An interview with Jacqueline Myers, BSP, Academic Detailer, RxFiles and Pharmacist, Infectious Diseases Clinic, Saskatchewan Health Authority – Regina Area. RxFiles is an academic detailing program that provides objective, comparative drug information to clinicians. Jackie’s work at RxFiles includes academic detailing and resource development. by Anna Morgan, MPH, RN, PMP, NaRCAD Program Manager Tags: COVID 19, Conference, Detailing Visits, Substance Use Anna: Hi Jackie! We’re excited to feature your work as a detailer. How did you first become involved in academic detailing? Jackie: RxFiles has a bit of a celebrity following in Saskatchewan. The RxFiles books, which are packed with resources and drug comparison charts covering various clinical topics, are a coveted possession. You receive one book for free as a pharmacy student and everyone looks forward to that day because it has all the study material you could ever need in one place! I think it’s a dream of pharmacy students to get involved with RxFiles at some point in their career. I started with RxFiles in 2019 while working within the Saskatchewan Health Authority (SHA) Opioid Stewardship Program (OSP). A partnership was formed between the OSP and RxFiles and I was able to work both as a clinician at the Regina Chronic Pain Clinic and as a detailer providing education and creating content for RxFiles. My role in SHA has since changed, but I’ve continued detailing for the RxFiles team. Anna: Your passion for academic detailing is palpable. You could tell how much you love academic detailing during your presentation at NaRCAD2020. Can you tell us a little bit more about why this work is so important to you? Jackie: It excites me to hear that--I’m so glad people see that I’m passionate about this. I’ve always admired musicians and artists for their passion, but I’ve never pictured myself as one of those people. Many healthcare professionals - nurses, pharmacists, physicians, physiotherapists – we all go into this field because we like or love working with people. I’m no different than any other healthcare professional. I also really love to learn and then share that knowledge through teaching or mentoring. Academic detailing is such a cool combination of those things. You get to learn about a specific clinical topic, share your knowledge with another clinician and ultimately improve patient outcomes. It’s a really special process. Anna: You’re absolutely right – it is special! What kind of support has been most helpful for you in becoming such a successful and passionate detailer? Jackie: When I first started with RxFiles, the rest of the team was working on topics other than opioid prescribing which left me feeling a bit isolated. Luckily, RxFiles has a great support system. My colleague Debbie, who I now consider my mentor, has been a huge resource for me. Even though we weren’t detailing on the same topic, I knew I could always talk through key messages with her, as well as recruitment strategies and other tips for approaching prescribers in our area. I still know that I can always go to her for a debrief at the end of a visit, whether it’s a successful visit or a mess of a visit. Academic detailing has the potential to be really isolating, so having someone who understands and can help guide you through some of your challenges can be so beneficial. Anna: We know that academic detailing can be isolating, so it’s wonderful to hear how supportive your team is. On the days when you’ve had hard visits, I’m sure it’s difficult to feel that you’ve made an impact. How do you know that you’ve been successful in a detailing visit? Jackie: At the 2019 NaRCAD Conference, I was amazed by the presentations and the data that different programs had collected to measure impact. When I first started detailing, I was very focused on the clinician I was detailing committing to make a change or doing something differently in their practice. Then I began to learn that success in academic detailing comes in two forms. One is making an impact that changes a clinician’s practice and the second is establishing a connection and developing a relationship with a clinician. Sometimes making a connection will come first and then lead to making an impact, or sometimes they’ll occur simultaneously. Those are the two ways that I define success for myself in academic detailing. Anna: That’s spot on – those are two of the main goals of academic detailing. Can you share any success stories from the field from a time when you felt you made an impact? Jackie: Of course! We are currently working on a special project to increase the number of buprenorphine/naloxone, or Suboxone, authorized prescribers in our province. One of the physicians I detailed was not yet authorized to prescribe buprenorphine/naloxone. He was a hospital physician and worked in internal medicine. He shared with me that he’d been thinking about becoming authorized and was apprehensive, but he saw a need for it in his patient population. A lot of his patients were being admitted for various diagnoses but would also have a concurrent substance use disorder that went unmanaged or ignored. After our detailing session, he reached out to me. He described a patient that he had admitted for an infectious process who also had opioid use disorder. He said, “before our conversation, I would have normally treated the infection and probably ignored the opioid use disorder. It’s possible the patient may have left against medical advice, and I would have thought, ‘that was their choice, and I did my best.’ ” After our detailing visit, he felt that he had the courage and the skills to discuss the patient’s opioid use disorder with them and think about what he could do as a physician to keep the patient comfortable and safe while they were in hospital. This honest conversation led the physician to speak with an authorized prescriber who was able to initiate the patient on buprenorphine/naloxone while they were admitted in the hospital. Even though the ask for this detailing project was to increase authorized prescribers, which he has not yet become, the interaction I had with this physician still led to a positive patient outcome and a better patient experience. Anna: Thank you for sharing that - it’s so nice to hear stories from the field. Even if you don’t accomplish the messaging you were sent out to do, you’re still making an impact. Can you share a story where maybe you weren’t as successful and how were you able to bounce back from a situation that was challenging for you? Jackie: During COVID, a physician reached out to request a virtual visit. We started our detailing session and I was beginning my needs assessment. I started asking about his practice and his familiarity with buprenorphine/naloxone. He said, “that’s a new weight loss drug, right?” From that point on, he was really sad that I wasn’t there to talk about a weight-loss drug. He was disinterested and I could tell he was distracted. I could hear him moving around papers through the phone and I could hear people talking in the background. I said, “if this is not a great time for you, we can definitely rebook” but he insisted that I continue. I could feel myself getting frustrated, but I finished the visit. I was able to deliver my key messages, but I left the visit not feeling great. There was no commitment to action or change and we didn’t build a connection. I felt like I wasted both of our time. In order to bounce back from something like that, I think you need to acknowledge that it will happen sometimes and debrief with colleagues who have been in your shoes. Then just pick yourself up and try again. Anna: That’s great advice. It can be discouraging to have a visit like that, especially if your new in the field! One last question to wrap up - do you have any personal academic detailing goals for this upcoming year? Jackie: Yes! I was previously detailing on only opioid-related topics. This year, my role has changed a bit and I will be detailing on various clinical topics and in a new geographical area with all new clinicians. My primary goal is to connect and build relationships with these new clinicians. Fortunately, I’m taking over for a cherished detailer who is retiring and will help provide a warm handoff. My secondary goal, which is a bit sillier, is to avoid troubles on the highway when we begin in-person visits again. The detailer I’m taking over for has had some very interesting car trouble heading out to his detailing visits. He’s met a lot of wildlife and his car was even once fried by lightning! Anna: We certainly hope you’re able to avoid those highway issues! Thanks so much for chatting with us today, Jackie. Your stories are inspiring, and we can’t wait to connect again and hear about all your 2021 accomplishments. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Biography. Jackie graduated from the University of Saskatchewan with her Bachelor of Science in Pharmacy in 2012. She has practiced in numerous clinical settings including community pharmacy, long term care, and hospital in the areas of internal medicine and opioid stewardship. Jackie is currently involved in the management of people living with HIV and substance use disorders at the Infectious Diseases Clinic in Regina. She also works with RxFiles providing academic detailing services and resource development. Overview: Dr. Nate Rickles, PharmD, PhB, BCPP, FAPhA is an associate professor pharmacy practice at the UConn School of Pharmacy with experience in developing AD programs, most recently for the CDC-funded CEDPP (Connecticut Early Detection and Prevention Program) project. Dr. Natalie Miccile, PharmD, MBA currently works as a retail pharmacy manager at ShopRite Pharmacy. She’s working with Nate to onboard pharmacies participating in the CEDPP program and working with the pharmacy students who are supporting the process of referring patients to screening, diagnostic, and prevention services. by: Winnie Ho, Program Coordinator Tags: Cancer, COVID-19, Detailing Visits, Health Disparities, Program Management Winnie: We’ve been excited for a chance to speak with you both! Nate, you spoke on our Clinical Innovations in AD session at the NaRCAD2020 Conference, sharing your work to support underserved, and sometimes undocumented, women in accessing care. Thank you both for joining us today – can you tell us a little bit more about the program and the issues it addresses? Nate: CEDPP consists of two components: the Connecticut Breast and Cervical Cancer Early Detection Program (CBCCEDP) and the Well-integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN). The services are offered free of charge with the goal of significantly increasing breast and cervical cancer services for medically underserved women. The Department of Public Health’s traditional outreach method of using clinical navigators at established WISEWOMAN sites could only reach a relatively small population. We received a CDC Innovation Grant to investigate the role that community pharmacies could play in increasing referrals to a free public health prevention program for vulnerable populations, as these pharmacies are accessible, front-line, and generally well-trusted in the community. W: That’s an important goal to close this gap and to ensure more women can access the services they need. Why did your team feel that AD was a useful approach to address the lack of access to screening services? Nate: I’m very passionate about the notion that building relationships through 1:1 connections are going to be more powerful long-term in creating behavioral change. AD works so well because the techniques are very persuasive in dealing with common barriers like pharmacists believing there’s little time in their day, not enough staffing, or not the right financial incentive. Our project manager Peaches Udoma had sent out flyers and e-mails to local pantries and shelters, but we hadn’t received many referrals through this tactic. The predominant way we’re getting referrals is through 1:1 outreach with pharmacists and our students reaching out to the referred participants to connect them with services. Winnie: Can you tell us more about how your intervention navigated the pharmacists’ barriers you described? Natalie: We had a lot of interest from pharmacists, especially when they learned about the impact they could have. However, for a full month, we weren’t seeing results. When I checked in, we learned that they were genuinely overburdened with their workflow, which wasn’t surprising. We had to think about who else in the office could do it – and it turned out to be the pharmacy technicians. They were often at the point of sale and would be more likely to know if patients were uninsured or underinsured. We began detailing the pharmacy technicians directly instead. Many of them were bilingual, which helped in distributing the right flyers to the right women. We worked with the pharmacy technicians on communicating the benefits our programs offered, with attention to utilizing accessible language and avoiding unnecessarily complicated healthcare terms. We learned that emphasizing key things like free gym memberships or free nutritional services provided was very useful in getting women to agree to be referred. Addressing the language barrier and slight language changes was key to us finally getting referrals. However, when COVID-19 hit, we had to reassess since we started getting zero referrals again. It made sense as few people want to wait around in a public space, and pharmacies also became overwhelmed. Our team pivoted to reaching out directly over the phone after receiving lists of potential contacts from the pharmacies. We wanted to show our partners that we could be resilient in this time and to not let this program fall through. Winnie: Pivoting your intervention to have team members directly contact the women you were trying to refer instead of through the pharmacy technicians must have required your team to make adjustments to accommodate language needs. How did your team tailor the AD intervention to address language barriers? Nate: We noticed that we had many of the women we reached out to who spoke Spanish as a native language, and quickly realized we were probably losing a lot of patients because of the language barrier. We onboarded a pharmacy student, Isabella Hernandez, who, in addition to being a very dynamic, charismatic, and outgoing person, also spoke Spanish. Once Natalie onboarded her and shared the main concepts around the screening and referral, Isabella was quickly able to pull in over 80 referrals; we didn’t have even half or a third of that through our prior efforts. We’ve been closely tailoring our work since, with flyers in Spanish, Portuguese, and in Arabic. We have also Arabic speakers to communicate with Arabic-speaking patients, and we have the capacity to expand into other languages. Natalie: I originally worked with the lists of contacts we received and tried to engage directly. However, because we recognized our bilingual pharmacy students were able to better engage with these women, my role now is to oversee our callers, get their referrals, and help touch base with site navigators to ensure referrals are being processed, and how we can improve our screening process. We’re prioritizing language accessibility because our first encounters are first impressions. Our patients matter, and we want to make things as smooth as possible for them. We’re even at a point where Isabella is running trainings with our other callers, so she can give them hints on how to be more flexible in the conversation to fit our clients’ needs. Winnie: This is a really outstanding demonstration of flexibility and tailoring a program to address barriers to practice change. We hope that other programs continue to follow your example of integrating best practices to communicate with patients from diverse communities! Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Nathaniel ("Nate") Rickles is an Associate Professor in the Department of Pharmacy Practice at the University of Connecticut School of Pharmacy. He received his B.S. in psychology and chemistry from Dickinson College, Pharm.D. from the University of the Sciences in Philadelphia, M.S. and Ph.D. in the Social and Administrative Sciences from the University of Wisconsin-Madison. Dr. Rickles also completed a psychiatric pharmacy practice residency and is board certified in this area. He was inducted as a Fellow of the American Pharmacists Association. His primary research interests are to develop, implement, and evaluate intervention programs that improve pharmacist communication with patients and/or other team members and subsequently to improve medication adherence and patient safety. Primary teaching interests involve courses on communication skills, mental health, health behavior change, cross-cultural health care, and research methods. Dr. Rickles is an active researcher with several grants and publications involving enhancing the role of pharmacists in changing patient and provider behaviors. Natalie Miccile received her PharmD from the University of Connecticut School of Pharmacy in Storrs, CT and MBA from the University of Connecticut School of Business in Hartford, CT. Her MBA concentrations include Digital Marketing and Strategy and Investment Analysis. She works as a consultant for UConn School of Pharmacy on research initiatives that involve enhancing the role of pharmacists in the community setting and is pharmacy manager at Shop Rite Pharmacy in Milford, CT. Dr. Miccile is MTM certified and an active member of the Connecticut Pharmacists Association. An interview with Ellen Dancel, PharmD, MPH, Director of Clinical Materials Development, Alosa Health. Ellen completed her pharmacy practice residency at Massachusetts General Hospital and later completed her Master of Public Health at Boston University. by Anna Morgan, MPH, RN, PMP, NaRCAD Program Manager Tags: Materials Development, Detailing Visits, CME Anna: Hi Ellen! Thanks for joining us today – we’re excited to hear about your 6+ years of experience developing impactful detailing materials. Can you walk us through the process you take when beginning to design a detailing aid? Ellen: Absolutely! The most important question to start with is, “who are you detailing with this material?” You also want to consider who is driving the goals of the intervention. Is there something your funder wants you to communicate in terms of key messages or is there new clinical information to convey? You then need to think about how to engage subject matter experts (SMEs). We work with an amazing endocrinologist for our diabetes modules and often ask, “what do you wish a primary care provider (PCP) knew before they referred a patient to you?” Having a specialist’s perception on what concerns they see in practice is key. We’re also fortunate to have access to focus groups at Alosa. We engage prescribers who receive our content to understand their needs on a topic. These peer-to-peer conversations are hosted by one of our clinicians. We also utilize our detailers’ years of expertise, gaining their insights on the materials. We use these two distinct focus groups to provide feedback on the content and messaging as well as the layout and visuals of our draft materials. We then take all this information and add it to the available literature to create a final detailing aid. Anna: These first steps are crucial when thinking about developing materials. Let’s talk about the layout of the detailing aids. What does that look like? Ellen: When it comes to laying out the detailing aid, Alosa has a certain look and feel that we always use that’s part of our brand. The front of the document is a cover page with a title and graphic. Our graphic designer does a tremendous job of taking a concept that isn’t quite fleshed out and making sure that the end product is streamlined. A title that works well is something that is very clear, simple, and focuses on the overall message. Our team selects images for the cover page that relate to the topic but also tend to generate conversation. The back has our logos and a description of the authors. On the inside, we start with a “why do I care?” section, so we can explain why the topic we’re focusing on is of importance to the clinicians being visited. The next page is often a summary of the content that is within the detailing aid. A summary could be an algorithm for treatment or a graphic for a framework for thinking about how to approach management (e.g., the four stages of heart failure). This is followed by the evidence, data, and tips to support a PCP in order to put the key message into practice. We follow that with a cost page, so the clinicians are informed when presenting new medications to patients. Lastly, we include a reminder page that summarizes key points. Anna: Wow! It’s so helpful to hear about the process your team uses for laying out content in the detailing aids at Alosa. From start to finish, how long does this entire process take? Ellen: It really depends on the topic. For example, if we’re updating a topic with a SME who has previously worked with the Alosa team, then we’d expect a timeline of around two to three months. For something new, such as a primary palliative care module or a serious illness module, we’d plan for a timeframe closer to four to six months, because we need the time to really look at the evidence and see how it shapes what we want to accomplish in the field. We also need the time to understand what our PCPs are interested in through feedback from a focus group and informally from our detailers. For AD programs with shorter timelines, we’ve found the resources at the CDC to be incredibly useful, such as the adapted patient materials for our latest immunizations module. There’s also a lot of academic detailing programs that have publicly accessible materials. Some may even allow you to use their graphics if you request permission or cite appropriately. Anna: It’s so important to allow enough time to not only create and build a detailing aid, but also work through multiple revisions of it. Ellen: I couldn’t agree more. When I created my first detailing aid, it took me a week to even come up with the first draft, which was then subsequently torn apart. My draft looked nothing like what we ended up with at the end of the process. Programs need to plan for time for back and forth communication and to engage as many viewpoints as they can. Our modules are accredited for continuing medical education and we have reviewers assess the detail aid to ensure accuracy. We also make sure that our detailers, who will be using the material in the field, have an opportunity to try out the materials. We often end up changing key graphics that we thought were fantastic but turn out to not be effective during the detailing visit through this process. Anna: When thinking about the gold standard for creating a detailing aid that is accessible to both detailers and clinicians, what comes to mind? Ellen: It’s really a marriage of evidence-based recommendations and clinical practice. We’re trying to find a way to bridge recommendations in the literature with usable tools for a busy primary care provider’s practice. We make sure we’re providing the best and latest evidence in a way that can be helpful for the primary care provider without them having to do a complete system redesign. Materials should be streamlined and allow clinicians to be flexible in their approach by offering different options in adopting the key messages. Anna: Thanks for walking us through this process, Ellen- what would you say are the key tips/takeaways for detailing programs who are just starting to do this? Ellen’s Tips for Creating Materials
Learn more by checking out the Alosa website, and these detailing aid building tools and examples from the NaRCAD team. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Biography. Ellen was a pharmacist at the Massachusetts General Hospital for ten years prior to joining Alosa Health, serving in various leadership roles. She received her MPH in epidemiology from Boston University where she worked on a project looking for potential economic efficiencies in the global donor-funded antiretroviral market. As Director of Clinical Materials Development, she leads the development of evidence-based, academic materials, in partnership with clinical experts, and oversees the production of clinical content from concept to completion. This interview features Carla Foster, MPH, who leads the conceptualization, implementation, and evaluation of Public Health Detailing as an Epidemiologist within the Bureau of Alcohol and Drug Use Prevention, Care and Treatment (BADUPCT) at the New York City Department of Health and Mental Hygiene (NYC DOHMH). She is currently activated for the COVID-19 emergency response as Lead Analyst managing the Reporting Unit within the Integrated Data Team of DOHMH’s Incident Command System. By Winnie Ho, Program Coordinator Tags: Data, Detailing Visits, Evidence-Based Medicine, Health Disparities, Program Management, Stigma, Substance Use, Training Winnie: Hi Carla! You’ve certainly had a lot on your plate with so many diverse campaigns. Can you walk us through the conceptualization process for your detailing campaigns, and how your team came to choose cocaine use as your current detailing topic? Carla: We can start with some data on this. In 2018, more New Yorkers died from drug overdose than from homicide, suicide, and motor vehicle crashes combined. Cocaine – in both crack and powder forms – has played an increasingly prominent role in this crisis. The mortality rate from overdose deaths involving cocaine more than doubled between 2014 to 2018, amounting to 52% of all drug overdose deaths in NYC. Some of the associated risks are serious - increased exposure risk to fentanyl, cardiovascular disease events and death. W: That’s stunning data. Especially in the midst of the opioid crisis, it’s important that we don’t lose sight of other substance use issues going on right now. I’d love to learn a little more about the challenges and lessons that your team has learned by detailing on cocaine use. C: First, we have to be aware that fentanyl, a powerful opioid 50 to 100 times stronger than morphine may be found in many substances, including cocaine. We’re very concerned about fentanyl and cocaine because people who use cocaine do not have tolerance to opioids and are at even higher risk for overdose. It’s also important to address the perception of who is most impacted by high mortality rates. There’s this idea that cocaine use is more prominent in younger populations, but our data show that it’s actually impacting an older population more than many might expect. In particular, residents age 55-84 in the Bronx Borough have experienced the largest increase in cocaine overdose death rates in New York City from 2014 to 2018. That’s why it’s critical for us to raise awareness in an effort to mitigate misconceptions and stigma around risky use and those who may have a substance use disorder (SUD). In addition to shame, there are still very real potential socioeconomic and legal consequences from disclosing substance use, which can deter folks from even seeking help. We take into account the unjust consequences of policies applied unevenly according to race, and how this impacts implicit biases in terms of which patients are thought to use substances, which types of substances they might use and even more critically, which type of treatment, if any, they are offered. Implicit biases combine with the effects of systemic racism to compound these consequences. It’s important to note that it’s not race that drives poor health outcomes, but racism. W: Challenging stigma is one of the most powerful ways that detailing campaigns can combat the damage done by the War on Drugs, because stigma can make the difference of whether or not people receive dignified care. With a campaign so focused on addressing stigma and with a topic this important, how do you prepare your detailers for this task? C: We devote a significant amount of time towards training our detailing reps – a week-long training, 8 hours a day. We spend a large amount of that time talking in detail about stigma as related to cocaine use. It’s critical to us that our detailers are comfortable and knowledgeable when speaking about this topic, because it sets the tone for the providers who then set the tone for their patients. We ensure that our representatives are prepared to respond to a wide range of questions or comments, because this builds the provider-detailer relationship and enhances the value of the detailing visit. We’ve found during our follow-up visits that this support has led to high provider engagement with the campaign and providers reporting incorporation of the key recommendations into their daily practice, which is the aim of our public health detailing campaigns. W: How have providers responded when detailed on a topic that carries so much stigma? C: The good news is that we’ve found NYC healthcare providers to not only be receptive to our work on substance use, but they’re eager to partner with us to support their patients once they learn about the severity of the issue. Our team provides statistics that relate to the provider’s specific neighborhoods and specialty, giving them real-time pictures of what’s happening with the patients they see. We know that it’s still a difficult topic to bring up, so we help address this with our action kit resources on stigmatic language and counter-top brochures that signal to patients that the provider’s office is a safe place to discuss these issues. W: It gives me tremendous hope to hear about that there’s been enthusiastic response from providers. It means that things are changing. Let’s also talk a bit about program sustainability. Your team has worked extensively on campaigns across multiple topics. What have you learned from implementing past campaigns? C: Each public health detailing campaign is different, but we’ve learned some key strategies that support the growth and success of subsequent campaigns:
