Academic Detailing

1
Academic Detailing

• Michael Allen MD
• Dalhousie University CME
• Symposium on Optimal Drug Utilization
• Quebec QC
• May 20-21, 2004

2
Outline

• Definition
• Methods
• Features
• Evidence
• Nova Scotia Program
• Canadian Academic Detailing Collaboration
• Benefits

3
Definition

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• One-on-one educational intervention provided to a
  physician in his or her office by a trained
  health care professional
• Evidence-based

4
Methods

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• Academic detailer
• Pharmacist
• Nurse
• Physician
• Physician/pharmacist pair
• Group or individual
• One or more than one visit
• Combined with other interventions

5
Features

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• Determine baseline knowledge and motivations
• Define clear educational and behavioural
  objectives
• Focus on specific types of physicians their
  opinion leaders
• Establish credibility through respected
  organizational identity

6
Features

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• Reference unbiased sources of information
  provide all sides of controversial issues
• Stimulate physician participation in educational
  interactions
• Use concise graphical educational materials
• Highlight and repeat essential messages
• Soumerai Avorn JAMA 1990263549-56

7
EvidenceCochrane review 2001

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• Reviewed studies to 1997
• 18 randomized controlled trials
• 13 prescribing practices
• 3 preventive services
• 2 common problems (asthma, diabetes etc)
• Positive effects on practice in all studies

8
Evidence Cochrane review 2001

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• Cochrane review 2001
• Academic detailing, especially when combined with
  social marketing, appears to be a promising
  approach to modifying health professional
  behaviour, especially prescribing.
• Thompson OBrien MA et al. Cochrane Library Issue
  3, 2001

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Evidence Cochrane review 2001

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• Cochrane review 2001
• Academic detailing, especially when combined with
  social marketing, appears to be a promising
  approach to modifying health professional
  behaviour, especially prescribing.
• Thompson OBrien MA et al. Cochrane Library Issue
  3, 2001

10
EvidenceSystematic reviews

• Grimshaw, Eccles 2004

Health Technol Assess.20048(6)
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Nova Scotia ProgramDalhousie Academic Detailing
Service

• Funded by Nova Scotia Department of Health
• Started fall 2001
• 3 academic detailers 0.8, 0.5, 0.5 FTE
• 1 drug information pharmacist 0.6 FTE
• 1 physician-educator 0.3 FTE
• Advisory committee
• 4 family physicians
• Content expert

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

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Nova Scotia ProgramDalhousie Academic Detailing
Service

• Topics
• Pneumococcal/flu vaccine
• Osteoarthritis
• Hormone replacement therapy
• Osteoporosis
• COPD
• Variety of methods used to select topics

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

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Academic Detailing Territories
O.5 FTE Lillian
O.5 FTE Cathy
Dartmouth
Halifax
O.8 FTE Isobel
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Nova Scotia ProgramDalhousie Academic Detailing
Service

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• Each visit see 350 FPs (50)
• Nurse practitioners
• Medical students/residents
• Nurses 65
• Pharmacists 150
• Handout
• 20-30 page booklet
• Summary statements
• Double-sided laminate

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Nova Scotia ProgramDalhousie Academic Detailing
Service

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• Supporting interventions
• Individual questions answered
• Original papers if requested
• Frequently answered questions
• Information on web-site
• Small-group sessions
• Provide list of patients if requested
• Evidence-based terms

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Nova Scotia ProgramEvaluations
1 strongly disagree 5 strongly agree
N215
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Nova Scotia ProgramEvaluations
1 strongly disagree 5 strongly agree
As a result of visit I will be more likely to
N215
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Nova Scotia ProgramEvaluations handout material
Osteoarthritis
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Nova Scotia ProgramDalhousie Academic Detailing
Service

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• Challenges
• No follow-up visits
• Not enough consistent supporting interventions
• Time required to prepare material
• No objective evaluation

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Canadian Academic Detailing Collaboration

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• British Columbia
• BC Community Drug Utilization Program
• Alberta
• Drug Utilization Program of Alberta
• Saskatchewan
• Sask Rx Files Academic Detailing Program
• Manitoba
• Prescription Information Service of Manitoba
• Ontario
• London Health Sciences Centre
• Nova Scotia

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Canadian Academic Detailing Collaboration

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• Process and Outcome Evaluation of Academic
  Detailing in 5 Provinces
• Malcolm Maclure Univ Victoria
• Michael Allen NS
• Harold Lopatka AB
• Anne Nguyen BC
• Loren Regier SK
• Shawn Bugden MB

Best Practices Contribution Program 308,000 / 2
yrs
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Canadian Academic Detailing Collaboration

• Projects
• Randomized crossover trial to determine effects
  of ADing on prescribing BC
• Improving physicians use of ADing NS
• Synthesis of Canadian and international
  experiences with ADing Univ Victoria
• Evaluate printed educational materials AB
• Time and motion study SK

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Other Benefits of Academic Detailing

• - Definition
• - Methods
• - Features
• - Evidence
• - Nova Scotia
• - Canada
• - Benefits

• Educate detailers
• Educate specialists
• Develop other workshops
• Critical appraisal
• Pharmacist/physician learning
• Work with other groups CCOHTA
• Work with guidelines committees
• Two-way communication