Background South Carolina (SC) ranks 10th in opioid prescriptions per capita - 33% higher than the national average. SC is also home to a large military and veteran population, and prescription opioid use for chronic pain is alarmingly common among veterans, especially those returning from Afghanistan and Iraq. This paper describes the background and development of an Academic Detailing (AD) educational intervention to improve use of a Prescription Drug Monitoring Program (PDMP) among SC physicians who serve military members and veterans. The aim of this intervention was to improve safe opioid prescribing practices and prevent prescription opioid misuse among this high-risk population. Methods A multidisciplinary study team of physicians, pharmacists, psychologists, epidemiologists, and representatives from the SCs Prescription Monitoring Program (PMP) utilized the Medical Research Council (MRC) complex interventions framework to guide the development of the educational intervention. The theoretical and modelling phases of the AD intervention development are described and preliminary evidence of feasibility and acceptability is provided. Results Ninety-three physicians consented to the study from 2 practice sites. Eighty-seven academic detailing visits were completed, and 59 one-month follow-up surveys were received. Participants rated the academic detailing intervention high in helpfulness of information, intention to use information, and overall satisfaction with the intervention. The component of the intervention felt to be most helpful was the academic detailing visit itself. Characteristics of the participants and the intervention, as well as anticipated barriers to behavior change are detailed. Conclusions Preliminary results support the feasibility of AD delivery to veteran and community patient settings, the feasibility of facilitating PDMP registration during an AD visit, and that AD visits were generally found satisfying to participants and helpful in improving knowledge and confidence about safe opioid prescribing practices. The component of the intervention felt to be most helpful to the participants was the actual academic detailing visit, and most participants rated their intentions high to use the information and tools from the visit. Intervention key messages, preliminary outcome measures, as well as successes and challenges in developing and delivering this intervention are discussed in order to advance best practices in developing educational interventions in this important area of public health.

The intervention was effective in promoting physician adoption of prescribing behaviors intended to reduce risks associated with prescription opioids. The self-report findings of this study should be confirmed by analysis using data on the number of queries submitted to the state's PMP. The present study suggests that a single academic detailing visit may be an effective tool for increasing physician voluntary registration and utilization of data on patient prescription history contained in a state PMP.

Box 1: Involving NHS staff in developing and evaluating an outpatient discharge checklist Box 2: Involving nurses in the design of a new nursing bag Box 3: Using a Delphi survey to identify research priorities of four different stakeholder groups Box 4: Identifying priorities for research in emergency prehospital care Box 5: Collaboration between staff and patients to increase accrual to a national hormone replacement therapy trial Box 6: Priority-setting partnership to identify research priorities in anaesthesia and perioperative care Box 7: Engaging staff in identifying research activity in a region and opportunities for further engagement Box 8: Priority-setting partnership to identify priorities in acne treatment uncertainties Box 9: Involvement of healthcare staff in an action plan to improve the Trust's research capacity xiii