The Details Blog

AD-vice: Strategies for Successful AD Program Management

4/12/2023

Curated By: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: ADvice, Program Management, Training

Academic detailing program managers oversee and coordinate all aspects of an AD program to ensure its success, impact, and strengthen the detailing team. They have a crucial role in achieving team goals. In this edition of AD-vice, we’ll look into how program management in AD contributes to team and program success.

Team Building and Support:

“Having a team that is well-prepared, confident and excited to bring this information to the practices is the cornerstone to a successful detailing program.” – Michelle Dresser, MPH, NYC Department of Health and Mental Hygiene

“It can be lonely when you’re in the field detailing by yourself, so managers need to have touchpoints with their detailers. Building trust and having your detailers know you’re all working together helps them stay self-motivated; it makes them want to go out into the field and do a good job because they know someone is backing them up.” – Tony de Melo, RPh, Alosa Health

“… 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. We want the team to be successful in moving towards our goals together.” – Marlys LeBras, PharmD, RxFiles Academic Detailing Service

“It’s also important to know that with your team, you’re never alone. You don’t need to know everything to be a leader, but you need to surround yourself with people who can collectively make decisions based on good information. Surround yourself with people who know more than you do, and listen to them.” – Liesa Jenkins, MA, ONE Tennessee

Recruitment and Training:

“When recruiting detailers, it is more important to make sure to recruit people who have the bandwidth to do the detailing, rather than making sure they have the perfect clinical background. It may be a good idea to create a formalized agreement to ensure they complete their required detailing visits.” – Amber Elliot, BSN, RN, St. Francois County Health Department

“The detailer upskilling process for other visits includes weekly webinars to review key messages and the surrounding evidence, and a two day in-person workshop where detailers get to practice their visit discussions with each other and family physicians prior to launching visits.” – Lindsay Bevan, MScHQ, Centre for Effective Practice

“If you have the capacity, take it one step further by adding practice role play sessions among peers and allow new detailers to observe other detailers in the field. When training, help the detailers step out of their comfort zone within a group of people that they know before they step out of their comfort zone with a stranger.” – Nicole Green, BSP, RPh, ACPR, DPLA, ThedaCare

Interprofessional Collaboration:

“Create an interprofessional team. It was very helpful to get insights from multiple health disciplines since there are many opportunities [within the health system] to encourage patients to be vaccinated.” – Kimberly C. McKeirnan, PharmD, BCACP, Washington State University

“Programs considering hiring student detailers can often rely on the flexibility of students’ schedules, as well as an enthusiasm and energy for learning that may exist in smaller quantities later in one’s career, when full-time roles in healthcare take priority.” - NaRCAD

Effective program management plays a crucial role in the success and support of academic detailing programs. We hope the insights shared in this edition of AD-vice will help in navigating and implementing strategies of team building, recruitment, training, and more. As always, our NaRCAD team is here to support you and your detailing programs!

Best,
The NaRCAD Team

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AD-vice: Navigating Clinician Stigma During Detailing Visits

2/16/2023

Curated By: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: Stigma, Primary Care, Data

Time and time again we’ve heard about the challenges detailers face when tackling clinician stigma. Detailers have shared comments from clinicians such as, “We don’t take those types of patients” or “I don’t want to be known as the gay doctor.”

Addressing stigma and fostering understanding with clinicians can often feel overwhelming for detailers. In this edition of “AD-vice” we shine a light on these issues and share experiences from our community on how they managed stigma during detailing visits.

Understanding 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. – Jessica Alward, MA, New Hampshire Bureau of Infectious Disease Control

“One of the biggest myths about stigma is that some people carry it, and some people don’t. However, stigma is not binary, and we all possess the ability to stigmatize another group that we perceive to be an ‘outsider’ group. Historically, stigma has appeared mainly in the form of social inclusion, with those identified as ‘others’ being treated as societal outcasts.” - NaRCAD

“Imagine that the clinicians or people you detail hold stigma not because they want to stigmatize others, but for some more relatable reasons: they’re impressionable, they’re naïve, they’re vulnerable. In the same way that a clinician wouldn’t expect someone with a substance use disorder to suddenly recover if harshly confronted, we can’t expect the person who stigmatizes to respond to similar tactics.” – Zack Dumont, BSP, ACPR, MSPharm, RxFiles Academic Detailing Service

