Understanding the Barriers and Facilitators of Implementing a Controlled Substance Safety Committee in a Primary Care Practice.

Abstract

The few studies about primary care based controlled substance safety committees (CSSC) to date have been primarily quantitative, focused on patient outcomes and lacked contextual data around their implementation. The purpose of this study is to qualitatively identify barriers and facilitators to the use of CDCs guidelines around opioid prescribing and the implementation of controlled substance safety committee in a primary care practice. Ten semistructured interviews were conducted with primary care clinicians in an academic medical practice. Potential barriers and facilitators to the uptake and use of the CDC opioid guidelines and the practice's CSSC were coded and analyzed against the Capability, Opportunity, and Motivation framework for Behavior change framework (COM-B). Six key themes were identified around uptake of the CDC guidelines. In general, the CSSC addressed some of the capability barriers around the guidelines but had limited impact on increasing motivation to follow the guidelines. We found the same recommendation in the guidelines could have differing impact on prescribing behavior. Simply promoting guidelines may be insufficient, especially for those viewing them as rules rather than recommendations. Our findings underscore the fact that guidelines are merely a starting point, not an endpoint of implementation.