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Abstract

Objectives: Several opioid prescribing initiatives have been recently evaluated including the Portrait letter program in British Columbia (BC). The experiences of primary care providers targeted by these programs have not been fully characterized. This qualitative study sought to examine barriers and facilitators to implementing prescribing Portaits with educational webinars on pain management with opioids in primary care. Methods: This study involved qualitative analysis of focus groups conducted for a mixed-method, randomized trial of an opioid prescribing feedback intervention (REDONNA). Participants were recruited following an educational webinar from primary care settings. As part of REDONNA's qualitative arm, 19 family physicians, 13 nurse practitioners, and three other professionals participated in focus groups. The data were analyzed in the light of the Consolidated Framework for Implementation Research (CFIR). Results: CFIR highlighted four topics represented by 12 sub-topics: four structural, three organizational, two individual, and three interventional factors. Participants identified that their decision-making for opioid prescribing was influenced not only by the intended educational messages, but also by their experiences with people who had opioid use disorders (PWOUD). Spending time with patients, supportive working environments, tailoring Portraits and accessing expertise facilitated implementation. Suggested improvements included more funding for non-pharmacological alternatives and more in-depth stratified data. Conclusions: Prescribing feedback programs should move beyond opioid sparing approaches to better address the challenged experiences by marginalized populations. Appropriate understanding of and sensibility towards PWOUD appears to benefit meaningful implementation of opioid training programs in primary care.