Host: Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

A conversation with Alexandria Stevenson, MPH, Academic Detailer, Florida Department of Health in Broward County.

​Tag: Podcast Series, Harm Reduction, ​Opioid Safety

​How can meaningful conversations impact the opioid crisis?

Academic Detailer Alexandria Stevenson from the Florida Department of Health in Broward County discusses her team’s important work on opioid safety and overdose prevention. Funded by the CDC's Overdose Data to Action Local Grant, Alexandria shares how her team collaborates with clinicians and community partners to promote harm reduction, distribute free naloxone kits, and educate the community.​

​(Click here here for the audio transcription.) 

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​Alexandria M. Stevenson serves as the Lead Academic Detailer and Health Educator for the Overdose Data to Action (OD2A) LOCAL grant at the Florida Department of Health in Broward County. Since joining the Department in 2015, she has worked in various programs, including the AIDS Drug Assistance Program (ADAP) and Women, Infants, and Children (WIC), in Broward and Brevard counties. She also has interned at Office of Health Promotion and Education in Seminole County. Alexandria has been with Broward County’s OD2A-L initiative since 2020, where she has excelled as an academic detailer for the past two years. She holds a bachelor’s degree in anthropology from the University of South Florida and a master’s degree in public health from Rollins College.

It's no exaggeration to say that our annual conference is our team's favorite time of the year. The chance to connect with everyone who makes our community so uniquely vibrant creates a consistently infectious renewal of enthusiasm every year, without fail. "NaRCAD 2024: Envisioning Our Future: Growth and Innovation in AD” will be no different, and we hope you'll be with us as we celebrate!

This year's event takes creative AD approaches to the next level. AD programs from across the globe will share their important work on myriad topics, from opioid use disorder to gender-affirming care; from preventing detailer panic to encouraging clinician use of person-first language in support of patients who deal with highly-stigmatized conditions. You can take a peek at our agenda here and see what we've got planned for you!

​Presenters will lead you through key strategies for AD success such as smart data tracking, EMR alignment, and increasing your program's visibility through better marketing. And of course, AD originator and NaRCAD Co-founder Dr. Jerry Avorn will deliver his Annual AD Talk, bringing you his reliable brand of insights from the year in healthcare and his visions for the future of AD. 

We'll also be exploring key adaptations to the model itself. Successful programs will share their innovations in delivering detailing sessions to alternative target audiences, branching out beyond frontline clinicians to community-based organizations who also play a key role in supporting patient safety. Want to move around during your breakout? You'll get a chance to try medical improv with seasoned detailers who are also experts in the world of theatre! And our Global Perspectives session will feature successes and diverse approaches to AD from our colleagues in Japan, Norway, and Canada.

​We're so eager to spend two days with you. Whether you're with us in Boston this year, or joining us virtually, we're here to listen to your ideas, think about ways to put them into action, share your successes and challenges, and connect you with the brightest and most creative folks in our field. 

And we'll be leading the charge in keeping the energy of excitement alive as we all prepare for the year ahead--2025 will be packed with opportunities to learn new approaches to clinical outreach education, train your team in the nuances of persuasive communication, and build new relationships with clinicians who need your expertise to provide the best evidence-based care to the patients who trust them. 

See you in six weeks!
Bevin K. Amira
​Deputy Director, NaRCAD

*Be the first 15 blog commenters below and win a free registration to the in-person event!*

Host: Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

A conversation with Debra Rowett, PSM, BPharm, Adv Prac Pharm, FPS, Advanced Practice Pharmacist, Drug and Therapeutics Information Service 

​Tag: Podcast Series

​What lessons can three decades of AD teach us about adapting to change? 

Hear from Debra Rowett, an advanced practice pharmacist and academic detailing leader in Australia for over 30 years. Deb shares the origins of AD in Australia and how it has evolved to support health professionals across various therapeutic areas. She discusses the importance of building trusted relationships with clinicians, particularly in rural areas, and how her team has adapted to challenges through the years. Deb also highlights the future of AD, emphasizing co-design, collaboration, and the role of technology. Don’t miss her insights on how AD continues to evolve and make a meaningful impact on patient care.


​(Click here here for the audio transcription.) 

​Want more? Follow us on Spotify!

Debra Rowett PSM, 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 and has provided consultancies to 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 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).

Curated by: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: ADvice, HIV/AIDS, Sexual Health, Gender-Affirming Care
 
In this edition of our AD-vice series, we delve into the critical role of community partnerships, approaches to address stigma, and evidence-based practices in HIV prevention and sexual health, empowering clinicians and patients to work together to make informed health decisions.