“Stigma isn’t something that folks are actively choosing, it’s more of what they’ve been taught. Changing that culture of practice is much more difficult compared to asking prescribers to prescribe cholesterol-lowering therapy. There’s very little societal baggage when it comes to improving cholesterol than there is when it comes to destigmatizing addictions or chronic pain.” – Andrew Suchocki, MD, MPH, Clackamas Health Centers

Addressing Stigma through Education and Conversations

“We’re approaching [stigma] with education and lots of conversations, since we’ve found that helping our staff to get a better sense of addiction as a disease is really invaluable to making them more open to [medications for opioid use disorder (MOUD)] and treating people with opioid use disorder (OUD).” – Carol Furlong, LCMHC, MAC, MBA, Elliot Hospital

“When we detail in groups, we focus on small group discussions. One method I use involves flashcards with myths or biases about OUD, and asking two or three of the attendees to discuss that amongst themselves. We have also used a language sheet that guides providers in what to say.” – Elisabeth Fowlie Mock, MD, MPH, Maine Independent Clinical Information Service

“A lot of the older language around OUD identifies with “bad choices” and “bad people”. For example, relapse is associated with a fault of the person. When we are talking about a person with OUD, we are talking about someone with a disease and relapse is a natural course of the disease. When a patient’s blood sugar goes up, we don’t call it a relapse. Just like people with diabetes, we will never cure a person with OUD, but we help them manage [it].” – Don Teater, MD, MPH, Teater Health Solutions

Addressing Stigma through Data and Resources

“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 [cocaine use] is 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.” – Carla Foster, MPH, New York City Department of Health and Mental Hygiene

“Know your patient population: Understand who the patients are, the trauma they’ve faced, and the stigma they may endure. Look at the experiences of your team, the clinicians, and the patients you’re working with and try to understand how these different perspectives all influence one another as you develop your resources.” – Trish Rawn, BScPhm, PharmD, Centre for Effective Practice

Our team at NaRCAD is here to learn and support you as we combat stigma and continue to promote inclusivity. Check out our new Healthcare Inclusivity Toolkit for detailers for additional resources.

Best,

The NaRCAD Team

Annual AD-vice: Recapping This Year’s Wisdom

1/11/2023

Curated By: Aanchal Gupta, Program Coordinator, NaRCAD

Over the past year, we’ve gained important insights from programs around the world by exchanging ideas at roundtable sessions, Peer Connection Program Gatherings, trainings, and our annual conference series. As we welcome in 2023, let’s reflect on some of the highlights that detailers and program staff have shared on our DETAILS Best Practices Blog over the past year. Enjoy!

Outside the Detailing Team: Leveraging Community Partners

“I’m so lucky to be able to work in the office side-by-side a recovery navigator [who] helps link folks in the community to addiction services. We often share resources and try to work together to ensure that community health goals are achieved […] by making sure that the work people are doing is connected rather than existing within silos.” – Carolyn Wilson, Ledge Light Health District

“We’ve benefited from connecting with administrators of health systems. We approach them like business partners; it takes a special skill to communicate and work with an administrator. It’s important to have team members who understand how to communicate with leadership effectively to get that buy-in.” – Sandeep (Sonny) Singh Bains, PharmD, BCPS, Alosa Health

“We [as detailers] attend a variety of community meetings. 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.” – Lexie Hach, MA, Iowa Health and Human Services Capacity Extension Program

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

Detailing Visits: Preparation and Building Confidence

“I encourage my team to be persistent. We can't take the first “no” from a clinician as rejection. It might mean, “not now,” “I don't understand,” or “I haven't been exposed to this.” It doesn’t mean that they never want to have a visit with an academic detailer or will never change their prescribing behavior.” – Nicole Green, BSP, RPh, ACPR, DPLA, ThedaCare

“Prior to your detailing visit, think about ways to slow down and limit the amount of information you share with the clinician so that the visit is of most value to them. You can do this by asking focused needs assessment questions and providing the clinician ample opportunities to speak and engage in the conversation.” – Chirag Rathod, PharmD, Illinois ADVANCE

“Examine your own biases: When developing detailing tools, you need to make sure that you’re aware of your own biases and that your tools include the lens of equity, diversity, and inclusion. This is something we are actively working on incorporating in all our work at CEP.” – Trish Rawn, BScPhm, PharmD, Centre for Effective Practice

