Physicians, Baltimore, Maryland
,
Andrew Maslen
4   Epic Application Team, Johns Hopkins Health System, Baltimore, Maryland
,
Amy M. Knight
1   Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Funding None.
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Abstract

Background Not all patients at risk for opioid overdose are prescribed naloxone when discharged from the emergency department or hospital. Clinical decision support (CDS) can be used to promote clinical best practices, such as naloxone prescribing; however, it may be ignored due to knowledge deficiencies or alert fatigue.

Objectives Assess the effect of academic detailing on responses to a CDS alert recommending a naloxone prescription for patients at risk of opioid overdose.

Methods A pre/postquality improvement study of 2,161 active providers at a 400-bed academic medical center. The first intervention was an educational email to all providers. The second intervention was individual emails to 150 providers who infrequently ordered naloxone in response to the alert. The main outcome measure was prescription-to-alert ratios, defined as the number of naloxone prescriptions signed in response to the alert divided by the number of times the alert fired.

Results The first academic detailing intervention resulted in a prescription-to-alert ratio increase from 32.6 to 51.7%, a 19.1% absolute increase when comparing the approximately 8 months before and after the email was sent (95% confidence interval [CI]: 16.3–21.9%, p < 0.001). The second intervention resulted in an increased prescription-to-alert ratio from 9.3 to 50.6%, an absolute increase of 41.3% when comparing the nearly 8 months before and after the emails were sent (95% CI: 36.9–45.7%, p < 0.001). Improvements were seen across all services and all provider roles, particularly for advanced practice providers, and were sustained for 8 months.

Conclusion Academic detailing can be used to augment responses to CDS for patients with opioid dependence. Further study is needed to see if this effect can be replicated with CDS for other high priority conditions, and whether academic detailing with one alert might improve responses to other alerts as well, potentially decreasing alert fatigue.

Keywords

formative feedback - clinical decision support systems - alert fatigue - opioid-related disorders - naloxone

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was approved by the Johns Hopkins Medicine Institutional Review Board.


Supplementary Material



Publikationsverlauf

Eingereicht: 30. August 2024

Angenommen: 27. Dezember 2024

Artikel online veröffentlicht:
07. Mai 2025

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