BUILDING RELATIONSHIPS & PARTNERSHIPS

• “We send out a Weekly Special [newsletter] with a buffet of options on new evidence and information related to HIV prevention and care. We’re creating an active and robust network of professionals!” – Rocko Cook, DISH-AZ

 

• “It’s important to build a relationship with your state’s health department leadership and obtain an official endorsement letter from the state supporting your activities. Establishing a relationship not only positively impacts your program’s visibility and ability to gain access to clinicians, but it also helps to make sure you're aware of other outreach initiatives.” – Ashley Allison, Oregon AIDS Education and Training Center

 

• “When I'm talking to providers, one of the things I hear most is, ‘I wish I had other providers to talk to about gender-affirming care.’ A big part of what we do with academic detailing is connect other providers together.” – Ryan Anderson, DISH-AZ

ADDRESSING STIGMA

• “Whenever I address something uncomfortable with a provider, stigma or otherwise, I try to create an environment where we can work collaboratively on the issue and the provider feels as though I am a resource for them.”  – Jess Alward, MS, State of NH

 

• “In order to talk about PrEP, you first have to talk about risks for HIV, which often means talking about sex. I think there can be discomfort on both the patient and provider side, and sex is often still a stigmatized topic. There are also overarching resource barriers, including the fact that clinicians are extremely busy and have to address competing health needs in the primary care setting.” – Alyson Decker, NP, MPH, San Francisco Department of Public Health

 

• “All clinicians and staff need to be able to communicate with patients in a sex-positive way and in a way that connects with patients’ specific experiences, identities, and needs. They need to be comfortable communicating about sexual behavior, testing, and PrEP.” – Rocko Cook, DISH-AZ

 

• “Racial and ethnic minorities continue to be underrepresented in PrEP utilization and overrepresented in new HIV diagnoses, and I want my work to contribute to correcting this. I think PrEP can be a tool for health justice and being part of that is valuable to me.” – Mary Nagy, MPH, RN/BSN, Michigan Department of Health and Human Services

BEST PRACTICES, FLEXIBILITY & ADAPTABILITY

• “Providers were asked which supports would best help them to incorporate PrEP into their practice, and ‘education’ was by far the most frequent answer. In addition to the research I’ve seen indicating detailing is an effective intervention to change provider behavior, it's clear that the providers themselves agree that education is important.” – Mary Nagy, MPH, RN/BSN, Michigan Department of Health and Human Services

 

• “There are many places where 1:1 visits aren’t feasible due to clinic structure or culture. If I’m able to detail to a small group, it can be a way to meet with a few providers and gain insight about how PrEP might be incorporated or enhanced in their setting.” – Alyson Decker, NP, MPH, San Francisco Department of Public Health

The insights shared by experts highlight the power of partnerships, approaches to address stigma, and evidence-based practices in creating meaningful change and positively impacting patient outcomes. Explore our revamped HIV Prevention Toolkit for more tools and resources.
 
Best,
The NaRCAD Team

Host: Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

A conversation with Jacki Travers, PharmD, Clinical Pharmacist, Pharmacy Management Consultants

​Tag: Podcast Series, Cardiovascular Health, ​Diabetes

​How can we ensure that community partnerships are front-and-center in improving patient health? Pharmacist, detailer, and trainer Jacki Travers shares insights into a five-year collaboration with the Oklahoma State Department of Health aimed at reducing health disparities related to diabetes and cardiovascular disease. This project empowers local populations by partnering with safe spaces at the heart of communities, inviting libraries, faith-based organizations, and community health workers to work in harmony with detailing to reduce health disparities and increase patient access to care, resources, and support.

​(Click here here for the audio transcription.) ​

Want more? Follow us on Spotify!

Jacki Travers is a clinical pharmacist with Pharmacy Management Consultants (PMC), a division of the University of Oklahoma College of Pharmacy. Since 2015, she has led the PMC academic detailing program. Her AD efforts are primarily in service to Oklahoma Medicaid providers, who in turn care for some of the state’s most vulnerable population. She has served as a training facilitator for the NaRCAD Academic Detailing Techniques trainings since 2019.

Since earning her Pharm.D. degree from the University of Oklahoma, she has served in the practice settings of independent, hospital, and clinical pharmacy. She currently develops detailing materials, delivers detailing services, and analyzes program results for multiple topics as part of a statewide plan. Her program efforts focus on bridging the gap between information and application in order to provide quality health care in a fiscally responsible manner.

Olivia Halle, Public Health Intern, NaRCAD

Tags: Harm Reduction, Health Disparities, Stigma, Substance Use

How do we begin to repair these complex harms? Harm reduction is an effective direct response to the rise of drug use and seeks to well equip people who use drugs with life-saving tools and information, and the emergency medical setting can be an access point to those services. Emergency clinicians are often the main point of care for people who use drugs or experience housing instability. By using a strategy like academic detailing (AD) within the emergency medical setting, trained public health educators can encourage emergency medical staff to integrate harm reduction as a critical tool to increase safety for people who use drugs. 

