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1. Please make this a banner 1.3m long and about 12 cm deep and correct distortions in logo What is needed to sustain a national academic detailing workforce Lynn Weekes, Gwen Higgins NPS Better Choices Better Health. Australia

2. ABSTRACT • Outcome measures: Number of doctors reached by the program per year, indicators of quality of the detailing service (duration of visits), turnover rates of personnel employed in the detailing workforce. • Results:The number of doctors reached by the academic detailing program has steadily increased from 2,364 in 1999–2000 to 11,482 in 2009–2010. The average duration of visits is 30 minutes (range 20–80 minutes). Almost half of the facilitators (46%, N=73) have been in their role for more than 5 years; 17 have been in their role for more than 10 years. • Conclusions: Academic detailing does require intensive support. When support is provided, the reach of the program, quality of the visits, longevity of staff, and hence viability can be maintained over a long period. The academic detailing visits remain the backbone of the NPS program to improve prescribing in general practice, and this program has repeatedly demonstrated changes in prescribing patterns and reduction of costs to government. • Problem: Academic detailing has been shown in several studies to be an effective way to improve prescribing and increase compliance with guidelines. It has also been noted to be a costly and resource intensive activity. NPS has delivered a national academic detailing program for more than 10 years and has identified and met the challenges of sustaining such a service. • Objectives:To describe NPS’s experience of what is needed to sustain a successful academic detailing program. • Design:Descriptive study. • Setting:Primary care in Australia. • Interventions:NPS partners with local general practice organisations to deliver a nationally coordinated and locally delivered program to improve the use of medicines. Academic detailers, known as facilitators,are provided with a range of support to deliver the program, including initial training in theory and practice of academic detailing; training on specific therapeutic topics; regular peer-support meetings by telephone; program resource materials, both print and online, via their own websites; and advanced training opportunities. Each facilitator is required to deliver 2 programs per year and to reach more than 50% of the general practitioners in his or her catchment area. NPS employs 7 full-time staff to support the 160 members of the facilitator workforce.

3. INTRODUCTION Academic detailing has been shown in studies over the past 25 years to be an effective way to improve prescribing and increase compliance with guidelines. The effect size is reported to be about 5% (range 3.0% to 6.5%)1 median adjusted. Academic detailing has been found to produce cost-effective results in prescribing within a study environment. 2,3 NPS has delivered a national academic detailing program to improve prescribing in primary care for more than 10 years as part of a multifactorial set of interventions. The objective of this paper is to describe NPS’s experience of what is needed to sustain a successful academic detailing service long term and outside of a study setting. 1. O’Brien MA, Rogers S., Jamtvedt G, et al. Educational outreach visits: effects on professional practice and health care outcomes.Cochrane Database Syst Rev 2007 Oct 17; (4)(4): CD000409 2. Soumerai SB, Avorn J. Economic and policy analysis of university based drug ‘detailing’. Med Care1986; 24:313-31 3. Mason J, Fremantle N, Nazareth I, et al. When is it cost-effective to change the behaviour of health professionals. JAMA 2001; 286:2988-92

4. ACADEMIC DETAILING AMONG A SUITE OF INTERVENTIONS • Provided for 2 major therapeutic programs per year. • Voluntary participation by general practitioners. • Locally-based facilitators undertake the visits. • Additional activities offered include: • written materials • feedback of prescribing data from a third party payer dataset • clinical audit of the individual practice and comparison with peers • small group meetings to discuss case studies. • Attracts CPD points and forms part of a package of activities to make practices eligible for a small annual payment.

5. NPS MODEL: DELIVERYTHROUGH A LOCAL PARTNER • NPS has contracts with locally-based groups called Divisions of General Practice. • The divisions employ NPS facilitators. • NPS provides training, program materials and quality control. • Cost of the division contracts is based on the number of general practitioners in the geographical area. • Contracts require the division to provide services (academic detailing visits or small group case study meetings): • to more than 50% of the general practitioners • on 2 topics per year. • All other activities (e.g. written materials and clinical audits) are provided by NPS nationally and do not rely on the facilitator. • Seven NPS staff support a local network of 160 facilitators.

6. NPS MODEL: TRAINING AND SUPPORT • Initial training in the theory and practice of academic detailing. Three-day intensive course with role playing and mentoring. • Training on each of the 2 required therapeutic topics per year, including education on the evidence base tor the topic and the social marketing messages to be imparted in visits. • Monthly teleconferences with small peer groups to support facilitators while in the field. • Program resource materials including summaries of the evidence, detailing cards and patient information that will be useful to the prescriber. • Extranet for regular updates and additional materials including original research papers. • Advanced training in academic detailing after 3 years in the position. Two-day intensive workshop. • Biennial forum to learn new skills and refresh existing skills.

7. OUTCOME MEASURES OF A SUCCESSFUL AND SUSTAINABLE PROGRAM • Absolute number of general practitioners reached by academic detailing. • Percentage of all general practitioners choosing academic detailing as part of the suite of activity they undertake. • Cost per visit. • Average duration of visits (as a proxy for quality of the visits). • Turnover rates of personnel in the facilitator workforce (as a proxy for stability and experience of workforce).

8. RESULTS Number of GPs reached by academic detailing per year and by all activity types There have been 108,000 detailing visits provided to >20,000 general practitioners since 2000. Academic detailing continues to be the most popular type of activity for GPs to undertake. Facilitators also provide group discussions and promote uptake of clinical audits.

9. RESULTS Support costs / academic detailing visit (AUD) Total support costs(AUD)

10. RESULTS Average duration of visits • 30 minutes (range 20–80 minutes) Longevity of service • 46% of facilitators have been in the role > 5 years • 11% of facilitators have been in the role > 10 years Turnover rates for mature service • 2009–2010: 8.4% (N=154) • 2010–2011: 8.2% (N=158)

11. IS IT COST EFFECTIVE? • *Includes for small group meetings, clinical audits and other written material provided in association with detailing.

12. CONCLUSIONS Academic detailing does require intensive support and it is expensive. When this is provided the reach of the program, quality of the visits, longevity of staff and hence viability can be maintained over a long period of time. The academic detailing visits remain the backbone of the NPS program to improve prescribing in general practice and this program has repeatedly demonstrated savings in excess of the costs of delivering the program.