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Systems consultation for opioid prescribing in primary care: a qualitative study of adaptation
  1. Nora Jacobson1,
  2. Roberta Johnson2,
  3. Bri Deyo2,
  4. Esra Alagoz3,
  5. Andrew Quanbeck2
  1. 1 Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  2. 2 Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  3. 3 Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
  1. Correspondence to Dr Andrew Quanbeck, Family Medicine & Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI 53726, USA; arquanbe{at}


Background In order to promote guideline-concordant opioid prescribing practices, a blended implementation strategy called systems consultation was pilot tested in four primary care clinics in one US health system.

Objectives To describe (1) how systems consultation worked during the pilot test and (2) the modifications necessary to adapt this implementation strategy to primary care.

Methods A team of investigators conducted observations (n=24), focus groups (n=4) and interviews (n=2). The team; kept contact logs documenting all interactions with the intervention clinics and preserved all work products resulting from the intervention. Initial analysis was concurrent with data collection and findings were used to modify the intervention in real time. At the conclusion of the pilot test, a pragmatic descriptive analysis of all data was performed to explore key modifications.

Results Time constraints, entrenched hierarchical structures and a lack of quality improvement skills among clinical staff were the main barriers to implementing systems consultation. Modifications made to address these conditions included creating a consulting team, giving change teams more direction, revising process improvement tools, supporting the use of electronic health record (EHR) functionalities and providing opportunities for shared learning among clinics.

Discussion and conclusion With the lessons of this research in mind, our goal in future iterations of systems consultation is to give clinics a combination of clinical, organisational change and EHR expertise optimised according to their needs. We believe a streamlined process for assessing the key characteristics identified in this study can be used to develop a plan for this kind of optimisation, or tailoring, and we will be developing such a process as part of an upcoming clinical trial.

  • implementation science
  • clinical practice guidelines
  • primary care
  • evidence-based medicine
  • qualitative research

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  • Contributors All authors provided substantial contribution to the conception and design of the study and interpretation of the data. All authors contributed to the acquisition of data and provided substantial contribution to drafting and revising the manuscript. NJ and BD contributed to the analysis of the data. All authors read and approved the final manuscript.

  • Funding The National Institute on Drug Abuse (NIDA) is the primary funder of the study (R34-DA-036720-01 and 1K01-DA039336-01). The funder had no role in study design, the collection or interpretation of data or the publication of results.

  • Competing interests AQ has a shareholder interest in CHESS Health, a public benefit corporation that disseminates software to the specialty addiction treatment system. The relationship between the author and CHESS Health is managed by the University of Wisconsin–Madison’s Conflict of Interest Committee.

  • Patient consent Not required.

  • Ethics approval The study protocol was reviewed and approved by the University of Wisconsin - Madison's Health Sciences Institutional Review Board, submission 2015-0280-CR002.

  • Provenance and peer review Not commissioned; externally peer reviewed.