Detailing would raise awareness and give hope to people with OUD by providing destigmatized access to care, leading to fewer overdoses. AD can also provide the necessary education in equipping emergency clinicians with person-first language. When many people who use drugs have little trust in the healthcare system, it is vital for emergency clinicians to lead with compassion when caring for people who use substances.

Connecting people who use substances to harm reduction services not only ensure safe practices in the person seeking out harm reduction services, but enable a sense of agency that often fades when experiencing housing instability. Increased referrals from emergency clinicians to harm reduction services would support people who use drugs in living safer lives, increasing community connection, trust in the healthcare system, and a greater sense of dignity. ​

Funding these relatively inexpensive interventions is critical. In 2023, the city of Philadelphia announced that $7.5 million dollars from national opioid settlement funds would be directly funneled into Kensington’s schools, parks, foreclosure prevention, and rental assistance. These services, which can be accessed through Co-Creating Kensington, in conjunction with harm reduction services such as Prevention Point Philadelphia on Kensington Avenue, would help to destigmatize home insecurity and drug use when paired with AD. While $7.5 million dollars will barely scratch the surface of what is owed to the Kensington community, it will begin to mobilize reparations. 
​
​
The people of Kensington, Philadelphia deserve better. They deserve access to harm reduction services and OUD treatment with the full support of the city behind them. By continuing to fund community-directed services, along with academic detailing and harm reduction, city officials can take these first steps to begin to repair harm and restore agency, security, and hope to the people of Kensington. 

Biography. Olivia is a summer intern helping the NaRCAD team through providing feedback and support on usability of NaRCAD’s online materials and training sessions. She also aids the NaRCAD team through conducting literature reviews along with organizing and collecting data for online toolkits covering critical academic detailing areas.

Olivia is an incoming sophomore at the University of Washington studying public health gaining exposure to the field through her summer internship at NaRCAD. Olivia provides insight into how academic detailing and other evidence-based public health research can be more digestible to a greater audience. Olivia enjoys reading and practicing yoga in her spare time.

​

Curated by: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: ADvice, Evaluation, Data
 
In this edition of our AD-vice series, we explore the importance of data collection, program evaluation, and leadership buy-in for AD programs. Gathering and analyzing data not only helps in understanding the challenges faced by clinicians, but also in driving meaningful change by demonstrating the impact of your detailing efforts. Read insights from experts in the field on planning and executing your AD program evaluations.

PRACTICE TOOLS & STRATEGIES FOR DATA COLLECTION

• "For a resource-constrained department, having that one-page Word document that allows detailers to chart their interactions is more than enough data. Charting for just five minutes after a detailing visit about everything that took place becomes a wealth of information. You can also use an Excel document to input data from provider surveys." -Kristefer Stojanovski, PhD, MPH, San Francisco Department of Public Health

 

• "When I’m detailing on one topic, I’m always thinking about future topics by gathering data from providers so that I can better understand their challenges. I ask providers their biggest concerns and I’ve been really surprised at how ready they are to share gaps in resources and information."

            -Jacki Travers, PharmD, Pharmacy Management Consultants

• "For every campaign, we conduct an initial and follow-up visit where we assess providers’ practices. This allows us to see if there has been a change in practice from the initial to the follow-up visit. Additionally, we rate what providers intend to adopt in terms of the key recommendations, supporting tools, and resources. We also collect a large amount of qualitative data because it's also critical to gain a more complete picture of the campaign’s success, especially when reporting on barriers, access, and materials." -Michelle Dresser, MPH, New York City Department of Health and Mental Hygiene

MAKING THE CASE TO LEADERSHIP & FUNDERS

• "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, PhD, MPH, San Francisco Department of Public Health

 

• "It’s always been useful for us to evaluate and publish our results, especially when we approach the government for more funding. While we can’t do every campaign as a research project, I’ve been working on evaluating a campaign we did on diabetes and also a study on the impact of group visits vs. 1:1 detailing." -Harald Langaas, MPharm, MPH, KUPP - RELIS

 

• "It would be a strong statement if someone was able to go to leadership with a story about how providers have changed their practices. Using concrete results and showing leadership that detailing is making a change is extremely helpful for buy-in." -Kristefer Stojanovski, PhD, MPH, San Francisco Department of Public Health

IMPACT & VALUE OF EVALUATION 
​
Key Insights from Melissa Christopher, PharmD & Mark Bounthavong, PharmD, MPH, VA Pharmacy Benefits Management Academic Detailing Services
​

• "Measuring program work builds a case not just for the success of one academic detailing intervention, but for the success of future programs--a case for sustainability. Evaluation measures the quality of a program, analyzing results to look at a program’s impact, and allowing for process improvement adjustments to be made to streamline efforts and strengthen that impact. Evaluation cannot be optional, especially when lives are at stake."