Our overall goal is to do everything we possibly can to improve the health of our fellow New Yorkers. I like to remind our detailers of this James Baldwin quote that informs our public health detailing mission: “Not everything that is faced can be changed, but nothing can be changed until it is faced.” Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Carla Foster, MPH is an Epidemiologist at the New York City Department of Health and Mental Hygiene (NYC DOHMH). Her research focuses on the implementation and evaluation of public health detailing campaigns across New York City with the aim of reducing overdose mortality. Prior to joining the NYC DOHMH, she led development of clinical practice guidelines at the American Urological Association. She received dual Bachelor of Arts degrees in Africana Studies and Neuroscience from Wellesley College. Carla also obtained her Master of Public Health Degree in Epidemiology from Columbia University. An interview with Lisa Gruss, MS, MBA, Practice Transformation Project Lead, Quality Insights. Quality Insights is a non-profit organization that is focused on using data and community solutions to improve healthcare quality. The organization is based out of West Virginia and operates in Delaware, Pennsylvania, Virginia, and New Jersey. Quality Insights has developed an innovative academic detailing campaign to increase human papillomavirus (HPV) vaccination rates across Delaware. by Anna Morgan, MPH, RN, PMP, NaRCAD Program Manager Tags: Cancer, Detailing Visits, Vaccinations Anna: Hi Lisa! We’re looking forward to learning about your academic detailing work as a multi-state non-profit, and your important work around HPV vaccination rates. We know these vaccinations are critical in preventing HPV, which can lead to many types of cancers. Can you tell us a little bit more about your current role and how it relates to academic detailing? Lisa: I’m focused on new business operations, science, and innovation. I implement new contracts that we receive through the Department or Divisions of Public Health, or any other funding sources. I also work with our Information Technology (IT) team to set up databases, work through any compliance issues, and define metrics. Additionally, I help manage the AD components of our contracts. Anna: You’ve had great success with many of your academic detailing campaigns, specifically your HPV campaign that you’ve been working on. Can you walk us through how the topic was chosen? Lisa: We originally received a pilot grant through the Delaware Division of Public Health in 2018. The project was co-sponsored through their immunization program and the Delaware Cancer Consortium to improve the HPV vaccination rate in Delaware. According to the National Immunization Survey-Teen, the HPV vaccination rate for the initial dose in Delaware in 2018 was 73.9%. The Division looked at the relationship between cancer rates and low vaccination rates and saw a huge opportunity. Per the Centers for Disease Control and Prevention (CDC), 90% of the 34,800 HPV-related annual cancer cases in the United States could have been prevented with the HPV vaccination. The pilot was small but successful. In the spring of 2019, we received additional expansion of funding and added the academic detailing component. We’ve been working with practices to implement various services that tie in with academic detailing. We review data, work on evidence-based workflow modifications, provide HPV vaccination resources for staff and patients, and offer technical assistance. Anna: Academic detailing dovetails so nicely with other interventions and services, creating more opportunities for impact and care improvement. It sounds like clinicians have been mostly amenable to the program—have any barriers come up throughout your HPV campaign? Lisa: To say we’ve had no barriers with access wouldn’t be true. We consider ourselves to be vendor neutral and ambassadors of the evidence - we don’t align and promote directly with any pharmaceutical company or insurance company. When looking at the broader scope of our work, it’s certainly complementary to what pharma might do, but we’re able to offer a broader menu of interventions beyond a vaccine. We’ve had some difficulty during the pandemic, like many AD programs, but we’ve found leveraging our past relationships to be key. Anna: I’m sure those existing relationships have helped with building new ones. Have the practices that you’ve visited been involved in your program’s other academic detailing campaigns? Lisa: It’s a mix. The family medicine practices have been involved in a lot of our other projects, like opioid safety, cancer screening, prediabetes, diabetes, and maternal health campaigns. The clinics that specialize only in pediatrics, where we’ve also been implementing the HPV intervention, are new to academic detailing but have been extremely receptive to this campaign. Anna: I recently saw your team’s work on your HPV project published in the Delaware Journal of Public Health. Can you briefly describe the results? Lisa: Sometimes, it takes a small change to make a huge impact, and that is absolutely what we found with our project. For our engaged practices, we saw in a one-year span that the initial dose of HPV increased 8.1%. It’s important to note that practices usually picked more than one intervention. For example, some chose academic detailing along with workflow modifications, like nurse reminders or scheduling the patient for their next vaccine before leaving the office. Anna: Those are significant results, especially in such a short timeframe! What’s one thing you’d want our detailing community to take away from this project? Lisa: We found that practices were most successful when they chose an intervention, stuck with it, and set attainable goals. Some practices were at a 50% HPV vaccination rate and wanted to be at 80%. In those situations, we sat down with them and asked them to think about something more attainable, like a 5% increase in 6 months. Practices that committed to smaller increases not only met their goal, but slightly outperformed it. We’re excited to continue our work around this topic! Anna: Setting attainable goals and following through is so important for all projects. We’d love to hear more about your future work and how this campaign continues to grow and succeed! Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Biography. Lisa is a Practice Transformation and Quality Improvement Project Leader with nearly 20 years of experience in the healthcare and managed care industries, with the leadership and skills to serve as a Program Manager. She is an expert in population health management, data analysis and audits, and customer engagement across payers and customer types, including Medicaid and Medicare and underserved and rural populations. She has applied leadership and project management skills to improving population health, quality results, and data integrity in Accountable Care Organizations (ACOs), Patient Center Medical Home (PCMH), and new business development and reporting. She's well versed in data analysis including Healthcare Effectiveness Data and Information Set (HEDIS) and National Quality Forum (NQF) measures, population health management tools, as well as internal Quality Insights reporting tools and state run database reporting. In the past 5 years, she has successfully managed multiple projects and people to meet deliverables and deliver value to customers. By: Winnie Ho, Program Coordinator 2020 was a year of many hard-earned lessons. We’re so fortunate to have an AD community that’s committed to sharing best practices, tips, and experiences. This communal knowledge base is what makes us stronger and allows us to all grow together. Here’s a collection of the great advice some of our DETAILS Best Practice Blog and Discussion Forum guests have given us this past year: Tags: Detailing Visits, Evaluation, Program Management Planning and Team Building:"The most critical thing is to allow enough time for the planning process – ideally, 18 months before you’re looking to launch. This allows you to gather resources, make partnerships internally and externally. If you can reach out to colleagues in the field, learn about what are good mistakes to avoid. It’ll save you a lot of time!" -Carla Foster, NYC Dept. of Health and Mental Hygiene (NYC DOHMH) "My best tip would be to create a standard operating procedure (SOP) or some type of guidebook for your visits. Our team developed a SOP which discusses how to conduct a needs assessment, conversational tips, how to weave in key messages, and how to address barriers. Developing the SOP really allowed me to understand the intricacies that need to be addressed before launching the campaign. It works as such a good practice guide, and you can always refer back to it whenever you need it." -Julie Anne Bell, NYC Dept. of Health and Mental Hygiene (NYC DOHMH) "One thing I’ve learned about AD is that it’s only as effective as your intervention across an entire system. Any work that I’m doing is irrelevant unless I’m addressing the culture of the entire system. If the front desk staff isn’t on board, or the clinical staff isn’t a believer, or the CEO doesn’t understand – there will be challenges that will be harder to overcome." -Andrew Suchocki, Clackamas County, Oregon, Medical Director "Building relationships with key stakeholders has made all the difference. They’ve helped me curate my detailing aids and key messages, and have even allowed me to practice my detailing sessions with them." -Kelsey Bolton, Gundersen Health System, Wisconsin "A strong team is an important part of a detailing campaign. Strong teamwork means supporting each other through tough detailing sessions, communicating well, and keeping a positive attitude. During virtual times, turning the camera on during staff meetings can also help keep the team spirit alive!" -Marlys LeBras, RxFiles Academic Detailing Service in Saskatchewan, Canada Gaining Access:"There are numerous external pressures when it comes to AD, but the most important part is keeping the human aspect in check when reaching out to providers. We can get bogged down into the guide posts, the bench posts, or the numbers – but the COVID-19 era reminds us that it’s all about empathy." -Tara Hensle, University of Illinois at Chicago/Illinois ADVANCE "You may find it helpful to create an e-Detailing materials packet and see if you can grab some time with providers over a virtual platform. It can be a helpful foot-in-the-door for future in-person detailing!" -Jess Alward, New Hampshire Division of Public Health, Dept. of Health and Human Services "Lunch time is still the best time for visits. They were the most popular when I did it, and they’re still the most popular now, as my team tells me." -Terryn Naumann, British Columbia Provincial Academic Detailing (BC PAD) Service Conducting Field Visits:"There’s a lot of listening that happens in AD. You might spend all this time learning about the topic before you meet the providers, but if you take the time to really listen to them, you might learn more than you came with. There is so much to learn from all the incredible people you meet in AD." -Debra Rowett, Drug and Therapeutics Information Service (DATIS) in South Australia "The big thing I’ve learned through networking with detailers is to be flexible and be prepared for any situation, especially in the virtual environment. You might have one idea of how your session will go, and it could go in the opposite direction, which is part of the charm of detailing. Also, practice mock detailing with your colleagues!" -Vishal Kinkhabwala, Michigan Dept. of Health and Human Services "It’s important to have several different ways of presenting information to providers and to use varied approaches to barriers or objections that come up. I typically focus on emotional connection, financial concerns, and the evidence behind the key messages I’m delivering." -Brandon Mizroch, Louisiana Dept. of Health "No visit is ‘one-size-fits-all’. You need to consider the provider, their situation, and their environment and decide what will be the best way to deliver the evidence. It’s critical that you’re attentive to the provider you’re detailing and that you continue to focus on the needs assessment at all times." -Mary Liz Doyle-Tadduni, Alosa Health in Pennsylvania "I was delivering an in-person visit, and the skeptical questions about AD from the provider kept coming. I tried not to be defensive, but I answered everything I could. Eventually, the provider allowed me to get to the topic, and that changed everything! By the end of the visit, the opposition took an about-turn. I gained a professional friend and ally and ended up seeing this person with virtually every topic over the next 20 years. Never write someone off because of some seemingly extreme pushback – you just never know!" -Loren Regier, Centre for Effective Practice (CEP) and Canadian Academic Detailing Collaboration (CADC) "Confidence is key. You can study and practice everything with your team, but at some point you have to get out there and just do it! You have something valuable to offer and a few opportunities a year to capitalize on that value. A strong relationship can overcome a difference in clinical background or even a rough start. It just takes enough of your effort to show that you’re really there to be of service. Remember, you wouldn’t have been hired in this role if you weren’t qualified!" -Amanda Kennedy, Vermont Academic Detailing Program "When addressing stigma, it’s important to note that tough conversations can produce some cognitive dissonance in people. All providers are human. They care about their patients. What helps is not overwhelming them with data, but repeated snippets of information over time to help reinforce the message." -Elisabeth Mock, Maine Independent Clinical Information Service (MICIS) "Don’t be afraid to ask for a specific behavior change and remember to follow up to make sure that change occurs. The ‘ask’ can be hard for detailers, so I always tell them to frame it as, “based on what you’ve heard today, what is one thing you’d do differently?” -Tony de Melo, Alosa Health in New England Data Collection & Evaluation:"We encourage providers to complete a post-visit survey. We ask them to share their level of agreement that they were given new/different information, and they intend to implement practice changes as a result of AD conversations." -Jacki Travers, Pharmacy Management Consultants in Oklahoma "It’s important to track a mix of quantitative and qualitative data, and the critical components that should be tracked are the outcomes and the process of detailing. Data is absolutely critical for getting leadership buy-in, especially if it can tell a story." -Kristefer Stojanovski, San Francisco Dept. of Public Health "Once you’ve identified the problem you’re addressing and done the work to understand it, jump in! AD works!" -Jennifer Pruskowski, University of Pittsburgh Medical Center Thank you to the AD community for your resilience, compassion, and incredible work through a tumultuous year. We hope the AD community continues to share its pearls of wisdom with us through the new year. We are excited by all the progress made in 2020, and look forward to a brighter 2021 with you all. Best, The NaRCAD Team Anna Morgan, MPH, RN, PMP, NaRCAD Program Manager Tags: Conference, COVID-19, Deprescribing, Diabetes, E-Detailing, Elderly Care, Health Disparities, HIV/AIDS, International, Jerry Avorn, Mental Health Over 240 members of our worldwide community came together to be a part of something special--our 8th annual conference, and our first in a virtual setting. We were able to expand our reach and overcome barriers like travel time and financial constraints that have prevented our colleagues from attending previous conferences. There was a palpable sense of positivity, enthusiasm, and resilience, especially in a virtual space. We’re so proud of evaluations that cited a renewed sense of passion and commitment to AD based on the new lenses we applied to our programming, including comments about feeling “empowered” to continue this work in the year ahead (even amidst inevitable Zoom fatigue.) Check out our highlights and access all event resources below and on the Conference Hub.