“When you initially step into something new, you're outside of your comfort zone. Do you harness the fear and turn it into excitement for learning or do you shy away from it? It's important to step into it and remember that the goal is to better the communities that we live in. Take that excitement and run with it.” – Rachelle Woods, MSN, RN, Colorado Department of Public Health and Environment

“Be patient, be persistent (after all, you care and want them to be their best selves) and be persuasive with those that you’re detailing. You have a lot of natural talent, training, and experience to efficiently help people make informed decisions through detailing visits. Don’t limit it to therapeutic decision-making; extend it to the mental and emotional aspects of care as well.” – Zack Dumont, BSP, ACPR, MSPharm, RxFiles Academic Detailing Service

Thinking Outside the Box: Exploring AD Innovation

“Everyone brought something critical and unique to the table. Our administration team was instrumental in getting our visits booked and our director was transparent with our team throughout the process. [As a result] our team was excited, enthusiastic, and proud to have the opportunity to provide this education to clinicians in our province.” – Jennifer Carefoot, BSc, Pharm, BC Provincial Academic Detailing Service

“Dentists fall into a different healthcare model that’s often siloed; this results in isolation, making the interactive, 1:1 outreach model of detailing even more important – we knew we needed to bring the information and support directly to them in their dental offices.” -Adrienne Butterwick, MPH, CHES, Comagine Health

“It’s critical that academic detailers continue to encourage primary care clinicians to discuss harm reduction with their patients and link them to services within their community. Academic detailers have the ability to empower clinicians to have difficult conversations with patients to reduce infections, overdose, and death.” - Anna Morgan-Barsamian, MPH, RN, PMP, NaRCAD

2022 has brought a wealth of opportunity and innovations. We hope to continue that momentum with all of you as we head into the new year. Stay tuned for more AD-vice blogs in 2023.

Best,

The NaRCAD Team

AD-vice: Getting the 1:1 Visit

3/21/2022

By: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: Detailing Visits, CME, E-Detailing

You asked, we answered! Getting your foot-in-the-door to schedule a detailing visit is a challenge for many detailers. We’ve compiled some of our best tips about gaining access from our past interviewees on the DETAILS blog.

Relationship Building:

“Being invited to an all-staff meeting is often an excellent way to kick off an introduction to this important intervention and can result in follow-up conversations with individual clinicians. One benefit of meeting in small groups is that if a clinician hears a fellow clinician say that he or she is already prescribing PrEP, there may be more openness to discussing the topic; other providers might feel comforted in having a PrEP "ally", resulting in buy-in from the clinic overall.” – Alyson Decker, NP, MPH, San Francisco Department of Public Health

“…although we try and limit group presentations, this has proven to be an effective strategy when entering into a new relationship. Once they get to know us and recognize the value of the program, they’re engaged in having us come back to conduct 1:1 visits on the follow-up and subsequent campaigns.” – Michelle Dresser, MPH, New York City Department of Health and Mental Hygiene (DOHMH)

“…I had learned strategies on getting in the door [at the NaRCAD training] that were useful in my effort. On a few occasions, the practice managers didn’t follow through on connecting me with the physicians. I got around this by utilizing physicians I knew in other practices to gain access to their practice. A lot of it comes down to how well you know the physicians.” - David O’Riordan, MPharm, MPH, PhD, University College Cork, Ireland

“I always say that the receptionists in doctors’ offices are the most powerful people in the world. If you can’t get through them, you’re not going to get what you need.”– Lutricia Woods, RN

“We had champions in the area that supported what we were doing, and we could use that to get our detailers in the door. Our program was also previously part of a demonstration project where providers were required to have an academic detailing visit as part of the initiative. I would say that our cold calls became “warm calls” during that time because all the offices and providers knew we were coming.” – Sarah Ball, PharmD, SCORxE

“Whenever possible, I want to try to connect with people in a way that is the most seamless for them. And that's absolutely true for detailing too! I've had providers who want to meet over coffee and muffins at 6:00 AM because it's the only time they have in their day, or providers who need to pump their breast milk during our visit. I roll with it all and make sure I’m meeting providers where they’re at.” – Jacki Travers, PharmD, Pharmacy Management Consultants (PMC)

Incentives:

