Na tional R esource C enter for A cademic D etailing

1. National Resource Center for Academic Detailing Supported by a grant from AHRQ

2. NaRCAD • Mission • Team • Background on academic detailing • Elements of a successful program • NaRCAD’s services • Next Steps

3. Mission • To promote the use of evidence based medicine by supporting the establishment and improvement of academic detailing programs. • NaRCAD provides training, materials, and consultative support to health care organizations to establish effective academic detailing programs. • NaRCAD aims to establish a network of programs sharing best practices in academic detailing to further the use of comparative effectiveness data in medical practice.

4. Team • Michael Fischer, MD, MS, Program Director • Jerry Avorn, MD, Co-Program Director • Niteesh Choudhry, MD, PhD, Core Faculty • Steve Farrell, MBA, Program Manager • Lindsay Ritz, MPH, Program Coordinator

5. The rationale for academic detailing • FDA has limited data when treatments or tests are first approved • with limited relevance to many patients • Physician data overload • hundreds of important clinical papers published each month • Imbalanced communication • manufacturers provide much of the information • Need for non-product-driven overviews • delivered in a relevant, user-friendly way

6. Two different worlds

7. Academic Detailing Drug/Device makers: great communicators Government/Medical School faculty: Trusted sources of Clinical information

8. The goal of academic detailing To close the gap between • the best available evidence • actual clinical practice …so that clinical decisions are based only on the most current and accurate evidence on: • efficacy • safety • cost-effectiveness

9. Academic detailing • Synthesizes up-to-date evidence about comparative efficacy, safety, and cost-effectiveness of commonly used therapies • Content independently created by medical school faculty and practitioners • MDs, pharmacists and nurses provide information interactively, in physicians’ own offices • A time-efficient way to keep up with new findings

10. The beginning of academic detailing • Developed in early 1980’s • “un-ads” for physicians with clinical background and specific prescribing recommendations • patient educational materials • Effective from the start • 92% MD acceptance rate from ‘cold calls’ to physicians • Significant 14% reduction in inappropriate prescribing • Avorn & Soumerai, NEJM 1983

11. Where Academic detailing is now(Partial Listing) USA • Initiatives in various states: • California – Kaiser Permanente • District of Columbia – DOH • Idaho – Medicaid • Maine – DHHS • Massachusetts – DPH and CDC • New York – Medicaid • Oregon – OHSU • Pennsylvania – Aged Care • South Carolina – Medicaid • Vermont – Medicaid • National – new effort funded by AHRQ World • Australia • Canada • United Kingdom • Sweden • Netherlands • New Zealand

12. Current status of the evidence • Evaluated extensively over the last 25 years • Large evidence base confirms efficacy • A large systematic review in 2007 combined 69 studies and confirmed efficacy of AD • O’Brien MA, Rogers S, et al. Cochrane, Database of Systematic Reviews 2007 • However, quality of execution dramatically impacts effectiveness

13. Example: South Carolina - SCORxE • South Carolina College of Pharmacy and South Carolina DHHS • Main Problem • 25% of Medicaid’s prescription medication spending was for mental health drugs alone • 4/5 prescribed drugs from the state’s Medicaid program were for mental health • Funded in 2007 by a 5-year grant from DHHS • Topics • Schizophrenia • Non-psychotic Major Depressive Disorder • Bipolar Disorder • Smoking Cessation

14. Effectiveness – PACE Program • Evaluated acid-suppression module in 2007 • Time-series analysis of PPI prescribing • Following their first educational visit, intervention-group doctors prescribed on average $124 less PPI per physician per month than external controls (p = 0.09), and $122 less PPI per physician per month than internal controls (p = 0.05) • For the first six months after the educational encounter • intervention-group physicians reduced their use of PPIs by about $286,000 within the PACE program alone • If these changes persisted for a year, the savings would have amounted to $572,000 for this one drug group

15. Differing Scales of Academic Detailing Programs • Temporary programs: address a specific issue over a defined time period • Redeployment of current resources • Often complimentary to other efforts • Limited scale, longer term programs: cover a wider range of issues • Redeployment of current resources • Augmentation of resources • Cut across multiple disease areas • Larger scale, longer term programs • Dedicated resources • Multiple topics • Broad range of medical areas

16. Flexible Uses of Academic Detailing • Improve knowledge • New guidelines • Health threats • Change in treatment • More effective/cost effective or safer • Decrease overuse • Improve patient education • Use of materials • Communication of vital information • Increase diagnosis/screening • What to look for • What to do when found • Increase utilization of complimentary resources • Public health programs • Referral resources

17. Basis for AD Programs(partial listing)

18. Possible Future Funding • Medicaid Match • Program eligible for federal funds • Matched at a certain percentage from the government • CDC Block Grants • Leverage NaRCAD’s resources • Other government sources • Mandate for dissemination of PCORI findings

19. Elements of a Successful Academic Detailing Program Identifying Program Needs Developing and Producing Materials Hiring and Management of Academic Detailers Training of Detailers Measuring Program Effectiveness

20. Identifying Program Needs • Goals • Organizational capabilities and experience • Health needs in target population • Gaps in target population • Current practice • Best practices • Evaluate existing data • Prescription data, other health records

21. Developing and Producing Detailing Materials • Compilation of evidence base (AHRQ Comparative Effectiveness Reviews) • Analysis and summary by relevant experts • Identifying key messages • Synthesized into communication materials • Relevant, useful information for: • physician • patient • Clearly and effectively communicated • Retained for future reference

22. Detailing Material Topics • Based on AHRQ Comparative Effectiveness Reviews • oral diabetes medications and insulin for adults with type 2 diabetes • off-label use of atypical anti-psychotics for agitation in dementia • analgesics for osteoarthritis • Updated for the latest evidence

23. Hiring and Management of Detailers • Job description • Successful detailer profiles • Full time hires vs. consultants • Establishing goals • Monitoring performance • Team building

24. Training of Detailers – How to Detail • Principles of social marketing • Structuring visit • Communicating messages effectively • Actively listening and engaging clinician in conversation • Message delivery under a variety of circumstances • Gaining commitment to action • NaRCAD will have two training sessions a year through 2013

25. Training of Detailers – Clinical Background • Grounding in clinical areas and treatments • Diabetes • Agitation in Dementia • Osteoarthritis • NaRCAD will have two clinical training sessions a year beginning Fall 2011 through summer 2013

26. Measuring Program Effectiveness • Change in patterns of care • Prescribing data, other sources • Cost-effectiveness of detailing effort • Potential impact of modifications to program • Impact on expenses outside of network

27. Elements of a Successful Academic Detailing Program NaRCAD performs NaRCAD performs NaRCAD performs NaRCAD advises NaRCAD supports Identifying Program Needs Developing and Producing Materials Hiring and Management of Academic Detailers Training of Detailers Measuring Program Effectiveness

28. NaRCAD Experience • Collectively over 40 years in academic detailing • Established or assisted programs in 6 states • Expertise in: • Evidence based prescribing • Training and materials development • Pharmaco analytics • Public and private partnerships

29. NaRCAD Partners • Groups wishing to know more about academic detailing • Groups seeking to establish new academic detailing programs • Groups seeking assistance to measure current program effectiveness • Groups seeking to improve or expand current programs • Experienced groups seeking to share best practices

30. Next Steps

31. Contact • Stephen Farrell, MBA, Program Director, sffarrell@partners.orgor Lindsay Ritz,lritz@partners.org • www.narcad.org