 

• "Leveraging results from well-designed evaluation is essential for academic detailing interventions to illustrate success, share value, and provide stakeholders and community members with a clear ‘Yes!’ in answer to their overarching question: ‘Was the investment worth it?’"

 

• "We encourage other academic detailing programs to prioritize program evaluation as we have at the VHA—no matter the size of your program, if you’re thinking, ‘we can’t afford to do program evaluations,’ we stress that you can’t afford NOT to do them."

For additional information, check out our AD Evaluation Toolkit for guides on planning an evaluation intervention, adaptable surveys, detailing visit tracking sheets, and more!
 
Best,
The NaRCAD Team

Host: Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

A conversation with Ryan Anderson, Academic Detailer, DISH-AZ, Arizona DHS

​Tag: Podcast Series, Gender-Affirming Care

​
​How can we ensure that every patient feels respected throughout their healthcare journey? Learn about the crucial importance of gender-affirming care and how AD can promote respectful, patient-centered healthcare for gender-expansive individuals. Listen to Ryan’s impactful personal story and vision for the future of gender-affirming care. ​​

​(Click here here for the audio transcription.) 

​Want more? Follow us on Spotify!

Ryan Anderson serves as an Academic Detailer for DISH-AZ (Detailing for Improved Sexual Health in Arizona), a program of the Office of Evaluation and Partner Contracts for the Southwest Interdisciplinary Research Center (SIRC) at Arizona State University in partnership with the Arizona Department of Health and Human Services. Ryan worked as a microbiologist for 9 years in manufacturing settings and has quality assurance experience in clinical settings. In addition to professional experience, Ryan has 14 years of experience volunteering with organizations that serve the LGBTQ+ community. Ryan is passionate about improving health outcomes for those in the LGBTQ+ community.
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Additional Materials from DISH-AZ:
MSM Syphilis Toolkit
Gender Expansive Care Toolkit
Congenital Syphilis Toolkit

Moderated By: Bevin K. Amira, Deputy Director, NaRCAD

A live interview from the 2024 AD Virtual Summit with Carla Foster, MPH, Epidemiologist at NYC Department of Health and Mental Hygiene (NYC DOHMH) and Sarah Popish, PharmD, BCPP, Clinical Program Manager at the VA Pharmacy Benefits Management Academic Detailing Services.

​Tag: Podcast Series

​
​In this episode, join us for our "Leadership Spotlight" at the AD Summit where Bevin Amira moderates a session featuring experts Carla Foster and Sarah Popish. They discuss the barriers to health equity, the importance of patient trust in healthcare, and the power of inclusive practices. Hear their insights on the importance of examining language, racialization, and individual biases in order to commit to authentic and effective anti-racist efforts. You don’t want to miss this thought-provoking session! ​Click here here for the audio transcription. 

Want more? Follow us on Spotify!

By: Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

A conversation with Emmeline Paintsil, PharmD, MSLD, BCPS, Director of Professional Affairs, Iowa Pharmacy Association

​Tag: Podcast Series

​Harm reduction is an impactful approach to empower people who use drugs (and their families) to live self-directed and healthy lives. In this episode, we speak with pharmacist Emmeline Paintsil, who delves into her team's innovative academic detailing project focused on harm reduction. Join us as we explore the impact of providing nonjudgmental care, building trust with patients, and advocating for harm reduction strategies. Click here here for the audio transcription. 

Want more? Follow us on Spotify!

Curated by: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: ADvice, Harm Reduction

​Harm reduction has gained significant traction, especially as an area of focus in AD, with campaigns encouraging clinicians to provide preventive care, discuss harm reduction services with their patients, and connect their patients to related community initiatives. In this edition of AD-vice, we explore the evidence supporting harm reduction strategies, the broader approach that shifts the narrative from stigmatization to inclusivity, and the crucial role of clinician-patient communication. 