“We also met with our medical board and asked them if our service could qualify as a mechanism for healthcare providers to receive their required pain management CME. They supported our request and that ended up being a huge win for our program. In addition to being detailed, clinicians can also get free CMEs.” – Alisha Herrick, MPH, CHES, Center for Health Innovation (CHI)

“Not only is offering CME/MOC credits an educational incentive for providers, but it lends credibility to our messages.” - Meagan Shallcross, MPH, Colorado Assuring Better Child Health and Development (ABCD)

Tools:

“We’re now working on trying some more targeted approaches, like Google Advertisements. For example, if a provider is googling "free pain management CME in New Mexico," our program might pop to the top of the list.” – Alisha Herrick, MPH, CHES, Center for Health Innovation (CHI)

“One of our solutions has been what we call “virtual office hours”. In the calendar slots where a detailer has no detailing visits scheduled, they can hold open office hours, and we send out a promotional email about them to clinicians. Multiple clinicians can be there at once and chat about anything under the umbrella of the HIV care continuum.” – Ashley Allison, Oregon AIDS Education and Training Center (ATEC)

“Near the end of 2020, we met with a couple of different video production agencies to learn more about creating a commercial [to use for gaining access to clinicians] and the resources required to make it come to life.” – Alisha Herrick, MPH, CHES, Center for Health Innovation (CHI)

“We spent a lot of time looking into different platforms for automated appointment scheduling and ended up finding the Appointlet scheduling app. It allows us to manage all of our detailers’ schedules in a centralized place. It’s extremely intuitive and easy to use.” – Ashley Allison, Oregon AIDS Education and Training Center (ATEC)

Our team at NaRCAD recognizes the difficulties detailers face in getting the 1:1 visit, and we’re here to support you! Check out the list below for more resources on gaining access.

Additional Resources on Gaining Access:

NaRCAD Materials Toolkit:
- Introducing Your Campaign: Adaptable Community Letter (NaRCAD)
- Adaptable Calling Script: Scheduling Detailing Visits (CDPHE)
- Decision Tree: Setting up Access Points (CDPHE)
- Opioid Academic Detailing Flyer Example (MAHEC)
- Public Health Detailing Flyer Example (Utah AETC)
- Academic Detailing Commercial (Center for Health Innovation)
- Scheduling a Visit: Fax Template (RxFiles)

Scheduling/Outreach Tools:
- Appointlet: Appointment scheduling platform
- Calendly: Appointment scheduling platform
- Survey Monkey: Pre- and post- evaluation questions
- AETC HIV Care Tools App: Featuring free point‐of‐care tools for clinicians caring for people with – or at risk for – HIV infection
- Pirate Ship Packet Materials: Sample detailing packet

NaRCAD Conference Hub:
- “Using Virtual Tools to Connect with Rural Providers” | Ashley Allison, Lead Training Coordinator, Oregon AIDS Education and Training Center (AETC)
  - Watch Video Recording (presentation begins at 36 minutes)
  - Download Slide Deck PDF
- “Virtual Detailing: Creating Supportive Networks in a Digital World” | Kelsey Genovesse, PA-C, MPAS, Director of Utah Public Health Detailing, AIDS Education Training Center (AETC), University of Utah Infectious Disease
  - Watch Video Recording (presentation begins at 1-hour and 17 minutes)
  - Download Slide Deck PDF

Have any additional questions or thoughts on gaining access? Write to us in the comment section below!

AD-vice: Pearls of Wisdom from the AD Community

1/18/2022

By: Aanchal Gupta, Program Coordinator, NaRCAD

As we kick off 2022, it’s been incredible seeing the detailing community build on new and previous strategies over the past year.

We’re continuously learning and sharing insights together. Let’s take a look at some of the advice shared on our DETAILS Best Practices Blog this past year.

