National Resource Center for Academic Detailing [NaRCAD]     857.307.3801
NARCAD
  • About
    • Why We Matter
    • Our Team
    • Contact Us
  • Tools & Resources
    • AD Core Toolkits >
      • Opioid Safety Toolkit
      • HIV Prevention Toolkit
      • E-Detailing Toolkit
      • Program Building Resources
    • AD Literature Archives
  • Webinars
    • Webinar Series
    • E-Detailing Webinars
    • E-Detailing Roundtables
  • Blog & E-News
    • Best Practices Blog
    • E-Newsletter
  • Community
    • Discussion Forum
    • Partners by Location
    • Detailing Directory
  • EVENTS
    • Training Series
    • CONFERENCE SERIES
    • THE CONFERENCE HUB
  • About
    • Why We Matter
    • Our Team
    • Contact Us
  • Tools & Resources
    • AD Core Toolkits >
      • Opioid Safety Toolkit
      • HIV Prevention Toolkit
      • E-Detailing Toolkit
      • Program Building Resources
    • AD Literature Archives
  • Webinars
    • Webinar Series
    • E-Detailing Webinars
    • E-Detailing Roundtables
  • Blog & E-News
    • Best Practices Blog
    • E-Newsletter
  • Community
    • Discussion Forum
    • Partners by Location
    • Detailing Directory
  • EVENTS
    • Training Series
    • CONFERENCE SERIES
    • THE CONFERENCE HUB

The DETAILS BLOG

Capturing Stories from the Field: Reflections, Challenges, & Best Practices

Academic Detailing and the Pain of the Opioid Crisis

4/18/2018

 
Picture
Jerry Avorn, MD, Co-Director, NaRCAD
​

​Of all the medication use issues facing the U.S., the most pressing is of course that of opioid mis-prescribing.  When the anatomy of that mis-use is dissected, it becomes clear that the principles and methods of academic detailing are especially well suited to addressing this crisis, for several reasons. 

Picture
First is the problem of information deficit:  before the mid- to late-1990s, practical issues of the assessment and management of pain were often poorly covered (or not at all) in most medical school or residency training programs – so there’s a lot of good that can be accomplished by simple personalized knowledge transfer, to start with.

​Second is dealing with the contamination of dis-information: the growing documentation of the fact that sales reps for OxyContin, for example, actually under-stated the drug’s risks and over-stated its potential indications when describing their product to prescribers – distortions for which the company had to pay $600 million in penalties.

Third is the fact that for this therapeutic category more than for most others, a prescriber’s attitudes and motivations play an especially important role.
​
These can involve “non-scientific” issues such as:
  • “This patient is hurting and I want to help them but am not sure how, so I’ll give them the strongest thing I can think of.”​
  • “The patient is demanding narcotics and I don’t know if I’m being scammed or not.”
  • “I keep getting memos from bureaucrats and managers telling me I’m using too much opioid, but these people don’t have a clue what it’s like trying to do my job.”
  • “I can’t manage this patient’s diabetes, angina, hypertension, memory loss, and depression in my too-short visit – how am I supposed to deal with their pain and all these new opioid constraints at the same time?”
​​… and dozens of other issues.
Picture
There is ample evidence that simple “gotcha” letters accusing a prescriber of opioid over-use have no effect. Similarly, draconian restrictions imposed by governments or health care systems limiting the amount of opioid that can be prescribed to a given patient clearly run the risk of under-treating genuine pain – a grotesque example of health care rules that seem guaranteed to increase patients’ suffering.

​Evidence-based guidelines, such as those promulgated by the CDC, are fine as far as they go, but most doctors haven’t read them, and even fewer have integrated them into their practices. 

Picture
But a well-trained, skilled academic detailer can interact with a prescriber to understand just what issues lie behind the apparent misuse of opioids by that physician, and present a set of interactive messages tailored to those particular needs.

​This will involve constructing a personalized blend of new knowledge transfer, dis-information detoxification, practice facilitation (including help accessing Prescription Drug Monitoring Program data less burdensomely), accessing local resources for help in patients with opioid use disorder, and assistance with patient education. 