HARM REDUCTION APPROACH

• “Harm reduction offers a powerful framework that facilitates a shift within communities that moves away from moralization and stigmatization of individuals who use drugs. It’s easy to blame individuals for their behavior, but it’s far more challenging to critically reflect on how systems and decisions put people in those circumstances in the first place.” - Adriane Apicelli, University of New Hampshire, College of Health and Human Services

 

• “We’re reducing harm, saving lives, and preserving a sense of family and community. When we reduce harm, we allow a mom to be a part of her family again, we allow her to get a job, we allow her to get off the street and out of harm’s way. Harm reduction can allow people to return home.” - Lindsey C. Beardsley, Individual in Recovery

 

• “Communication and empathy are two huge pieces to consider with this topic. We spent a lot of time asking clinicians about the conversations they have with patients and the types of questions they ask about substance use. We really wanted to understand what was going well and where there were gaps that we could help fill with resources and support.” - Meghan Breckling, University of Arkansas for Medical Sciences

 

• “With this topic, paying attention to the emotions of the clinician you're detailing and acknowledging those emotions before jumping into your key messages is much more important than any other topic I’ve worked on. Be patient and empathetic – every visit counts toward making a change.” - Shuchin Shukla, North Carolina Technical Assistance Center

CLINICIAN-PATIENT SUPPORT & COMMUNICATION

• “Clinicians need to have open, non-judgmental, inclusive discussions. That starts with asking all patients about their mental health and substance use history. Educators can provide clinicians with scripting tools if they feel uncomfortable having these conversations.” - Lindsey C. Beardsley, Individual in Recovery

 

• “We provided clinicians with screening tools to help identify patients with mental health conditions and SUD to determine who could benefit from additional services. We even created a local resource guide for clinicians to easily connect patients to community services. The clinicians found that these accessible tools helped them have open conversations with patients.” - Meghan Breckling, University of Arkansas for Medical Sciences

 

• “Patients seem grateful that I approach conversations in a straightforward way that doesn’t stigmatize their use of drugs. I’ve never had a patient be offended or confused about why I was talking to them about harm reduction. Their eyes usually widen when I ask them things like how they use their drugs, how they cook their drugs, or where they get their drugs from.” - Shuchin Shukla, North Carolina Technical Assistance Center

 

• “… peer support in the plan of care can help take some of the stress off of the clinician. This can include reviewing community resources and continuing the conversation with patients, while also educating the clinician on substance use through sharing personal experiences.” - Lindsey C. Beardsley, Individual in Recovery

We hope these insights inspire you to consider harm reduction approaches in your detailing work. If you’re interested in learning more, join us at our 2nd annual AD Virtual Summit where we will dive into these areas further!
 
​Best,
The NaRCAD Team

By: Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

A conversation with Bevin Amira, Deputy Director, NaRCAD. 

​Tag: Podcast Series

How can we change the minds of clinicians? Tune in for an insightful conversation with our NaRCAD team members Anna Morgan-Barsamian and Bevin Amira as they discuss the impact of public health detailing programs across the country. Get the inside scoop on what we do here at NaRCAD and how the AD field continues to evolve, with campaigns focusing more and more on harm reduction and collaborative, community-wide initiatives! Click here for the audio transcription. 

Want more? Subscribe to our podcast on Spotify!

By: Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

A conversation with Julia Bareham BSP, MSc, Pharmacist, RxFiles Academic Detailing Service

​Tag: Podcast Series

How does teaching others encourage us to evolve as health educators? Today we're chatting with expert trainer Julia Bareham as she reflects on providing structure and a personalized approach to training new detailers, resulting in her own professional and personal evolution. Click here for the audio transcription.

Want more? Subscribe to our podcast on Spotify!

By: Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

​Tag: Podcast Series

Introducing the Changing Minds podcast! Dive into conversations with experts and thought leaders from around the world as you join our growing community of listeners committed to advancing the field. Each episode is packed with insights and actionable tips to inspire you on your AD journey!​

Listen to Episode 1 to hear from two of our expert detailers, Jess Alward & Chirag Rathod, as they share about the impact of improv. We'll discuss how it can be used to shift communication and how detailers can incorporate these skills into their work. Click here for the audio transcription.

Resources on Medical Improv: 

• Resource: About Medical Improv
• Article: No Joke: The Serious Role of Improv in Medicine
• Article: How Medical Improv Training Sparks Better Communication, Teamwork
• Video: Improvisation and the Art of Medicine: Adaptable skills for an Uncertain World
• Book: A New Way to Improve Communication​
• ​Book: If I Understood You, Would I Have This Look on My Face?​

Want more? Check out our Podcast Series page!

Bevin Amira, Deputy Director, NaRCAD

To say that health disparities are rampant is not new information to any of us in the field of improving patient outcomes. Our community of educators have much to think about as we prepare to meet with clinicians who care for patients across a spectrum of care needs, patients whose care access correlates directly to their socioeconomic status, the diseases and conditions they're dealing with, and whether or not they feel able to trust that their care providers really DO care about their needs. 