With so many of you expressing a continued need around more of our peer working sessions, we’ll be focusing largely on that in 2021—we can’t wait to support your work this year. In the meantime, tell us what you need to make next year a success. See you in 2021. The NaRCAD Team Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! An interview with Alok Kapoor, MD, MSc a cardiovascular investigator at the University of Massachusetts, Worcester about his work on the SUPPORT-AF II Study. By Mike Fischer, MD, MS, NaRCAD Director and written by Winnie Ho, Program Coordinator. Tags: Cardiovascular Health, Data, Detailing Visits, Evaluation, Primary Care Mike: We’re glad to have you join us to talk about your recent work using AD to improve anticoagulant use in patients with atrial fibrillation (AF). Could we start out by getting an understanding of your work and the goal you had set for your SUPPORT AF II intervention? Alok: I am an internist doing cardiovascular outcomes research, and for the last few years I have been really laser-focused on how to fill the gap in anticoagulation use for patients with AF who have an elevated risk for stroke. These patients tend to be older adults with multiple co-morbidities, which presents certain challenges for primary care providers and cardiology specialists. The goal of our particular AD intervention was to provide evidence and patient case scenarios to show some of the common situations where patients go untreated for stroke prevention despite experts’ suggestions that therapy is warranted. M: The underuse of anticoagulants is more common than we would like, and the impact of that underuse is substantial. What made you decide to utilize AD as a part of the intervention for your study? A: I was thinking about an intervention that would be more than a simple reminder to providers, and thought that perhaps something more customized that would take into consideration the individual provider’s practice and experience with prescribing anticoagulants made more sense. AD was suggested as a potential strategy by our grant sponsor to address those concerns, so I began to read more into it. The SUPPORT AF II intervention is a combination of the audit and feedback reminders given in our original study, SUPPORT AF I, plus the new offering of AD. M: How did you anticipate that those different components of the SUPPORT AF I and II interventions would work together? Were there any unanticipated surprises during the implementation? A: I believed that the reminders would encourage providers to reach out to their subspecialty colleagues and also remind them to have discussions about anticoagulation with their patients. Then, AD would allow us to get closer to the underlying belief and resistance factors that might be making it more difficult to prescribe in challenging situations, such as a patient with prior falls, bleeds, or on other medications that can make bleeding more common. Some of these barriers included also unfamiliarity with initiating direct oral anticoagulants and guiding patients to coverage information for the cost of newer anticoagulants. There were some specialists who were not necessarily enthusiastic about receiving messages from us. There were also providers during the course of messaging that indicated that they did not think that these messages were helpful for them, so we adapted. However, most people were appreciative or otherwise silent when receiving messages. The harder work was the convincing needed during the AD visit that could help lead to a more impactful intervention. M: Yes, an impactful intervention is the goal. In your paper, you talked about the importance of patient choice as a factor in anticoagulant use, and this has been consistent with a few other studies of anticoagulation in AF that highlighted similar challenges. Are there any ways that you’ve thought about to adapt an AD intervention to address the importance of patient choice? A: As part of our AD intervention, we gave prescribers a Jeopardy-type menu where you could choose which themes to explore, and one of those was a shared decision making module with resources including an app designed by my co-collaborator David McManus. This app allowed patients to input their unique conditions and circumstances into our risk stratification algorithm. Knowing the patient risk level, the provider would then be shown questions frequently asked by AF patients that would presumably help the provider address certain concerns during the next patient visit. M: As you reflect on your experience implementing this intervention, were there themes that especially connected with the primary care providers or cardiology specialists who were receiving AD? A: I was responsible for AD with the primary care physicians while my collaborator worked with cardiology specialists. The providers I spoke with seemed to be really drawn to the evidence in the guidelines and often requested support from me in identifying specific evidence that would be helpful as they developed their own improved management strategy around anticoagulants. I think where we could have added something more robust would be to offer providers a way to deliver these messages to their patients and how to do motivational interviewing with patients who are resistant to start a recommended therapy. M: Support AF II is an impressive piece of work that provides many insights. Do you see other topics in cardiovascular care, or other clinical specialties where it might be useful to do similar studies to test AD to increase the use of evidence-based care? A: There are other types of adherence issues in cardiovascular medicine that are potential targets such as blood pressure management. The issue doesn’t seem to be starting the medication, but in continuing to take it on a daily basis. The AD intervention would be done directly to the providers, but there might be value in also directly approaching the patients. M: It would certainly be interesting to understand whether management issues are based on clinical inertia and hesitation in taking the next step, versus barriers in patient adherence itself. Thank you for taking the time to speak with us today, you’ve given us all a lot to think about! Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Alok Kapoor, MD, MSc is an investigator who has developed several projects related to anticoagulation and conditions requiring anticoagulation. He is one of the former directors of the medical consultation service at Boston Medical Center. In that role, he routinely educated other providers on the need for anticoagulation versus potential harm, particularly for underserved populations. At the University of Massachusetts, he has established a focus on filling the gap in anticoagulation of patients with atrial fibrillation. This started with SUPPORT-AF, an audit and feedback project funded to give providers a snapshot of their AC prescribing rates relative to their peers and to a national benchmark. In SUPPORT-AF II, he expanded the team's previous efforts to include educational outreach in the form of academic detailing. In his subsequent efforts, he have collaborated with informatics experts to understand the potential for electronic health record-based decision support to fill the gap in AC use. A Team Effort: Strong Provider-Detailer Relationships to Amplify Evidence-Based Care (Part II)11/3/2020
Overview: The DETAILS blog presents a special two-part series of what it takes to build a strong provider-detailer relationship from the perspective of a long-time academic detailer and then, from one of her local physician partners that’s received AD for almost 15 years. You can read Part One here. In Part Two, we get a chance to speak with Dr. Robert ‘Bob’ Schwartz, a Vermont family physician and medical director who discusses the impact of AD on his clinical practice. Bob reflects on what a strong provider-detailer relationship looks like from the perspective of a clinician, especially in the midst of COVID-19, and offers his advice to other providers considering AD. An interview with Winnie Ho, NaRCAD Program Coordinator. Tags: Detailing Visit, Evidence-Based Medicine Winnie: We’re so excited to have the chance to speak with a clinician who’s been receiving AD for a long time! Can you tell us a little bit about how you came to work with the Vermont Academic Detailing Program? Bob: It’s been several years that I’ve been blessed with Amanda Kennedy’s presence on the AD service. I would say that it actually all started back when we first decided we were not going to allow pharmaceutical representatives in the office about 20 years ago. We decided that it wasn’t a good use of our time. Then Amanda and the Vermont Academic Detailing Service came onto the scene. They presented a formal alternative to learn about medications from a non-biased view – and so we’ve participated in every single session since then. W: That’s incredible! B: The program is great – I think what’s really critical is that the program has such a high level of professionalism that you can be completely trusting of the information that you’re getting. My colleagues and I are always so thrilled when there’s another topic ready. I know how long it takes to get these things set up. You know it’s not just something someone slaps together on a random afternoon. Amanda is an absolutely amazing professional, and the fact that she’s been with us for so long helps develop a personal relationship and it builds trust. W: This relationship has been developed over more than a decade! Here at DETAILS, we don’t always get a chance to ask about what happens after the detailer leaves the office. What challenges in clinical care make it critical to lean on Amanda as a trusted source of evidence and resources? B: I like that AD is not about a specific medication, but rather a specific medical condition. As a clinician, I think about the patient sitting in front of me with COPD, not about who I can get on a specific drug. Pharmaceutical detailers only talked about specific medications and you couldn’t trust the information as unbiased. They never gave you the whole picture. What’s really important in medicine is how all the pieces fit together, and that’s really hard as a clinician to figure out on your own. With AD, I can reach out to say that I have COPD patients and I really want to get more knowledge about COPD. W: Right, and there’s an abundance of research that’s difficult to sort through on your own. B: AD is one of the few places that you can get this comprehensive evaluation of a specific condition and the medications that surround that. The other thing is that they bring materials. It might be a one-page sheet with diabetes medications based on class, relative cost, brand and generic names, and dosage. Or, it might be a COPD assessment score tool that I can easily refer to. These clinical aids are a big part of what detailers bring for us. W: Absolutely – those materials take a long time to create! I wanted to dive a little deeper into the provider-detailer relationship. What role do you think trust plays in sustaining a provider-detailing relationship for the long-term? B: When we ask Amanda a question that she doesn’t know the answer to, she will tell us that she doesn’t know, but will look into it. A week later, you get an e-mail with information that she’s put together. We trust her and know that the dynamic of the relationship is not manipulative. We know that the information is carefully researched and that she’s not going to fill in the blanks by winging it. All of our detailing sessions have an unstructured portion where we can ask specific questions of Amanda. It allows the providers in our practice to have an organic conversation about a specific issue, and it can be hard to replicate this without the support of a detailing program. W: It’s always important to acknowledge what we know and what we don’t know, especially right now with COVID-19. It’s disrupted a lot of things, and I imagine for our healthcare providers, more than ever, there’s a lot of extra challenges. Our detailers’ main goals have always been to support their local providers and to be there with them through obstacles as they arise. What would you want detailers to understand about the challenges that COVID has brought on for clinicians? B: Everything has been changing over the last several months and navigating COVID challenges takes up a lot of time. However, we still have to take care of our diabetes and our COPD patients and so more than ever, it’s critical that we have access to information that is streamlined, accurate, and that we can be confident in. I always tell people that medicine and life are team sports, and if you think you’re going to excel at either one of those alone, you’re going to be disappointed every time. We need Amanda on our team because she fills this vital role, that’s even more vital to have filled today. W: And finally, we know that there’s a lot of other clinicians who may be on the fence about receiving AD because they’re unfamiliar with it, or may have lingering distrust from pharmaceutical representatives. As someone who’s received AD for a long time, what advice would you give to other providers who may be considering these visits? B: I conceptualize AD like this – it’s like getting on the super highway instead of taking the secondary roads. I could drive to Chicago and never leave a two-lane highway, or I can get on the 90 and drive on that to Chicago all the way. To other clinicians – we have certain responsibilities to ourselves and our patients, and one of those responsibilities is to keep up with what’s going on and to know how to use it to better care for our patients. What I would tell other clinicians is that, you have this responsibility anyway – why not have another team member who’s an expert on this and give this information to you in an hour what would have taken you six hours to do yourself? We’ve loved our partnership with Amanda, and we look forward to what comes next out of it. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Bob Schwartz, MD, is a family physician at Northshire Medical Center in Manchester, Vermont. He’s served as the Associate Medical Director for Dartmouth Hitchcock Putnam, a multi-specialty group in the southwestern part of Vermont. Dr. Schwartz completed his family medicine training at Lancaster General Hospital in Lancaster, PA following his medical education in the Honors program at Northwestern University. He currently lives in East Dorset, Vermont. It's a time when continuous comparisons of the COVID-19 era to that of the Spanish Flu of 1918 are frequent. More than 100 years later, we've moved from telegrams to Instagram--staying connected seems like it'd be easier than ever. With so many channels and platforms available to stay on top of the ever-changing influx of info on the current state of healthcare, why do we so often feel less connected? We're speaking, but we're having a hard time listening. We're viewing, but we're not reading. With platforms like Twitter, output is the main focus. Sure, we scroll through others' feeds, leave comments and likes, all with a quick tap or two. But this is the virtual version of 'speaking at' someone, rather than with. What will encourage us to invest in opportunities for more circular, reflective dialogues during an era where the perceived preciousness of time leaves us running at an ever amped-up, task-oriented pace? What slows us down in these moments of overstimulation? For many, it's 'feeling seen' for the work that they do, the values they share, the experiences they've had. It's pausing to sharing stories as often as sharing data; contextualizing our experiences with vivid imagery, details, reflections. It's trading in the hashtag for a moment to pause and be present with others. Consider it akin to drinking a cup of tea or coffee--rushing makes it an unpleasant task rather than something to be enjoyed as it should be. With a personalized approach like this in mind, and with a sense that it's more critical than ever to slow the pace at which we give and share information, investing a few more moments in the art of storytelling allows us to deeply digest each other's experiences. Our Discussion Forum provides space to do just that--share and digest; a space where there isn't a speed at which info is refreshing your app, there are no 'push notifications', there are no alerts. Instead, our goal is to offer you time to sit and pause, to be present and learn with other health professionals who, like you, invest their valuable time in supporting frontline clinician care. We invite you to take a moment to invest in this library of stories, where a few minutes of time will not be lost to the ethers of endless Facebook or TikTok scrolling (which serve their purposes, too). Instead, your return on investment will be as valuable as the time you spend--a connection to a community full of dedicated health educators who share their struggles, setbacks, and solutions. Make as many small (or large) moments in your day to pause--it's more important than ever for healthcare professionals and beyond to take the best care they can. And if you're willing, share one of those moments together with us. Trust, Mutual Respect, and Transparency: Building a Strong Provider-Detailer Relationship (Part I)10/20/2020