Planning and Team Building: Communication, Trust, Building Morale

“We spend a large amount of time talking in detail about stigma as related to cocaine use. It’s critical that our detailers are comfortable and knowledgeable when speaking about stigma, because it sets the tone for the providers, who then set the tone for their patients.” – Carla Foster, New York Department of Health and Mental Hygiene (NYC DOHMH)

“Programs need to plan for time for back-and-forth communication and to engage as many viewpoints as possible [for their materials development process]. Our modules are accredited for continuing medical education and we have reviewers assess the detail aid to ensure accuracy. We also make sure that detailers, who will be using the material in the field, have an opportunity to try out the materials.” – Ellen Dancel, Alosa Health

“You don’t need to know everything to be a leader, but you need to surround yourself with people who can collectively make decisions based on good information. Surround yourself with people who know more than you do, and listen to them.” – Liesa Jenkins, ONE Tennessee

“Trust is essential for effectively exploring differences of opinion, and how to turn challenges into opportunities. Without it, you don’t get to understand where someone is coming from, or to truly grow and learn.” – Loren Regier, RxFiles Academic Detailing

“For your work to be fulfilling and for you to have that sense of satisfaction, it needs to be meaningful. We want to know that the work that we do matters and that we're making a difference. I find that it can be hard to see that right away with academic detailing.” – Julia Bareham, RxFiles Academic Detailing

“We previously defined success for detailers as the number of visits they had completed in a given period of time. Now, we define success as making a connection or having any type of interaction with office staff, whether that be with front desk staff, an office manager, or a clinician. Focusing on these small wins has been a morale booster for our detailers.” – Anna Gribble, Maryland Department of Health

“I recommend starting recruitment efforts early [for the NaRCAD training] to allow plenty of time to find the right recruits in order to build a successful training cohort!”– Karen Curd, Midwest AIDS Training and Education Center in Indiana

Gaining Access to Clinicians

“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.”– Natalie Miccile, Connecticut Early Detection and Prevention Program (CEDPP)

“Utilize e-Detailing; it’s a wonderful tool! Many developers are coming out with apps to serve this new digital landscape that can assist in implementing e-Detailing successfully. It’s just a matter of finding the right tools by taking a little bit of extra time and patience to experiment.” – Ashley Allison, Oregon AIDS Education and Training Center (ATEC)

“The 1:1 approach is something that separates AD from other tactics, and makes it easier for both clinicians and funding organizations to see you as unique. This work is worth it.” – Harald Langaas, KUPP – The Norwegian Academic Detailing Program

Conducting Field Visits: Resilience, Empowerment, and Leverage

“It takes time to educate providers. It also takes time to alleviate some of those misconceptions that this is “just too good to be true”. So be patient, talk to people, and listen twice as much as you talk to build those relationships.” – Alisha Herrick, Center for Health Innovation (CHI)

“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, Pharmacy Management Consultants (PMC)

“There was [a recent visit I had where there was] no commitment to action or change and we didn’t build a connection. 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.” – Jacqueline Meyers, RxFiles Academic Detailing

Addressing the substance use crisis requires an “all-hands-on-deck” approach. Any setting where patients seek care are environments where detailing can improve patient access to support.” – Clement Chen, Rutgers New Jersey Medical School

Data Collection and Evaluation

“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.” - Lisa Gruss, Quality Insights

“For anyone looking to intertwine AD with their state legislative process, you need to understand what your state’s priorities are. You can start by looking at state plans and guidelines for major health issues, just like the opioid crisis. You may need to do more research to understand where your program fits in and more importantly, who the movers and shakers in your governance are.” – Mary Moody, University of Illinois Chicago (UIC) College of Pharmacy

“Be flexible in your approach – group detailing sessions or detailing sessions with non-clinicians can be extremely effective, and can lead to 1:1 clinician visits. Also, stay organized! Keep track of who you're reaching out to and who you're following up with. Having all that information tracked over time will help with your evaluation down the road.” - Kelsey Genovesse, Utah AIDS Education Center (ATEC)

Our team is incredibly proud to see all the dedication from the community each year. We look forward to seeing what opportunities and innovations 2022 brings.

Best,

The NaRCAD Team

The DETAILS BLOG

AD-vice: Strategies for Successful AD Program Management

AD-vice: Navigating Clinician Stigma During Detailing Visits

Annual AD-vice: Recapping This Year’s Wisdom

AD-vice: Getting the 1:1 Visit

AD-vice: Pearls of Wisdom from the AD Community

Highlighting Best Practices

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The DETAILS BLOG

AD-vice: Strategies for Successful AD Program Management

AD-vice: Navigating Clinician Stigma During Detailing Visits

Annual AD-vice: Recapping This Year’s Wisdom

AD-vice: Getting the 1:1 Visit

AD-vice: Pearls of Wisdom from the AD Community

Highlighting Best Practices

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