Can patients afford the prescriptions we're encouraging clinicians to offer? Are the patients who need cancer screenings most able to find transportation to a clinic? Will patients fear being shamed or unheard about their experiences and needs? "Health disparities" and "social determinants of health" aren't just trendy phrases that we should be conversational in--they're lenses through which we MUST consider every key message we deliver within every detailing intervention we implement.


How do we do this and do it well, especially when things feel more urgent than ever? It may seem counterintuitive, but our first piece of advice is to hit the PAUSE button. That's right--at NaRCAD, we're urging clinical educators to pause, zoom out from clinical care, and make sure you're looking at these three key areas:

-THE PATIENT VOICE: What do patients in my community want and need? (How will I know?)

-MY COMMUNITY'S IDENTITY & STRENGTHS: What is the community already doing around this issue?
  
-BEING A STRONG COMMUNITY PARTNER: How can I connect my detailing work to other community initiatives to maximize impact and forge community bonds?

These questions must be considered before you detail if you want to have a sustainable, positive impact. While our field is a niche area, quality improvement cannot happen in a bubble. Our work is only as strong as our ability to think about the entire chain of relationships that exist, all the way down to the patient who is receiving the care the evidence says they should be receiving. 

As we move into the year ahead, we're more dedicated than ever to helping you all ask these nuanced questions and recognize that even programs with low resources can find ways to incorporate patient reflections and community buy-in into their campaigns. We're here to teach you how to navigate these areas with care, curiosity, and passion--because each one of us became invested in healthcare improvement out of a sense of dedication to patients receiving the best care possible. 

Join us, and keep telling us what you want and need. We'll be hosting more community conversations, strategy sessions, check-ins, one-to-one role plays, trainings, convenings, and connections to other experts in the field, inviting you all to share what you've experienced as you work creatively to improve care.

Jerry Avorn, M.D.
Co-Founder & Special Adviser, NaRCAD

​Tags: Evidence Based Medicine, Jerry Avorn​

​Following the astonishing debut of AI applications like ChatGPT a year ago, “knowledge workers” (that’s us) have been forced to ponder how much of what we do could be replaced by a very smart set of computer programs. Such applications can already pass medical licensing exams better than many graduates and have gotten remarkably good at reading X-rays and pathology specimens. How soon will AI systems become adept at reviewing the clinical literature and preparing concise, user-friendly summaries, complete with prescribing recommendations?  Not yet, but likely before long.

​Try it yourself at home: log onto OpenAI.com (it’s free) and ask ChatGPT for advice about medications for diabetes or hypertension or HIV or anything else.  Just be careful about its “hallucinations” – the fact that sometimes AI just makes up wrong stuff. (I prefer the term “confabulation,” also used to describe this well-known phenomenon.) That can be whimsical if you’re a N.Y. Times reporter and ChatGPT advises you to leave your spouse, and it can be very problematic if you’re a lawyer who relies on case law that ChatGPT simply fabricated. (Both actually happened.) But it can be lethal if it involves incorrect clinical recommendations.

​Yet that said, AI is getting smarter every day. If programmed well in the coming years, large language models like ChatGPT or its growing number of competitors could eventually also learn how to gauge prescribers’ current knowledge, attitudes, and practices, and then ask just the right questions to find out why they’re doing what they’re doing, what their concerns are, and what it would take to get them to change.

Once things mature a bit further, will large health care systems interested in academic detailing and in cost-cutting simply replace humans with AI-AD-bots? After all, they could work 18-hour days, don’t need health care benefits, and can disseminate any message their employer wants. It will be easy replace a recommendation like “SGLT-2 inhibitors in diabetes can reduce cardiovascular and renal disease as well as lower glucose” with: “SGLT-2 inhibitors are extremely expensive and increase our drug budget.  Use metformin or sulfonylureas whenever possible.

​So if we have a few years to prove that actual people still have a vital role to play in helping practitioners make better decisions, what can we do? 
​

• First, we should consider and then embrace what makes us fully human in our work: our capacity to bring a critical eye to the clinical literature, and to understand and embrace nuances in the evidence.
• Second, we can draw on our genuine empathy for the perspective of the practitioner, and an appreciation that that it’s hard to be a front-line clinician. This is a property the bots may eventually be able to simulate, but at the moment still do imperfectly.
• Third and most important, we can remember to bring to our work a clear moral mission – that good evidence matters a lot, and that patients have to come first.

​Those are values that endure and can distinguish our work from a sophisticated set of algorithms. Best of all, they can’t be changed if whoever is in charge overwrites a few lines of code to maximize some other agenda, or if the algorithms just make stuff up.

Believe it or not, it was 1838 when 3D technology was born. We've clearly made it a long way since; being able to have The Jetsons-style video calls is something that was once so futuristic that Saturday morning cartoons blew our minds with the very concept.