Picture
A similar approach could also be enormously helpful for encouraging naloxone prescribing and improving the care of patients with opioid use disorder, including medication-assisted treatment, where information deficits and attitudinal issues are even more prominent.
 
Together, this kind of individualized outreach education can accomplish far more than mailed guidelines, accusatory nastygrams, or legal restrictions – and in doing so, do more to improve patient care and reduce preventable misery than can be expected from more old-fashioned interventions.

Picture
Biography.
Jerry Avorn, MD,​ Co-Director, NaRCAD
Dr. Avorn is Professor of Medicine at Harvard Medical School and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics (DoPE) at Brigham & Women's Hospital. A general internist 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. ​Read more.

Nora Gurun
10/10/2019 08:26:13 pm

HSV1 & HSV2 Negative.
Saying that, herpes virus is not curable is because you have not seen the right person to help you get rid of the virus. I testify because it's only someone who have experience this virus that konws what it means to be in this situation. After my marriage to Loe my hubby, i noticed one day that I had sudden Cold Sores in my genital part. I went for test and the doctor confirmed me being HSV2 positive.
I felt my life and happiness with my hubby was finished. But to my greatest surprise my husband had contacted this virus and was later confirm HSV1 positive. I started noticing symptoms like cold sores, sore throat, fever blister, weakness of the body, runny nose, cough and finally the was a serious Outbreak. So I started looking for a remedy to our situation because the phamacytical drugs and the pains was too much for I and my hubby. I was looking for remedy online and different website when i saw a testimony about Dr. Akintunde and the herbal medicine that helped Erica to get rid of HSV2, I remembered my doctor told me the is no cure to this virus, I had to contact Dr. Akintunde on his WhatsApp number and told him about us and the virus, he promised to cure this virus with his herbal medicine. And he prepared four bottles of the herbal medicine and send to me through UPS delivery with instructions on how to take it. And only first week of my start, I noticed the outbreak and all the symptoms was off so, I told Dr. Akintunde about it and he said the medicine will eradicate the virus and boots my immune when i complete my medication. After I took the medicine I went back for retest and my doctor was surprised with my new status HSV2 negative my hubby also was cured. Thanks to Dr. Akintunde I am proud to say you safe our life and we remain greatful and we support your mission on humanity Sir, Do you experience such too?
Tell Dr. Akin your health problem and be sure of total cure with his natural roots and herbs. Like Erica did testify to me I also testify for everyone who need help to be free from this inconveniencing virus, and any other health challenges you're having is curable believe me. All the best.
Dr. Akintunde email and WhatsApp number below.
Via email:-
drakintundehomecare@gmail.com

WhatsApp number:. +2347035245593


Comments are closed.

    Highlighting Best Practices

    We highlight what's working in clinical education through interviews, features, event recaps, and guest blogs, offering clinical educators the chance to share successes and lessons learned from around the country & beyond.

    Search Archives
    by Topic:

    All
    Autism
    Cancer
    Cardiovascular Health
    Chronic Illness
    CME
    Conference
    COVID-19
    Data
    Detailing Visits
    Diabetes
    Director's Letter
    E-Detailing
    Elderly Care
    Evaluation
    Evidence Based Medicine
    Expert Trainer Insight Series
    Health Disparities
    Health Policy
    Hepatitis C
    HIV/AIDS
    HPV
    International
    Jerry Avorn
    LOOPR
    Materials Development
    Medications
    Mental Health
    Obesity
    Opioid Safety
    Pediatrics
    Practice Facilitation
    PrEP
    Primary Care
    Program Management
    Rural AD Programs
    Sexual Health
    Smoking Cessation
    Stigma
    Substance Use
    Sustainability
    Training
    Vaccinations

    RSS Feed


​NaRCAD is a program of the Division of Pharmacoepidemiology & Pharmacoeconomics [DoPE], Department of Medicine at Brigham & Women's Hospital.

Partners Privacy Notice

Proudly powered by Weebly