Academic detailing: Where we are, and where we

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Academic detailingWhere we are, and where were
going

• Jerry Avorn, M.D.
• Professor of Medicine, Harvard Medical School
• Chief, Division of Pharmacoepidemiology
• and Pharmacoeconomics
• Department of Medicine
• Brigham and Womens Hospital

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The goal of academic detailing

• To close the gap
• between the best available science
• and actual prescribing practice,
• so that each prescription is based
• only on the most current and accurate
• evidence about efficacy, safety,
• and cost-effectiveness.

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The logic of academic detailing

• Medical (and pharmacy) school faculty have a
  solid grasp of the evidence about drug benefits
  and risks
• but were often terrible communicators.
• Drug makers are superb communicators
• but do so only to increase product sales.
• Can the content of the former be communicated to
  prescribers through a delivery system based on
  the latter?

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The content of academic detailing

• Experts in internal medicine and evidence
  synthesis at Harvard Medical School review the
  literature and formulate recommendations.
• Well trained clinicians (pharm, RN, MD) offer a
  service that provides non-commercial,
  evidence-based information about the comparative
  benefit, risk, and cost-effectiveness of drugs
  used for common clinical problems.

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The method of academic detailing

• Educational outreach
• in the doctors own office
• Information is provided interactively, so the
  educator can
• understand where the MD is coming from in terms
  of knowledge, attitudes, behavior
• modify the presentation appropriately
• keep the prescriber engaged
• The visit ends with specific practice-change
  recommendations.
• Over time, the relationship becomes more trusted
  and useful.

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Essence of the approach

• Focus is on optimal management of a specific
  clinical problem
• not just which drugs to use or avoid
• Learning about the practitioners perspective and
  needs informs the discussion content
• prior focus group research is key in developing
  modules
• Validated in 100 randomized controlled trials
• practice change, savings, patient outcomes

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Programs now in place

• The Independent Drug Information Service
• several US states, the Veterans Administration
• consultation on
• drug use problems
• program development
• evaluation
• Other programs

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Topics at www.RxFacts.org

• G.I. acid Sx
• anti-platelet drugs
• hypertension
• cholesterol
• diabetes
• depression
• osteoporosis
• HIV for the PCP

• COPD
• cognitive impairment
• incontinence
• gait impairment, falls
• sleep meds
• atrial fibrillation
• chronic pain
• anti-psychotics

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Some useful links

• Evidence-based clinical modules
• www. RxFacts.org
• Research on medications from the BWH Division of
  Pharmaco-epi and Pharmaco-eco (DoPE)
• www. DrugEpi.org
• Academic detailing resources
• www. NaRCAD.org
• Powerful Medicines the Benefits, Risks, and
  Costs of Prescription Drugs (Knopf)
• www.PowerfulMedicines.org