What's most compelling about all of the constantly-expanding technology is that it doesn't do the trick when we want to have good old-fashioned water cooler talk, the kind of talk those of us who ran the 9-5 office gauntlet once took for granted. There's nothing like the quality of an in-person laugh over one that is cut up by static and the repeated query, "Can you guys hear me?", the response to which is so often, "Nope, you're on mute."

So please do come on out! And if you can't make it, please join us via LiveStream, whether you can only attend one session or the whole she-bang. Register on our Conference Series page and come spend time with us--it's a rare treat these days, and maybe that's one benefit to having had in-person time be scarce these past few years. But that's part of the NaRCAD Team's tendency to look at opportunity over setbacks.

​We'd love to share that energy with you in just a few weeks.

With excitement,
Bevin Amira, Deputy Director

We're never going to stop telling you, our creative, dedicated, and talented community of clinical education professionals, how much we appreciate you. You've spent the past 3 years with us fully online, including our at our trainings, our annual summit, and our conferences. It's been lively and exceeded our wildest expectations of how truly connected and dynamic a virtual conference could be. 

This year, we're finally back onstage in person at the Copley Fairmont Hotel in Boston. We couldn't be more excited to kick off a return to the kind of connections that only arise in a face-to-face setting. (For those of you who want to join us virtually again, we'll be having an interactive livestream option--learn more on our Conference Series Page!)

To say thank you and stoke the 'in-person' excitement, we're having a FLASH GIVEAWAY: for the next 24 hours, the first 10 people to share 1 thing they're most excited about @ #NaRCAD2023 in the comments below will receive a code for free in-person registration. You'll be contacted by our team within the next day with your code! (*This offer is only for new registrants for this specific promotion.) 

See you in a few weeks!
​-The NaRCAD Team


Sound off in the comments:
What're you looking forward to most in person @ NaRCAD2023?

Curated by: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: ADvice, Rural AD Programs
 
Academic detailing programs face unique challenges in both rural and urban communities. Rural communities often encounter barriers with both clinicians and their patients having limited access to resources, as well as the difficulty they both face in navigating geographic barriers. In the latest edition of the AD-vice blog, we’ll explore past conversations with public health and healthcare professionals working to close the gaps for patients in rural populations.

CAPACITY-BUILDING & RESOURCE SUPPORT

• “We know that many people living with HIV pass through community-based organizations. We want to make sure that those organizations are equipped with the correct information to get people the care they need through resources or referrals. Our team has created detailing materials for both medical professionals and community-based organizations to maximize our impact.” - Lexie Hach, Iowa Department of Public Health

 

• “We expanded our team to include two pharmacists, one nurse, two physicians, two student pharmacists, one student nurse, two medical students, and a biomedical data analysis student. Our team of physicians were able to identify physician champions and convince local medical practitioners that our detailing would be helpful for the medical team.” - Kimberly C. McKeirnan, PharmD, BCACP, Washington State University College of Pharmacy and Pharmaceutical Sciences

COLLABORATION AND COMMUNITY SUPPORT

• “...it is important that collaboration occur at local levels as well as at state levels—both among clinical colleagues in the same community who care for the same patients, and also with support from state-level organizations who can leverage resources that may not be available in the local community.” - Liesa Jenkins, MA, ONE Tennessee

 

• “I try to connect providers with resources like care management teams, electronic referral platforms, or other providers in their area who are implementing particular services like parent-child interaction therapy, medication therapy management, and applied behavioral analysis. If I'm asking a provider to do something, I want to make sure that they have the tools and the bandwidth to carry it out!” - Jacki Travers, Pharmacy Management Consultants (PMC)  

 

• “If you’re just starting out, reach out to community partners and get a sense of what patients with substance use disorder are experiencing and the challenges they’re facing before you start detailing clinicians. You’ll be better able to represent what is happening in the community and share the resources that exist when you’ve done your research first!” - José Peña Bravo, PhD, Florida Department of Health in Duval County

ADDRESSING STIGMA AND HEALTHCARE ACCESS

• “In a mostly rural state like New Hampshire, healthcare access is limited to begin with, and clinician stigma could drive patients who need help to either forego care or have to travel very far to seek care. We know providers want the best outcomes for their patients, and through detailing, we want to help the providers achieve those outcomes. Looking at potential stigma is one of the keys to making sure we address health inequities.” - Megan DeNubila, State of New Hampshire

 

• “To encourage access, our state has created a TelePrEP program that offers PrEP services to anyone via telemedicine. Consultations take place over the phone, labs are obtained at third party lab companies, and medications are mailed right to the front doors of patients.” - Brandon Mizroch, MD, MBBS, Louisiana Department of Health  

 

• “We provided clinicians with screening tools to help identify patients with mental health conditions and SUD to determine who could benefit from additional services. We even created a local resource guide for clinicians to easily connect patients to community services. The clinicians found that these accessible tools helped them have open conversations with patients.” - Meghan Breckling, PharmD, BCACP, University of Arkansas for Medical Sciences

We hope the insights shared in this edition of AD-vice will inspire implementation of strategies on community support, access, and more in your AD programs. Check out our updated Program Planning Hub for examples and guides on how to build and sustain detailing programs as well as resources to support frontline clinicians!
 
