rectives, imposed goals) have all been shown to reduceintrinsic motivation . In terms of opioid prescribing,an extrinsic motivator for physicians would be the threatof additional regulation. Self-determination theory positsthat behaviour can become self-determined, or intrinsic-ally motivated, if actions are modelled or valued by othersto whom an individual feels related or attached. Peopleare more likely to adopt actions when they feel competentdoing the activities, and to adopt changes that relate totheir goals and values.Contribution of this researchThe SCS offers two innovations to promote the adoptionof EBPs. First, panels of experts are commonly convenedto reach consensus and develop guidelines for EBPs, aswas done for opioid prescribing . This proposal addsa novel step by bringing together guideline writers, im-plementation experts, and primary care physicians totranslate the guideline into a checklist-based format thatcanbeimplementedmoreeasilythanaguidelineappearing in an academic journal. The experts convenedfor this proposal include pain physicians from the panelthat developed a leading opioid prescribing guideline;internationally recognized experts on healthcare qualityimprovement and drug policy; and community-based fam-ily medicine physicians (see Acknowledgments). Collect-ively, the advisory panel monitors and advises the researchteam throughout the pilot test of the implementationstrategy.Second, peer-to-peer physician consulting is a corner-stone of the SCS. While many efforts have been made toincrease the use of EBPs among physicians, a literaturereviewrevealedasurprisingdearthofresearchonmodels in which physicians consulted other physiciansin primary care. Medical conferences have been used topromote new practices, but they are generally not effect-ive.Improvementcollaborativesareacommonmethodinhealthcare;theseinvolveclinicalteams(which often include physicians and other clinicians)learning with and from one another . More targetedtypes of physician education (such as coaching, facilita-tion, and academic detailing) often are conducted byhealth professionals such as nurses, physician assistants,or others with master’s degrees in business administra-tion, public health, counselling, public administration, orsocial work [9,35-37]. In our literature review, the Physi-cians’ClinicalSupportSystem-Buprenorphinecameclosetoofferingaformalphysician-to-physicianconsulting model , though it did not include on-sitevisits and implementation support, and little programevaluation took place beyond statistics on the frequencyand type of contact with mentors. Dartmouth MedicalSchool developed a consulting model for medical stu-dents in which they received guidance and career devel-opmentadvicefromseniorfacultymembers,amodel that took place only in an academic setting anddid not target clinical practice.
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