Rectives imposed goals have all been shown to reduce

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rectives, imposed goals) have all been shown to reduce intrinsic motivation [15]. In terms of opioid prescribing, an extrinsic motivator for physicians would be the threat of additional regulation. Self-determination theory posits that behaviour can become self-determined, or intrinsic- ally motivated, if actions are modelled or valued by others to whom an individual feels related or attached. People are more likely to adopt actions when they feel competent doing the activities, and to adopt changes that relate to their goals and values. Contribution of this research The SCS offers two innovations to promote the adoption of EBPs. First, panels of experts are commonly convened to reach consensus and develop guidelines for EBPs, as was done for opioid prescribing [32]. This proposal adds a novel step by bringing together guideline writers, im- plementation experts, and primary care physicians to translate the guideline into a checklist-based format that can be implemented more easily than a guideline appearing in an academic journal. The experts convened for this proposal include pain physicians from the panel that developed a leading opioid prescribing guideline; internationally recognized experts on healthcare quality improvement and drug policy; and community-based fam- ily medicine physicians (see Acknowledgments). Collect- ively, the advisory panel monitors and advises the research team throughout the pilot test of the implementation strategy. Second, peer-to-peer physician consulting is a corner- stone of the SCS. While many efforts have been made to increase the use of EBPs among physicians, a literature review revealed a surprising dearth of research on models in which physicians consulted other physicians in primary care. Medical conferences have been used to promote new practices, but they are generally not effect- ive [33]. Improvement collaboratives are a common method in healthcare; these involve clinical teams (which often include physicians and other clinicians) learning with and from one another [34]. More targeted types of physician education (such as coaching, facilita- tion, and academic detailing) often are conducted by health professionals such as nurses, physician assistants, or others with master s degrees in business administra- tion, public health, counselling, public administration, or social work [9,35-37]. In our literature review, the Physi- cians Clinical Support System - Buprenorphine came close to offering a formal physician-to-physician consulting model [38], though it did not include on-site visits and implementation support, and little program evaluation took place beyond statistics on the frequency and type of contact with mentors. Dartmouth Medical School developed a consulting model for medical stu- dents in which they received guidance and career devel- opment advice from senior faculty members [39], a model that took place only in an academic setting and did not target clinical practice.
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