A ROADMAP for Detailing Success: Improved Outcomes for the Medicaid Population in Oklahoma

Guest Blogger: Jacki Travers, PharmD
Clinical Academic Detailing Pharmacist
Pharmacy Management Consultants
NaRCAD Training Alumnus
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Tags: Detailing Visits, Mental Health, Pediatrics

​In June of 2015, I had never even heard the term “academic detailing.” If you’d asked me to define it, I might have said it had something to do with the relationship between teachers and their cars. Little did I know that I was about to become an academic detailer, embarking on an exciting, rewarding, and sweaty-palmed journey to bring evidence-based materials to providers across the state of Oklahoma.

My journey is probably somewhat different from yours, so let me briefly introduce our program. Our organization is Pharmacy Management Consultants (PMC), and we are a division of the University of Oklahoma College of Pharmacy. Our primary function is providing pharmacy services to support the Oklahoma Health Care Authority (OHCA), otherwise known as Oklahoma Medicaid. 

The Oklahoma Medicaid population is mostly under age 21. Detailing topics have included treatment of ADHD, use of atypical antipsychotic medications, and decreasing the use of antibiotics for treatment of upper respiratory infections. We are a small program by comparison, having one full-time detailer since 2015. We added one quarter-time detailer within the last year.

I will share some specific activities that worked for us, which creates a ROADMAP that has served us well and may help you as you begin or enhance your detailing efforts.

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R – Review
When each set of materials neared completion, we asked the experienced NaRCAD staff to review our materials. Having an outside source helped clarify any confusion and identify ways to help the AD visit flow more naturally.

O – Objectivity
In identifying providers, we were making a bit of a judgement about their prescribing. As a detailer, I found it unhelpful to bring these judgements into the detailing visit. It is important for providers to see detailers as an ally for change rather than a source of punishment or criticism.
 
A – Acceptance
We surveyed providers’ acceptance of the program with each AD visit by asking them to evaluate the detailer and the materials. We also asked if they were willing to participate in future visits and recommend the program to colleagues.
 
D – Define 
Defining the expected care gaps helped guide creation of our key messages. The treatment guidelines for ADHD are well established and remain unchanged since 2011. Comparing these guidelines to national and state patterns gave us a starting point for developing key messages. In addition to published guidelines, evaluation measures such as the Healthcare Data and Information Set (HEDIS) were very helpful. Doing this examination on the front end helped us begin with the end in mind and ensured we collected data we needed from the start.
 
M – Motivational Interviewing 
Motivational interviewing (MI) is a communication style that is used to modify behavior. MI techniques helped us avoid some of the pitfalls that can accompany potentially confrontational conversations.
 
A – Appealing Graphics
We use Adobe Creative Cloud, which we find it to be very user-friendly. For someone with no graphic design experience, YouTube training videos were very helpful. We also use Pixabay as a source for ready-made graphics. All materials are open source and royalty free. We looked at the graphics used by other programs and even materials distributed by pharmaceutical representatives. Having appealing graphics is necessary for any AD program.
 
P – People 
Having professional mentoring has helped move our program to the next level. Specifically, our detailers received invaluable preparation from the excellent NaRCAD Training Series. Moreover, I never miss the chance to learn from all the presenters and breakout participants at the International Conference each year.

We are encouraged by the outcomes we have seen to date. The ADHD campaign produced a 58.33% reduction in medication claims for the very young (age 0-4) and cost savings of more than $226,000 across all ages. The antipsychotic campaign produced a 19.51% reduction in medication claims across all ages with associated savings of more than $365,000.

​I hope this snapshot of our program demonstrates that even small AD programs can show sizeable improvements in health outcomes and improve utilization of healthcare resources. Now, more than three years later, my understanding of academic detailing is much deeper and continues to grow with each new challenge. I was not completely wrong in my definition though: I absolutely see myself as a teacher and I certainly spend a lot of time in the car!

Biography
​Jacki Travers, PharmD
​Clinical Academic Detailing Pharmacist, Pharmacy Management Consultants
Jacki joined Pharmacy Management Consultants (PMC) in 2015 and serves as the chair of the academic detailing committee. She has been active in the development and implementation of PMC’s academic detailing program as part of its service to Oklahoma Medicaid. Prior to joining PMC, she served in the practice settings of independent, hospital, and clinical pharmacy. She currently participates in developing detailing materials, delivering detailing services, and analyzing 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.