Overview: The DETAILS blog presents a special two-part series of what it takes to build a strong provider-detailer relationship from the perspective of a long-time academic detailer and from one of her local physician partners that she's detailed for almost 15 years. In Part One, we speak with Amanda Kennedy, PharmD, BCPS, who serves as the Director of the Vermont Academic Detailing Program and has been an active detailer since 2002. The Vermont Academic Detailing Program sees about 450-500 providers a year on 1-2 clinical topics. In Part Two, we hear from Dr. Robert “Bob” Schwartz, a Vermont family physician who reflects on his experiences with academic detailing visits with Amanda. Stay tuned for Part Two! An interview with Winnie Ho, NaRCAD Program Coordinator. Tags: COVID-19, Detailing Visits, E-Detailing Winnie: Amanda, thank you for taking the time to reflect on the relationships you’ve built through the years with local providers. What would you say are the key elements for building a strong provider-detailer relationship, and why? Amanda: Trust and mutual respect. If the clinician doesn’t trust you, then it’s going to be very hard to make recommendations for practice change. Mutual respect goes both ways. As much as I am providing a service, I also expect the clinician to show up and be engaged in our visit, because only then can we have the kind of conversation that gets at the heart of the behavior change we hope to see. W: Engagement is such a key component of these visits, especially for creating a safe space for providers to be open and honest with the detailers about their concerns and needs. I want to take you back to the start and ask you to reflect on what it was like to be brand new to AD. What advice would you give to a new detailer in those shoes? A: Confidence is key. You can study and practice everything with your team, but at some point you have to get out there and just do it. Building that relationship requires confidence and the belief that you have something valuable to offer. When you only have a few opportunities a year to meet with clinicians, you have to capitalize on those moments. It can be difficult to establish that rapport and trust when contact is infrequent. It’s about persistence, patience, and continuing to show the clinician that you want to be helpful. Some things can get in the way, such as not having the same clinical background as the provider you’re working with, and not always feeling qualified. But remember, you wouldn’t have been hired in this role you weren’t qualified! W: That’s certainly important to keep in mind. You were also recently introduced to a new playing field – virtual visits. Compared to traditional in-person visits, what’s it like starting new relationships through e-Detailing? A: Virtual visits can be efficient, because we eliminate the cost of travel, we can reach more people and more often. Most of the content of that first call is the same as in person. On a first visit, most of what you’re doing is the introduction of your work and your program. I’m transparent about everything with them. I don’t bring up my materials or share my screen until that clinician has had the opportunity to ask me any questions they have. I give them a chance to see me as a person first, without distractions. This takes a few minutes longer virtually than in person, and it can be harder to gauge body language, but it’s an important first step in establishing a relationship. W: That’s a good piece of advice for many programs making that transition into e-Detailing, as I know it was a big concern about starting these relationships over a new medium. Do you have an example of how maintaining these relationships can support better health outcomes for patients? A: Yes. While our team was putting together information on a COPD campaign, I was meeting with Dr. Schwartz on a different topic. At the end of our visit, I told him about the next topic and asked him what was concerning him about it. He asked for more information on benzodiazepines and patients with COPD. While this specific information wasn’t included in the overall COPD campaign, I’ve personally been looking for good articles that would be helpful for his particular interest. In attending to this specific request, I’m showing him that I’m listening to and addressing his need. W: That’s some strong needs assessment! And I’m sure that information will be put to good use. You’ve been in this field for 18 years - have you seen how your support has resulted in clinical behavior changes over the years? A: The most rewarding thing for me is going into a clinic and seeing a tattered version of a handout we used five years go, or a clipped out table taped up on a board. That’s how you know your information has stuck around and has had a long-term impact. Also, on visits, if a provider is struggling to think of how to incorporate a behavior change into their practice, I have stories from other providers and can provide suggestions and ideas that have worked for them. I can leverage a community of long-term relationships. W: Have you found that these strong relationships allow you to get more out of a detailing visit, especially when there are some difficult conversations? A: Yes, absolutely. It’s important to know, especially right now, that we’re suffering a community-wide trauma because of COVID-19. Out patients need their providers, but those providers have their own challenges going on too. There are family issues, financial issues, and community issues. Our jobs as detailers is to be a support as much as we can, and to help providers make beneficial changes for patients that are rooted in evidence. We’re currently doing a topic on managing stress related to COVID, but before we get into how providers can help their patients, we pause and ask them how they’re doing. I’ve had providers share deeply personal information with me that can be important in understanding how to best support them in addition to them supporting their patients. They know that they can trust us. W: As we wrap up, what would your final advice be to other detailers looking to replicate your success? A: My advice? It doesn’t take 18 years to build a relationship with someone. It just takes enough of your effort to show that you’re really trying and taking opportunities to be of service. It means showing that you’re trustworthy, and that you’re going to respect and support them just like you’re promising them that you will. (Part One of Two). Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Amanda Kennedy, PharmD, BCPS, is the Director of the Vermont Academic Detailing Program at the University of Vermont’s Office of Primary Care. She has also been an active academic detailer for nearly 20 years. Amanda regularly serves as a faculty facilitator for NaRCAD’s Academic Detailing Techniques trainings. In addition to her role with academic detailing, Dr. Kennedy is a Professor of Medicine at the University of Vermont’s Larner College of Medicine. She currently serves in the Department of Medicine Quality Program, teaching and mentoring physician residents, fellows and faculty in quality improvement and health services research. An interview with Vishal Kinkhabwala, MD, MPH, HIV Prevention Activities Coordinator, HIV Prevention Unit, Michigan Department of Health and Human Services. The overarching goal of the HIV Prevention Unit is to expand access to PrEP for patients throughout the state of Michigan. by Anna Morgan, MPH, RN, PMP, NaRCAD Program Manager Tags: Conference, Detailing Visits, E-Detailing, HIV/AIDS, PrEP Anna: We’re so happy to be catching up with you today, Vishal! Can you tell us a little bit about yourself and how you got into the work of academic detailing? Vishal: My background is in both public health and medicine. After finishing medical school, I realized that as much as I loved the clinical aspect, I wanted something that combined both my passions of public health and clinical medicine. My first job after graduating was in New York where I linked newly-diagnosed HIV patients into care. About a year later, I found an opportunity at the Michigan Department of Health and Human Services that fit with what I ultimately wanted to do, HIV prevention. My current work is focused on ending the HIV epidemic in Wayne County. One of my favorite parts of my job is detailing, which I do part-time. Our program officially began detailing in September of 2019. We’re in the process of making the jump to e-Detailing, but we’re still in the planning stages. Anna: Before we chat about how you and your team have been preparing for e-Detailing, let’s talk about how clinicians in Michigan have received your messages around PrEP. Were clinicians receptive to your detailing efforts when you were conducting in-person visits? Vishal: Most clinicians that we detailed were either already familiar with PrEP or had that enthusiasm to learn about it. Many of the clinicians were excited about helping with MDHHS’s overall goal of increasing patient access to PrEP and talking about the associated HIV prevention counseling. Clinicians were typically familiar with PrEP but weren’t aware of the nitty-gritty details of how to prescribe and manage it. A big part of what we discussed during our detailing visits was identifying which patients are candidates for PrEP. Our program’s purpose is to increase access, even if it’s just for one or two patients. Anna: It’s wonderful that the clinicians you’ve detailed have been supportive of your program’s goals. Transitioning to e-Detailing will certainly be easier knowing that you have support from clinicians. What have you learned so far from planning for e-Detailing? Vishal: It’s been fun prepping for e-Detailing with our team. The big thing I’ve learned through networking with detailers from other jurisdictions is to be flexible and be prepared for any situation, especially in the virtual environment. You might have one idea of how your session will go, and it could go in the opposite direction, which is part of the charm of detailing. It’s about forming a connection and tailoring your methods to what the clinicians' and practices' needs are. I’m a relationship-oriented person, and I feel like that’s one of the most rewarding parts of doing this. One of the things that also excites me about virtual education is the access to information right at your fingertips. For example, I was detailing a clinician about PrEP and HIV prevention last year who asked me, "Well, I have this issue with a lot of patients with STDs. Can you talk to me about STD treatments?" It was an in-person visit, so I only had the materials that I had brought with me, which were all focused on HIV. The beauty of doing e-Detailing is that you can have resources pulled up and can get the information for the clinician almost instantaneously. As I said earlier, detailing is all about having that relationship, meeting the clinician where they're at, and serving their needs. Virtual education gives you another tool to be able to do just that. Anna: What a positive spin on e-Detailing! Speaking of sustainability, that’s the theme for our upcoming conference. You attended our conference last year in Boston and will be presenting at our virtual conference this year. What were some key takeaways from last year’s conference that you were able to bring back to your program and implement? Vishal: Last year’s conference was my first exposure to NaRCAD and the world of detailing- it was honestly one of the coolest experiences I’ve ever had. It was great to be exposed to e-Detailing through the virtual detailing panel before it was even brought to the forefront during COVID. Because I was hired a few months prior to the conference, I had not attended a training yet. I joined the “AD 101” breakout group, which was supremely helpful. When I got home, I did mock detailing sessions with my colleague and reviewed all the resources on the NaRCAD website. I also practiced detailing on the stress balls I have in my office! Anna: It’s so nice to hear how impactful the conference was for you as a new detailer. We strive to include a diverse audience of new and veteran detailers each year. What are you looking forward to most about this year’s conference? Vishal: There are so many absolute rock stars in the field of detailing. I’m looking forward to getting to see familiar faces and meet new faces over the virtual platform. I’m excited for the exchange of ideas, programs, and concepts. So many people have given me ideas for our program in Michigan. It’s such a good feeling when I can say that not only have I received help from others, but that I’m able to inspire other people. It’s also comforting to know that this is such a passionate group of people that no matter the adverse situation, the work continues getting done. I’m counting down the days until the conference in November! Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Biography. Vishal has been working with the Michigan Department of Health and Human Services since August 2019 as the HIV Prevention Activities Coordinator. His work focus is on program planning and implementation for the Ending the HIV Epidemic Initiative, focused on southeastern Michigan. As part of this initiative, he works as a part-time Academic Detailer with a focus on HIV Prevention with the overarching goal of increasing access to PrEP throughout the state of Michigan. He completed his Master of Public Health degree from Benedictine University in Lisle, IL in August 2013 and his Doctor of Medicine degree from Avalon University School of Medicine in Willemstad, Curacao in June 2018. Prior to working for the State of Michigan, Vishal worked for the New York State Department of Health as a Disease Intervention Specialist, working on a pilot HIV Molecular Clusters initiative. Vishal is particularly looking forward to moving the Michigan Department of Health and Human Services PrEP Detailing program forward into the realm of virtual “eDetailing.” Jerry Avorn, MD, Co-Director, NaRCAD Tags: COVID-19, Detailing Visits, E-Detailing, Jerry Avorn The pandemic has changed everything about our lives and our work. Some occupations have been able to adapt to the new abnormal, such as programmers and financial traders. Others have found it harder to do their jobs as before, like brain surgeons and academic detailers. For the latter, in a socially-distant, avoid-human-contact world, how can we pursue an activity that has as its very definition in-person, interactive communication? Academic detailing programs around the country and the world have been grappling with this challenge. And unlike our colleagues the brain surgeons, we have been able to come up with some plausible solutions, even if nothing is quite the same as being up close and personal. We’ve been learning about the virtues and limits of Zoom/Skype/WebEx. If we’re paying attention, using them can bring into sharp focus the central aspect of interactivity, on steroids. It’s a little like becoming a better runner by strapping weights on your ankles (or so my athletic friends tell me). A non-adept academic detailer can mis-use a Zoom encounter even worse than a face-to-face one: “Sit still for 20 minutes while I do this presentation at you.” That will fail on a platform even more calamitously than it does in person. (One clue is when the prescriber mutes their video to read their e-mail.) But if we’re open to it, the e-encounter can focus our attention even more on whether we’re learning where the clinician is coming from, getting feedback, actively asking what sub-topics they most want us to cover. The artificiality and forced intimacy of a screen-to-screen encounter, and the reason we currently have to do our work like this, can also focus us even more on another key aspect of academic detailing, empathy. “How are you holding up?” or “I bet COVID has really changed your practice” are opening statements that can address the 800-pound virus in the (virtual) room, acknowledging the obvious strangeness and discomfort that afflict so many conversations in these awful times. On a more concrete level, pandemic-style education is also forcing us to come up with new ways to use our educational materials. What to do when you can’t focus a practitioner’s attention on a particular graph or table you’re showing them because they’re dozens of miles away? Displaying a PDF of a document and whizzing around your cursor is one easy, but primitive solution. What about presenting a list of topics hot-linked to a detailed display for each? Or completely re-formatting our materials (stop moaning) for better adaptability to a computer screen? Those of us who also used to teach in classrooms have learned that with a little work (ok, a lot of work) coronaeducation can even be better than what we’ve been used to doing: using links to video clips or animations, real-time interactive polling, techniques that maybe we could have been using in the classroom, but weren’t. Another key advantage of academic e-Detailing, if we can figure out how to make it work well, is the prospect of having a virtual visit with a clinician without the sunk time of getting to their office – a major enhancement in working with practitioners who may be an hour’s drive or more from the educator’s base. The benefit for our field in productivity and cost-effectiveness could be considerable. Contrary to naïve beliefs that “Soon everyone will be protected by the vaccine and we can get back to normal,” this virus probably won’t let us return fully to the old ways any time soon. Instead, it will force us to mutate our work to cope with it. And in the process, not only will we be able to continue our work, we may even discover better ways of doing it. Be strong and stay safe. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Biography.