​Best,
The NaRCAD Team


Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

Tags: Stigma, Evidence-Based Medicine, Health Disparities, Conference

Missed our event? Check out the AD Summit videos and materials on our Summit Hub.

We’re fresh off of the excitement of hosting our Academic Detailing Virtual Summit, “A Deeper Understanding of Our Impact on Patient Care.”  In prioritizing patient-informed care more than ever before, we explored patient narratives through live interviews, workshops, and special panels, all within a virtual space. Innovations included AD for criminal justice involvement, care delivery redesign for veterans, affirming care for transgender and nonbinary people, and patient-informed communication on sex positivity in HIV prevention. Take a peek at some of the highlights from our event below!

AD Fireside Chat: A New Spin on a “Keynote Address”
We opened our AD Summit with a real-time interview featuring the originator and co-founder of NaRCAD, Dr. Jerry Avorn, and the National Director of the Veterans Affairs Pharmacy Benefits Management Academic Detailing Service, Melissa Christopher. Audience members were excited to throw ideas around and ask questions about:

• Universal terminology for the role of “academic detailer”
• Best practices for making connections with clinicians
• AD’s role in advocacy work
• Clinical topics suited/not suited for AD
• Inviting curiosity and play into AD team meetings and 1:1 visits
• The changing landscape of AD and where the field is headed

Program Development Workshops: Attendees Led the Charge!
Our revamped course catalog of workshops invited attendees to be in the director’s seat, as well as behind the scenes as co-creators in small groups. Participants created resources that we’ve published on our website and social media channels, sharing creativity and expertise with the larger AD community.
Our workshops covered a wide range of topics including:

• Motivational interviewing
• Recruiting the best detailers for your AD project
• Sleuthing before a detailing visit to better understand the patients, clinicians, and clinics
• Role play scene studies featuring challenging clinician scenarios chosen by the audience
• Building a fictional AD program
• Telling the story of program impact through case studies
• Critiquing detailing materials
• Empowering clinicians to leverage community connections

Special Panel: Understanding Critical Care Needed for Formerly Incarcerated Patients
The outstanding team from New York City Department of Health and Mental Hygiene (NYCDOHMH) shared their groundbreaking detailing campaign, “Public Health Detailing for Criminal Justice Involvement”, with an audience that was hungry for innovation around inclusivity. The NYCDOHMH team shared NYC clinicians’ understanding of formerly incarcerated patients’ care, including clinicians who met the campaign with stigma, and those who were grateful to see such a campaign being implemented.


Best Practices Spotlight: Prioritizing the Patient Experience 
For the first time in NaRCAD’s history, we highlighted leaders in the field who’ve been prioritizing the patient experience. The San Francisco team created space for conversation and discussion about gender-affirming care and ways to encourage safe clinical environments for transgender and nonbinary individuals through language, storytelling, and community outreach.

We also heard from the Arizona team about the importance of pleasure being part of a patient’s sexual health history and the role of a detailer in supporting these conversations between clinicians and patients. 

Inclusivity Roundtable: Real-time Script Creation
We wrapped up our AD Summit with a roundtable session where attendees co-created a scripting resource to empower detailers to combat stigma during visits.

We asked attendees to come up with responses to the stigmatizing comments below. A five-page resource was created in 60 minutes!

1. “I can’t believe patients keep coming back without having lost weight. They’re clearly not trying hard enough, and not making healthy food choices.”

2. “I don’t want those patients at my practice. They’re so difficult to handle and are really just looking for another opioid prescription. Treatment won’t work for them.”

3. “I’m so tired of keeping up with all these different pronouns. You’re either a man or a woman. It gets in the way of providing care.”

4. “I don’t need to use an assessment tool. I can always tell when someone’s at high risk of contracting HIV.”

We want to continue these conversations, hear about your team’s innovations, and share resources in person this fall at our annual conference in Boston, MA. We hope to see you there!

-The NaRCAD Team

A special thank you to all of our AD Summit attendees and presenters as well as our partners at the 
Agency for Healthcare Research and Quality. For more information on our presenters, you can view the AD Summit Program Book.

​Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!