Jerry Avorn, MD, Co-Director, NaRCAD Dr. Avorn is Professor of Medicine at Harvard Medical School and Chief Emeritus of the Division of Pharmacoepidemiology and Pharmacoeconomics (DoPE) at Brigham & Women's Hospital. A general internist, geriatrician, and drug epidemiologist, he pioneered the concept of academic detailing and is recognized internationally as a leading expert on this topic and on optimal medication use, particularly in the elderly. Read More. Evidence into Value and Action: Reflections on 30 Years of AD in South Australia (Part Two)10/5/2020
An interview with Debra Rowett, BPharm, Adv Prac Pharm, FPS, the Director of the Drug and Therapeutics Information Service (DATIS) in Adelaide, Australia. Debra joins Winnie Ho, NaRCAD Program Coordinator in a two-part conversation about a 30-year career of pioneering academic detailing in Australia and reflects on the past, the present, and the future of the field. In Part Two, we discuss the evolution of academic detailing as the world of healthcare changes. You can read Part One here. Tags: Detailing Visits, Evidence-Based Medicine, International, Medications, Program Management Winnie: You wear so many hats when it comes to AD. How have those roles changed over your time with DATIS? Debra: Before I was Director of DATIS, my role was primarily around developing our detailing materials, and evaluating the evidence and our program. I was always interested in the synthesis of evidence and turning that into value for clinicians. I was a clinical pharmacist who was working with people across many disciplines, and there was a growing body of evidence, but translating that into practice was always a challenge. W: I think you touch on a fundamental aspect of AD – that we turn evidence into value, and that we translate all this research into action. It’s very critical that AD continues to provide that independent, trusted, unbiased source of information to ensure evidence is disseminated responsibly and utilized properly. D: I would agree with that, very much. We live in an information-dense era and much of the information is synthesized and aggregated at the population-level, but clinicians are responsible for decisions at the individual patient level. I think AD is about bringing evidence to the point at which clinical decision making is made. W: I’m curious about your experience with evaluating evidence for AD materials. It’s clearly a difficult, but super important aspect of AD. You have all these clinicians who are trying their best to make the best possible decision for their patient – and AD comes in, and in many ways, helps share in that responsibility. D: Evaluating evidence is also about recognizing what we don’t know in the evidence. When reviewing the evidence for an AD program, we look for where there are gaps in the evidence, where there’s controversies, and differences in opinion about the evidence. No matter how well done, you make choices along that entire process about what to include, what to exclude – and even with the synthesized evidence, there is still human judgement about how to use it. W: Right, and that human judgement also needs to focus on how that evidence came to be and how it was produced. D: Absolutely. As we know evidence-based medicine is not just about the randomized controlled trials and published evidence, it’s about the intersection of published evidence, clinical judgement, and the patient’s specific needs, goals, and circumstances. The real opportunity for AD is that you can personalize this information for the provider to work with. W: It’s extraordinarily rewarding work, and it’s a constant process in grappling with the things we don’t know. As someone who has been in this work for a long time and has had to adapt a long-standing AD program to changing guidelines and medical evidence, you’ve likely seen some big shifts in the medical consensus. Take opioids for example – the consensus around the safety of its use has had a dramatic change over the years. How have you adapted when the evidence base can sometimes change quickly within a few years? D: It’s important that we come to providers with a balanced view, and that we acknowledge with them that there is uncertainty, that there is complexity, and that it isn’t easy to make these decisions with their patients. There’s a lot of things that we don’t know. If you come with too much certainty, you lose credibility because translating evidence into routine clinical practice is complex. Every time a medicine is prescribed for and used by a patient, we’re forecasting how the future will proceed - the exact benefits and harms that a patient will experience are uncertain. People are living longer and with multimorbidity which presents new medical challenges. We’re seeing more people living with issues like musculoskeletal problems, hypertension, diabetes, renal problems, atrial fibrillation, and surviving their myocardial infarctions. The number of medications that patients take now compared to 30 years ago have increased. There are individual guidelines for each condition, that don’t necessarily take the other comorbidities into account. The drugs used to treat one issue may lead to treatment conflicts for another condition and needs to be taken into consideration. It’s not just in one area of practice that has changed too, or just our demographics – we’re seeing fewer solo General Practitioners and more team-based practice in Australia. AD needs to take all of that into account when considering how to detail, and also who to detail. W: Can you explain what you mean by “who to detail”? D: It’s important to understand who the decision-maker is and what the decision you’re trying to address is – for some of our AD programs it might involve other health professionals; it’s not always the doctor. W: Right, and this whole of office approach looks at all the players involved in the continuum of care, and acknowledges that they may play a role in how clinical decisions are ultimately made. D: Yes, and I think this is why AD is even more important now than it was when we first started. It allows us to bridge individual condition silos, and helps providers navigate multimorbidity. Healthcare is never a one-size fits all, even for an individual. Their circumstances and treatment goals can change over the course of their lives. AD can personalize the information and tailor it to the needs of the clinician. AD can also be the conduit between population level evidence and its translation into clinical decision making - that is one of its greatest strengths. W: NaRCAD has been lucky to see overarching growth of AD programs everywhere, along with all of its exciting new innovations and evolutions. Any final thoughts on AD before we hear from you at our upcoming conference? D: One of the things I try and impart when teaching the method of AD is to value the knowledge of the person you are detailing. There is a lot of listening that occurs in successful AD if you are truly to meet the needs of the provider you are visiting. If you keep at the very heart of what you do, respect for learning together and hold true to the principles of academic detailing, you will meet incredible people everywhere you go. It makes for a wonderful career. (Part Two of Two) Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Debra Rowett, BPharm, Adv Prac Pharm, FPS, has led an academic detailing team for over 20 years and is a member of the team which designed, developed and delivered the “Best Practice in Educational Visiting” training for academic detailers in Australia. Debra has worked closely with NPS Medicinewise since their inception and has provided consultancies to other national and international academic detailing programmes. Debra is an experienced academic detailer with expertise in designing, developing, training, implementing and evaluating academic detailing programmes. Debra has served as the President of the Australian Pharmacy Council and is currently the Vice President of the Council of Pharmacy Schools. Debra has worked extensively in the area of quality use of medicines, inter-professional practice, policy and health workforce development in Australia. Debra is a member of the national Drug Utilisation Sub-Committee of the Australian Pharmaceutical Benefits Advisory Committee (PBAC). An interview with Debra Rowett, BPharm, Adv Prac Pharm, FPS, the Director of the Drug and Therapeutics Information Service (DATIS) in Adelaide, Australia. Debra joins Winnie Ho, NaRCAD Program Coordinator in a two-part conversation about a 30-year career of pioneering academic detailing in Australia and reflects on the past, the present, and the future of the field. In Part One, we introduce you to DATIS and academic detailing in the Australian context. Stay tuned for Part Two! Tags: Data, Evidence-Based Medicine, International, Program Management Winnie: We’re so glad to have a chance to chat with you about your long career in AD, Debra! Debra: This is a great part of the job, talking to other people in the AD community. It really is a great privilege to be working with academic detailing organizations in different countries. I’ve loved getting to meet and learn from so many different people. W: I would agree! I’m sure you have some great stories of what it’s like to work internationally in this field. D: One of the things that it has really highlighted is the nuance of language. At a training workshop in the U.S early in my career, I was saying how we would meet with doctors in their "surgery", and how important it was to meet them in their surgeries close to where they make decisions. The workshop participants really politely said to me, but isn’t surgery a really bad time to detail? Oh! Surgery – I meant their office. W: We really would have quite a different communication model if we had detailers visiting providers mid-surgical operation! This does gives us a good starting point into discussing how Australian AD is unique. Besides the context of the word "surgery", what else would our non-Australian colleagues need to know about Australia to understand the context of what you do with the Drug and Therapeutics Information Service (DATIS)? D: I have been involved with DATIS since its formation in 1991. I was a clinical pharmacist at the Repatriation General Hospital, a teaching hospital, when Jerry Avorn’s paper was published. His work on how AD could influence clinical decision making really resonated with us in Adelaide. One of the big things to know about Australia is that we have a National Medicines Policy, which aims to improve positive health outcomes for all Australians through access to and quality use of medicines. DATIS was one of the first programs funded through the Quality Use of Medicines initiative, and in 1998 NPS MedicineWise (formerly the National Prescribing Service) was funded. W: Australia is enormous - it must be a challenge to cover. What is the geographical coverage of your AD program? D: South Australia has a population of about 1.4 million people and a vast geographic reach – the furthest of my AD visits is about 800km (500 miles) away from where we are! We work to provide AD to over 85% of all family physicians in South Australia, so about 1,300 General Practitioners (GPs) each year. We provide AD services to aged care, primary care and hospital providers. We also work in partnership with NPS MedicineWise who have implemented AD at the national level. W: That’s certainly an enormous coverage zone, especially for those core 12 people! How has this work manifested in South Australia? D: At the heart of our program is service, and we build our program to emphasize that. There are three aspects of DATIS: service delivery of detailing visits, training of detailers, and research. We have a core team of 12 people who carry this work out alongside our colleagues who join us for various projects. Because of our multiple different contracts, the clinicians we provide services to can see us for multiple reasons in a year. Between visits, providers will ring us with clinical questions about therapeutic issues that have arisen in their practice. We have also developed interprofessional communication training to support interprofessional practice with a focus on pharmacists and physicians. Our AD programs usually seek to address a therapeutic area or clinical issue however a recent AD program we developed with our hospital pharmacy colleagues was to support pharmacist preceptors implement a performance outcome framework based on entrustable professional activities for interns and undergraduate pharmacy students. W: It's incredible that DATIS has such a focus on this three-pronged approach, because it continues to help push our understanding of best practices in AD through implementation, study, and training others to carry on the work. Can you tell us a little more about the foundation that DATIS is built upon? D: Behavior change theory and implementation science has informed our work from the outset in 1991, including the development of the training program which was designed in collaboration with psychologists and experienced GP medical educators. Social marketing frameworks, an adult learning approach, the concept of cognitive biases, clinical reasoning all recognize the many interacting and complex influences on behavior. We try to learn from these and apply to the design and implementation of AD. We also use pharmacopidemiology methods to understand evidence to practice gaps and for evaluation. As AD evolves and changes, something I really emphasize is staying true to the principles of AD – this is a rigorous process. W: We’re seeing innovations all over the world and across so many clinical topics. Are there any unique innovations that you feel differentiates Australia AD from other AD programs? D: One innovation that we're exploring is applying the principles of AD to patient behavior change interventions. As part of person-centered care, it is important for patients to understand their medicines, and to be involved and empowered in shared decision making. We haven’t called this work AD, but have applied the principles of AD in this research. Complex clinical decisions need to be made each and every day by providers, and it's a privilege to be able to bring providers the best available evidence through academic detailing services, part of the power of AD is the adaptability and personalization to providers along the continuum of care. We are seeing the world of healthcare change, and we have so much to learn as it does. (Part One of Two) Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Debra Rowett,BPharm, Adv Prac Pharm, FPS, has led an academic detailing team for over 20 years and is a member of the team which designed, developed and delivered the “Best Practice in Educational Visiting” training for academic detailers in Australia. Debra has worked closely with NPS Medicinewise since their inception and has provided consultancies to other national and international academic detailing programmes. Debra is an experienced academic detailer with expertise in designing, developing, training, implementing and evaluating academic detailing programmes. Debra has served as the President of the Australian Pharmacy Council and is currently the Vice President of the Council of Pharmacy Schools. Debra has worked extensively in the area of quality use of medicines, inter-professional practice, policy and health workforce development in Australia. Debra is a member of the national Drug Utilisation Sub-Committee of the Australian Pharmaceutical Benefits Advisory Committee (PBAC). An interview with Julie Anne Bell, MPH, Program Manager of Clinical Operations, Bureau of HIV, New York City Department of Health and Mental Hygiene. The mission of the Clinical Operations and Technical Assistance Program (COTA) is to provide innovative, culturally responsive, needs-based technical assistance and training to organizations and individuals working with people impacted by HIV. by Anna Morgan, RN, BSN, MPH, NaRCAD Program Manager Tags: Detailing Visits, E-Detailing, HIV/AIDS, Materials Development Anna: Thanks for joining us today, Julie Anne! Can you tell us about yourself and what brought you to your role as Program Manager of Clinical Operations at the New York City Department of Health and Mental Hygiene? Julie Anne: My first position out of graduate school was as a research assistant in the HIV program at the State University of New York. I’ve moved through a lot of sexual health work and have been with the Bureau of HIV at the New York City Department of Health and Mental Hygiene for three years. I love the programmatic work that I do in my current role. I deliver training, tailored technical assistance and public health detailing to clinical and non-clinical providers who care for people with HIV. Being a content expert and bringing the information directly to the clinics to support them is rewarding and, most of all, fun. Anna: It sounds like your career path has led you to a wonderful position! What detailing topic is your program currently working on? Julie Anne: We’ve been focused on developing a public health e-Detailing campaign to support and strengthen providers’ initiation of immediate antiretroviral treatment, or “iART”. iART is for people newly diagnosed with HIV or returning to care after a long lapse. It recently became a standard of care in New York. Immediate initiation of ART is associated with several health benefits for people with HIV, including a significant decrease in the time to viral suppression, which ultimately, reduces the risk of disease progression, morbidity, and mortality for people with HIV as well as onward transmission and new HIV diagnoses. Prescribing ART immediately versus waiting for the patient to return after all lab work/genotype results come back can feel like a paradigm shift for providers, but HIV medications have advanced so much in terms of their high threshold to resistance and there is no longer a need to wait. Anna: Your team recently completed a campaign on strengthening the integrated care approach, which is a team-based approach where mental health care and medical care is offered to patients in the same setting. How did your previous campaign help shape your new iART campaign? Julie Anne: During our previous campaign, we brought providers an array of materials and resources to help them meet New York City’s Ending the Epidemic benchmark. We included HIV-specific materials and resources, as well as additional tools to address substance use, housing, and mental health in order to strengthen their integrated care approach. Among those HIV-specific materials and resources was information about iART. During our detailing sessions, providers were consistently reporting the same barriers to implementing iART in their clinics. Barriers that were reported were lack of clinic workflow for iART, not knowing how to get the medications covered/paid for immediately, and feeling uncomfortable prescribing ART before receiving a lab based confirmatory HIV test and genotype testing result. We began to realize that the providers needed more support around this topic. Because our work is heavily data driven, we used the feedback we received from providers on the barriers they were experiencing around implementing iART to create our iART campaign and associated public health detailing action kit. The tools and resources in our detailing action kit highlight each component of iART, including HIV testing, payment options, genotype testing, and example clinic workflow. In the past, our program developed the public health detailing action kits and would hire consultants to do the detailing. For these campaigns, my colleague and I wanted to deliver the messages to the clinics ourselves and focus on relationship building. Anna: Having strong detailer-clinician relationships is an integral piece of a successful academic detailing program. How have you been able to build strong relationships with clinicians? Julie Anne: We visited over 100 clinics that provide HIV services in New York City during our last detailing campaign, and we now have friendly relationships with these providers because of the trusting relationships we’ve built with them through our previous detailing work. Our team also attends regional group meetings for HIV providers to bring more awareness to our work and continue to build relationships and connections. We recently hosted a virtual launch event for our iART campaign and we had over 200 providers register. We provided an overview of COTA, our services, and e-Detailing. We wanted the providers to know exactly how we’ve pivoted during COVID-19, why this work is still important, and that we would reach out to them in the coming weeks for an e-Detailing visit. Being with the health department, we know where people are getting their care for HIV in New York City. We’d love to reach everyone who’s working with people who are impacted by HIV, including non-clinical providers. Since iART is an integrated care approach, both clinical and non-clinical providers are an integral part of the process. The first steps in the iART process begin with a positive HIV test which can happen in a non-clinical setting, such as a community-based organization. The next steps include looping in a medical provider with the addition of non-clinical support, such as benefit navigation, social work, and peer navigation. It can take multiple providers of different training and expertise to work together to achieve iART seamlessly. Anna: Wow! You’re certainly connected to a lot of clinics and it doesn’t sound like you’ll have issues recruiting clinical or non-clinical providers for your upcoming e-Detailing visits. How has your team prepared for e-Detailing? Julie Anne: When the reality of the pandemic hit, the idea of transitioning our detailing program to a virtual platform was overwhelming. We did a deep dive into the existing literature to see how programs have done virtual detailing in the past. NaRCAD has also been an amazing resource to learn from and we continually check the website for new resources on e-Detailing. We then developed a Standard Operating Procedure (SOP) for our iART e-Detailing campaign. We worked as a team to create a step-by-step guidebook that includes our key messages, how to do a needs assessment, and how to address barriers that we expect might come up. We’re currently working on doing mock e-Detailing sessions with our colleagues and with providers who are iART champions in New York City. Our SOP will help guide us during these mock sessions and help prepare us for our field visits this fall. Anna: Creating a Standard Operating Procedure is a great idea and will be extremely beneficial to prepare for field visits. What are some challenges that you expect to face when you begin your e-Detailing work? Julie Anne: We’re expecting the usual technical problems like poor internet connection and access issues, but we’re working on strategies to overcome this. We also expect that providers will be experiencing burn out, so they may be hesitant to make some of the changes in their clinic to implement iART, such as establishing a new clinic workflow. However, the resources we’ve selected and created for our iART detailing action kit are a direct result of what providers reported that they needed during our last detailing campaign. We’re hopeful that the tools we’re providing will enable an easy transition for providers to adopt our key messages related to iART. Anna: It’s remarkable that you’ve been able to create your e-Detailing campaign based on the specific needs of the providers in your community. How else is your team working towards sustainability? Julie Anne: iART is a sustainable practice because once providers understand the “why” and “how” to do it and the steps involved, there is no reason to go back to waiting to initiate a patient with HIV on ART. It’s important that people with HIV are given the opportunity to start ART immediately because it provides individual and public health benefits. iART is the new standard of care in New York, which encourages providers’ commitment to the practice, and the iART detailing kit will introduce tools and resources to increase the knowledge and confidence of providers to prescribe ART immediately. Additionally, COTA offers ongoing technical assistance at the request of the providers and full-day trainings on iART for new providers. We’re currently focused on our iART e-Detailing project, but it’s always an open-door relationship with providers. Right now, it’s iART, but providers can reach out to us about anything they’re struggling with and we’ll work with them to overcome the challenges they’re facing. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Biography. Julie Anne began working at the NYC Health Department in 2016 with the Bureau of Sexually Transmitted Infections in a research role. She transferred to the Bureau of HIV in 2017 where she focused on health policy work, and was promoted to her current role with the Clinical Operations team. She now manages the team that focuses on providing data-driven technical assistance to clinical and non-clinical HIV providers across New York City on HIV specific and supportive topics that address social determinants of health for people with HIV. Julie Anne is currently preparing to conduct e-detailing visits with NYC providers to support and strengthen practices for initiation of immediate antiretroviral treatment (iART) for people with HIV. An interview with Tara Hensle, a research coordinator with the University of Illinois - Chicago, School of Pharmacy (UIC) and Illinois ADVANCE (Academic Detailing Visits And New Evidence CEnter). by Winnie Ho, Program Coordinator Tags: COVID-19, E-Detailing, Opioid Safety, Program Management, Substance Use Winnie: Hi Tara! It’s been a crazy year so far, hasn’t it? We want to check in with you and the University of Illinois, Chicago (UIC) team about your experiences in navigating the pandemic. Can you tell us a little more about yourself and your role in the ADVANCE academic detailing team? Tara: I was hired about 7 months ago as the research coordinator, and it’s been one heck of a 7-month run. The majority of my work is focused on implementation, so I do all the scheduling and outreach to hospitals to talk to providers. I develop and establish relationships with office managers and providers, and I assign detailers to visits. W: Our team at NaRCAD has been lucky to have worked with the UIC and ADVANCE team for a while through our trainings and your presentations at our conferences and our webinar series, and we’re excited about the research intervention that had been planned. Can you tell us a little bit more about the mission? T: Our intervention is a CDC-sponsored, three pronged approach that’s built off a pilot program that we started in 2018 for Chicago-land providers. We have a team of about 30 detailers who are now trying to cover as much of the state as possible. We wanted to follow-up with providers to get a sense of whether or not the ‘dosage’ of AD made a difference, but we also wanted to expand the providers we worked with, and to introduce updated topics like the new features of the Illinois PMP or opioid alternatives. The third prong is creating a toolkit to give programs a blueprint and resources of what was effective for us. We would love to make the “how to” of AD more accessible to other groups. W: Compared to other programs, you have quite a large and robust team at UIC. It must have been difficult for the pandemic to hit right in the middle getting your program launched. T: It really impacted our recruitment as we had called providers from the end of January through early March 2020. There are a lot of things going on right now. Even a small ask, such as 15 minutes of their day, can feel like a big ask for providers. W: Right, and interventions are very carefully laid out and planned ahead of time. COVID-19 has disrupted everything – especially those on the frontlines who are both detailing and being detailed. Can you tell us a little bit more about how else the impact on your original plans for the intervention? T: We had been so focused on ramping up that by the time we hit mid-March, we had many people on deck reaching out to providers. We started hearing “No, we can’t do this right now” or “this is a really bad time” often. Once the stay-at-home order came through, we stopped contacting offices for about 2 months. We had to sort out so many protocols and even our IRB to make amends for virtual visits. What we’ve found since we’ve resumed virtual visits in May is that there’s a lot of variability – some offices have capacity because they aren’t seeing many patients, while others have providers that have been transferred to hospitals and have no idea when they’ll be available. We’re also talking about layoffs and burn-out and low morale. W: There are many of considerations on how best to proceed safely right now. One is looking at the impact on the critical work you’ve done on opioid safety. Unfortunately, the pandemic has only exacerbated the overdose epidemic. What progress has been made on your opioid initiative? T: One of the ways our team has shifted has been moving to virtual visits. We knew that these would have its own difficulties, such as concerns about “no-shows”. But our team is relatively tech-savvy, and now my job is making sure they’re all familiar with how to troubleshoot the technological pieces of virtual visits. There are a lot of tech issues that can interrupt a visit. So we do mock detailing and have the detailers practice with each other, where we introduce certain needs and obstacles, maybe even a tech problem for instance, we role play a provider not turning on the webcam, or not being able to see your screen. Practice to strengthen adaptability and resilience become important in ensuring the detailers are prepared. W: There’s definitely no time like right now to test detailing skill and ability to think on your feet! As a research coordinator, what do you think you’ve learned in the past few months? T: How to be flexible! There are all sorts of external pressures right now to keep our project on track, but the most important part is keeping the human aspect in check. Having some insight and empathy for providers is important to understand what they’re going through. We can get bogged down into the guide posts, the bench posts, or the numbers – but this era reminds us that it’s all about empathy. W: At the end of the day, we want better for our patients, for our communities, and for health outcomes everywhere, right? T: Absolutely! Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Tara Hensle is a research project coordinator at the University of Illinois – Chicago for a CDC-funded research study investigating the effectiveness of academic detailing for opioid prescribing. She received her Bachelor of Science in Behavioral Science and Speech Pathology at Purdue University, and has worked in a variety of healthcare research settings before coming to UIC. Since working on this project, she is inspired by academic detailing’s simplicity, versatility, and the variety of topics to which it could be applied. An interview with Kelsey Bolton, Continuing Professional Development Consultant, Gundersen Health System by Anna Morgan, RN, BSN, MPH, NaRCAD Program Manager Tags: Detailing Visits, COVID-19, CME, E-Detailing, Smoking Cessation, Substance Use Anna: Hi, Kelsey! Thanks for taking the time to chat with us today. Can you tell us a bit about your academic detailing program in Wisconsin and your role? Kelsey: I’m a Continuing Professional Development Consultant in the Continuing Medical Education (CME) Department at Gundersen Health System. Gundersen Health System is a teaching hospital with a multitude of specialties that serves patients in Wisconsin, Minnesota, and Iowa. As part of my CME work, academic detailing stood out as an effective tool to disseminate our information and meet our clinicians’ educational needs. We started our detailing program last fall and have been focused on tobacco cessation. The detailing intervention is a spinoff of a performance improvement project we are working on for diabetes. I’m currently a one-woman show; I’m the program coordinator and the sole detailer. I detail physicians, NPs and PAs across the health system. Anna: Wow, it’s incredible that you’ve been able to build your detailing program from the ground up! Can you tell us what that’s been like? Kelsey: Academic detailing was a new concept to me prior to being introduced to it by my former manager, who sent me to the NaRCAD training in May 2019. Academic detailing is not a well-known concept in our hospital system. It was difficult to get past the gatekeepers and “enlighten” them about academic detailing. There are still misconceptions when I walk into a room for a meeting with a clinician – they often think that I’m a drug sales rep, that I’m an internal quality control person, or that I’m there for punitive reasons. I must quickly refute that and explain that I’m there to support and unburden them, not to make judgments about their work. Anna: Those misconceptions are quite common when starting a new academic detailing program. How are you able to “enlighten” the gatekeepers? Kelsey: It was bumpy at first and we tried a few different approaches, but I think we’ve finally been able to smooth it out. I have an advantage because I’m internal and I’m contacting clinicians from an internal email or phone number. I’ve also had our medical program coordinator, the doctor who is partnering with me to learn the clinical information, send out emails to gatekeepers prior to my detailing visits. Anna: Stakeholder buy-in is imperative when building a new detailing program. Kelsey: Absolutely. Building relationships with key stakeholders has made all the difference. The medical program coordinator I work with, as well as other experts in the organization, helped me curate my detailing aid and key messages. I practiced my detailing sessions with these stakeholders before going out in the field. It was an easy way to build relationships and get them on board – it only took a 15-minute practice detailing session! I’m also fortunate enough to have support from senior leadership. They’ve been able to open doors by letting people throughout the organization know that they support the academic detailing work I’m doing. Anna: It sounds like both managing your academic detailing program and being in the field has helped you be successful in getting your program off the ground. What has it been like to grow and manage your AD program? Kelsey: It’s like herding cats! The detailing program is 25% of my workload, so completing all the administrative work plus the detailing visits is quite a commitment. By the end of this year, I will have detailed over 200 clinicians. “Marathon detailing” has put me in a groove. It has definitely been challenging, but I appreciate that I know the ins and outs of it now – both the administrative tasks and the field work. I feel prepared to help train others. I plan to start training one of my colleagues to become a detailer in the fall. Anna: When thinking about team expansion, it’s also important to think about the impact of COVID-19. How has COVID-19 impacted your program? Kelsey: We paused our detailing visits for about 3 months, and by the time we started talking about bringing them back, NaRCAD was putting out a lot of information about e-Detailing. Before COVID, I had barely done anything with video calling, but getting thrown into working from home, we jumped into a lot of video calls. I learned how to work virtually on the fly, which made it easier to adapt to e-Detailing. I did a few practice e-Detailing sessions with my colleagues and I’ve now successfully completed several visits virtually. The NaRCAD webinars were a lifesaver. We plan to continue e-Detailing until it’s safe to return to in-person visits. Anna: A lot of academic detailing programs had to adapt quickly to e-Detailing during the pandemic. What does the future look like for your program? Kelsey: For the more near future, we are working on collecting data for the tobacco cessation campaign to eventually publish research on the efficacy of the academic detailing intervention. We’re going to pull patient data from the EMR, as well as look at the qualitative data from the evaluation surveys. This research will help inform our organization on the benefits of academic detailing as an educational intervention. We would also like to continue the program with other strategic initiatives like substance use disorder, social determinants of health, and cancer screening. I have a soft spot for topics similar to tobacco cessation that are sometimes discouraging to clinicians because they don’t feel like they can make a difference. I know that through detailing, I’m able to give them a fresh take on these topics, and reinvigorate them in providing the best care for their patients. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Biography. Kelsey Bolton is a Continuing Professional Development Consultant in the CME department at Gundersen Health System in La Crosse, WI and the program lead for its Academic Detailing program. She received her Bachelor of Arts degree in Communication Studies in 2015, Healthcare CPD Certificate in 2019, and is currently pursuing her Master’s in Organizational Leadership. She has completed over 100 detailing visits and is presently conducting a research project on the efficacy of tobacco cessation academic detailing. An interview with Marlys LeBras, PharmD, a clinical pharmacist with RxFiles Academic Detailing Program. by Winnie Ho, Program Coordinator Tags: COVID-19, E-Detailing, International, Program Management Winnie: Thank you for speaking with us today Marlys! Can you tell us a little bit about your work with the RxFiles Academic Detailing team? Marlys: Absolutely! I’ve been with RxFiles for just over 4 years as an Information Support Pharmacist doing both frontline academic detailing as well as co-leading various academic detailing training sessions, with the most recent being this past April. Our program covers Saskatchewan, Canada, but our website, app, and book are used outside of the province and Canada as well. W: RxFiles is definitely one of the larger and more established programs we’ve had the honor of partnering with through the years. Can you tell me how maintaining the daily operations of your program have been impacted by COVID-19? M: One of the bigger things that’s changed for our team has been moving our academic detailing training sessions online for our team of 12 detailers. We had to shorten our two-day in-person training, and shifted to hosting shorter sessions and offering more pre-training day and post-training day webinars to cover all of the content, including “how-to virtually detail”. W: No matter how well virtual substitutions are planned, it’s not the same as being together. We’re all really missing our colleagues, and it’s heightening a sense of isolation. How do you think your team has adjusted to moving the training online? M: I think our team adjusted quite well to the training adaptations. We were able to give them enough notice about the shift. What came out from training days is that our team members really do miss being in-person and having that social interaction – even the chit-chat in between sessions. For in-person trainings, we typically have time for a team-building activity in the evening where people catch up. We’ve been trying to incorporate more games and fun into our virtual training to have that social aspect. Personally, I really miss debriefing with colleagues in-person after detailing visits. W: It seems like keeping the team connected is a big part of your team culture. How has your team stayed connected through the pandemic? M: We typically do a roundtable at the mid-point of a detailing topic. We typically go around and share a little bit about our detailing experiences. Pre-COVID, no one wanted to turn on their cameras. It was never a requirement, but now everyone is turning them on. It’s been really nice just seeing people’s faces. Also, one of the things that’s been nice about going virtual is that we are able to open up staff meetings and invite more detailers to participate with us. We would have never been able to do that as easily in person. W: We’ve seen opportunities like these spring up as teams need to be particularly innovative under tough circumstances that prevent in-person connection. Speaking of teams, dream teams don’t come out of nowhere. A lot of work goes into creating and maintaining a strong, positive, and connected team. At NaRCAD, we talk a lot about what makes a good detailer, but what are some of the hallmarks of a strong detailing team? M: Team work is a really interesting thing to dive into. I reflected on this question, and think that a strong detailing team supports one another. That support can be helping each other out in the detailing session itself (e.g. co-detailing), or through communicating with each other about the providers we serve and in between detailing sessions (e.g. a prescriber moved from one detailing area to another). We want the team to be successful in moving towards our goals together. Another thing that COVID brought to my attention is that a strong detailing team also has a positive attitude. I really feel that during our transitions, everyone has been really positive and embraced the changes. W: You’ve shared a lot of examples of how your team regularly communicates at various points during a detailing campaign, which shows a culture of checking in and making sure no detailer is left out. Can you speak a little about how that culture’s been built up at RxFiles and how you maintain it? M: I think Loren Regier, who is in charge of Projects, Transitions and Training, has been such an asset in the development of our program, has really emphasized checking in. He really showed us the value of that, and not only does he talk about it, he has made it very easy for someone to approach him and talk about how the detail went, both the successes and challenges. W: Having access to mentorship, and making sure a team-based approach is emphasized by leadership is key. It’s clear that the RxFiles team is doing well in adapting to these challenges faced by so many detailing teams. Maintaining positivity and seeing challenges as opportunities for growth is something that’s critical for teams to continue to have an impact. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Biography. Marlys LeBras is a clinical pharmacist with the RxFiles Academic Detailing Program at the University of Saskatchewan. She completed her Bachelor of Science in Pharmacy at the University of Saskatchewan, her Hospital Residency with the former Regina Qu’appelle Health Region, and her post-graduate Doctor of Pharmacy (PharmD) degree at the University of British Columbia. An interview with Mary Liz Doyle Tadduni, PhD, MBA, MSN, RN, Education Consultant, Independent Drug Information Service and Expert Training Consultant, National Resource Center for Academic Detailing by Anna Morgan, RN, BSN, MPH, NaRCAD Program Manager Tags: Detailing Visits, E-Detailing, COVID-19 Anna: Hi, Mary Liz! We’re excited to learn more about what the pivot to e-Detailing has been like for you as an expert academic detailer for over 16 years and a NaRCAD training facilitator. Can you tell us briefly how your role as an academic detailer at Alosa Health has changed since the COVID-19 pandemic began? Mary Liz: The restrictions on in-person meetings has resulted in all of my detailing visits switching over to phone or video calls. The number of providers I’ve been detailing has also considerably decreased due to time constraints and office restrictions related to COVID-19. In terms of the topics I’ve been detailing on, our team has been maintaining focus on delivering our planned modules, but I do discuss the impact of COVID-19 quite a bit with providers. Our current topic for Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly (PACE) is dementia, which is important as it relates to COVID-19. Patients with dementia who reside in nursing care facilities in Pennsylvania can’t see their loved ones due to restrictive visiting policies. Primary care providers are dealing with the challenges and consequences of this every day – and academic detailers can’t ignore it. Anna: It’s crucial that detailers understand the ways COVID-19 impacts the work of frontline care providers. Mary Liz: Absolutely. With COVID, healthcare delivery has changed dramatically and there’s been a large increase in telehealth visits. Many providers in Pennsylvania are working from home and not going into the office or seeing only a limited number of patients in the office setting. Even if they are seeing patients in person, the process of seeing a patient has changed. The offices sometimes have front desk staff working from home and require patients to wait in their cars before entering the building. Primary care providers are still trying to adjust to all of this. You need to consider what is really happening on the ground for providers during your detailing visits – it’s part of your needs assessment. The needs of the primary care provider right now differ greatly from the pre-COVID era. Anna: Assessing a clinician’s individual needs is an integral piece of a traditional academic detailing visit. How have you been able to implement AD in its intended form when detailing virtually? Mary Liz: The original model of academic detailing with Dr. Jerry Avorn has always been 1:1, face-to-face encounters, but that doesn’t mean you can’t have a productive visit virtually. It’s just another venue to deliver the evidence. I really do believe that it’s better to be in person, but delivering the evidence, no matter what the platform, is better than having a provider not know what they need to deliver the best care. Anna: You’ve carried out this traditional, in-person model for over 16 years – what challenges have you faced when detailing providers virtually, especially during the pandemic? Mary Liz: Time has been a barrier due to the overall stress on the healthcare system. There are also more distractions when visits are done virtually because providers are taken out of a controlled office setting. A provider could be home with their kids, or even driving in a car during a visit. You never know where a provider will be during a virtual detailing visit. Some offices in my area also aren’t picking up their phones, so you can’t have conversations on the phone or "stop in" for a cold call. Having a scheduled in-person visit with a provider is much easier than trying to connect with a provider over Zoom. You add another step to your process when you have to work through technology glitches. Virtual platforms or telephone calls can also be difficult for providers who are visual learners. You need to be creative with the way you share materials. But there are many similarities to in-person visits; no visit is “one-size-fits-all”. You need to consider the provider, their situation, and their environment and decide what will be the best way to deliver the evidence. Anna: You’re right! It’s never one-size-fits-all when it comes to academic detailing. This has become even more evident as programs around the world have pivoted to e-Detailing. Do you believe that virtual visits can be as effective as traditional, in-person visits? Mary Liz: I do. It may not be as personal as an environment, but if you have a relationship with the provider, it shouldn’t matter whether it’s in person or virtual. I would continue to detail virtually in the future if a provider requested it, but I do favor in-person visits – it’s what I’ve done for so many years and I’d rather see the providers face-to-face. You get even more out of a detailing visit when you have that interaction. Anna: There’s certainly something to be said about the impact of the original model’s focus on in-person, 1:1 interactivity; it’s what has been studied for many years as effective and impactful. In a time where being flexible is critical, what are some tips you would offer to detailers during this time? Mary Liz: It’s crucial that you’re attentive to the provider you’re detailing. Continue to focus on the needs assessment. While you need to communicate your key messages, if you aren’t doing a proper needs assessment, you aren’t operating under the guidelines of academic detailing, which is all about listening and being interested in how someone is practicing. This leads you to be able to provide the evidence in the most effective way. Also, remember to be patient with providers! They’re still adjusting to this new world and they may even have questions about the impact of COVID-19 on the future of healthcare, as well as on their place within the healthcare system. Mitigate that impact by offering providers community resources that will support them through the pandemic – if you do that, then you’re fully realizing the true purpose of academic detailing as a supportive service that’s customized to real-world challenges. Biography. Dr. Mary Liz Doyle Tadduni’s background has included critical care and medical-surgical nursing, nursing administration, and hospital administration in major university teaching hospitals in the city of Philadelphia. Dr. Doyle Tadduni is a training facilitator at NaRCAD, and an academic detailer with the Independent Drug Information Service of the Alosa Foundation. Dr. Doyle Tadduni is a BSN graduate of DeSales University. She completed her MSN, with a concentration in Nursing Administration, from Widener University. Dr. Doyle Tadduni was awarded the MBA degree, with a concentration in Healthcare Management Services Administration, from Widener University where she was the recipient of the Healthcare Management Services Administration’s Student Excellence Award. Following her graduate work in both nursing and business, Dr. Doyle Tadduni completed her administrative residency at the Hospital of the University of Pennsylvania in Philadelphia. She completed her Ph.D. in Nursing from Widener University. Dr. Doyle Tadduni presented her doctoral research, “Terrorism Preparedness: Perceptions of Connectivity of Emergency Nurses of the Emergency Nurses Association,” at the 10th Annual Interdisciplinary Research Conference in Dublin, Ireland. |
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