By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Adriane Apicelli, MSW, Project Manager, Harm Reduction Projects, University of New Hampshire, College of Health and Human Services.
 
Tags: Harm Reduction, Detailing Visits, Evidence-Based Medicine

Anna: Hi, Adriane. Harm reduction is deeply meaningful to many individuals – can you share why harm reduction is meaningful to you?

Adriane: The core principles of harm reduction, such as self-determination, mutualism, and self-advocacy, resonate with my personal and professional values. I firmly believe that individuals are the experts in their own lives, and it’s essential that people have access to the necessary resources, materials, and support systems to ensure their safety and well-being.

Harm reduction also 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.

Anna: By embracing harm reduction principles, people within our communities can foster empathy and understanding for those facing challenges with substance use. Everyone deserves the same dignity, respect, and access to necessary resources.

Can you tell me about the harm reduction detailing project you’ve been working on in collaboration with the National Association of County and City Health Officials (NACCHO)?

Adriane: We’re currently focused on detailing elected officials in the State of New Hampshire, including city counselors, mayors, and senators. The opinions and decisions of elected officials shape the harm reduction service landscape – they make decisions that either enable or constrain available resources.
​
Anna: Recognizing the influential role of elected officials is crucial when working on public health initiatives, including harm reduction. What is the overall goal of your current detailing project?

Adriane: We want to empower elected officials to make informed decisions that increase capacity of harm reduction services based on the needs of their communities.

We’re currently encouraging elected officials to establish direct connections with individuals who use drugs so they can integrate the expertise from those with lived and living experience into decision-making processes regarding laws, policies, and resource allocation.

Anna: Actively listening to those with lived and living experience helps to better understand how to support specific populations. How did your team decide to focus on encouraging elected officials to directly connect with people who use drugs?

Adriane: During the development of our detailing project, we consulted with local syringe service program (SSP) participants and asked them how they think elected officials can better understand substance use and harm reduction. The overwhelming response was for direct communication between individuals who use drugs and elected officials, or having elected officials spend the day with them to understand their experiences firsthand.
​
We’re trying to figure out how we can facilitate these approaches to ensure the safety and ethical treatment of SSP participants. We’ve also been exploring the possibility of forming advisory committees to incorporate the perspectives of individuals who use drugs in the decision-making process in a safe and supportive environment. 

Anna: Advisory committees certainly help to ensure that voices and perspectives are heard and valued.
​
Let’s transition to thinking about all of your detailing work to date – what makes you most proud to be a harm reduction detailer?

Adriane: The people I detail. We shouldn’t underestimate how hard it is to change our minds, our attitudes, or our behaviors. It takes so much humility and effort to receive and integrate new information, especially when it counters your social values and beliefs. It’s an honor to work through that learning process with those that I detail.

Anna: Do you have a specific example of that learning process that you can share?

Adriane: I detailed someone who was initially hesitant to publicly announce that she prescribes buprenorphine because she was worried how that information would affect her patient panel. We ended up having a conversation about substance use stigma and its implications.
​
We discussed that openly sharing that she prescribes buprenorphine serves as a powerful signal to patients, assuring them that she provides a safe environment to seek treatment. It also sends a message to other clinicians about the importance of prescribing this medication to patients who need it.

Anna: Having those types of honest conversations with people you detail is imperative to changing behaviors and reducing stigma at the individual and community level. Is there anything else you’d like to add before we wrap up today?

Adriane: Remember that it’s much easier to build harm reduction capacity in collaboration with others. Last year, I collaborated with individuals from the public health department, a local hospital, the New Hampshire Harm Reduction Coalition (NHHRC), and a community volunteer to address a concern raised by a business owner regarding improperly discarded sharps on their property.

We formed an informal work group and created a proposal aimed at piloting an anonymous syringe disposal project, installing two disposal units in the community. The disposal units were proposed to be on city property, so we needed buy-in from City Council to be able to do this. We recognized the power of engaging elected officials and presented our proposal to the City Council. Our proposal received unanimous support and it’s currently being piloted in the community. Collaborative advocacy and engagement with members of the community and elected officials can bring about positive change and enhance the health of all.

Anna: We often have more power than we think when we collaborate with others who have similar goals. Detailing is an effective approach for encouraging collaboration and connection with experts in the community, including experts with lived and living experience.
​
Thanks for joining us today, Adriane! We look forward to continuing to hear about your inspiring harm reduction work in New Hampshire.

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

Biography. Since 2020, Adriane Apicelli has served as the Project Manager and primary academic detailer of the University of New Hampshire (UNH), Department of Nursing’s Harm Reduction Education and Technical Assistance (HRETA) project. She holds a Master of Social Work (MSW) from Boston College, where she also earned a Certificate in Management. In addition to her role with the HRETA project, Adriane serves as a nonprofit strategic planning consultant and has previously served as an adjunct professor for the Department of Social Work at UNH.

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Rocko Cook, Public Health Detailer and Public Health Detailing Program Manager, Detailing Improved Sexual Health (DISH), Arizona State University.
 
Tags: Detailing Visits, Evidence-Based Medicine, HIV/AIDS

Anna: Hi, Rocko – thanks for joining DETAILS today! HIV prevention work is critical and often deeply meaningful to those working in the field. Can you tell me why this work speaks to you?

Rocko: I found out I was positive for HIV and syphilis in 2002. I encountered firsthand the stigma and shame associated with these diagnoses. It was devastating, but it’s made me feel even more connected to the work I’m currently involved in.

I’ve worked in various roles in the field of HIV prevention and care since 1994, just two years before medication was widely available. In the 90s, there was little support for people who tested positive for HIV from a care perspective, financial perspective, and housing perspective. We now have the medications and tools to prevent, treat, and support people with HIV.
​
Despite this, there’s an urgent need to continue educating clinicians, staff, case managers, community health workers, and other people who are on the frontlines about these tools and resources. Academic detailing helps to close that gap and gives me the opportunity to live my passion of educating others about HIV.

Anna: Thank you for your openness in sharing your personal and professional experiences. Your passion for HIV prevention and care is evident. What’s the number one thing you want clinicians and staff in your community to do differently when it comes to HIV?

Rocko: I’d love for them to change the culture of the entire clinic space and create a more welcoming environment for patients. There needs to be a focus on consistent communication coming from every professional a patient meets with when receiving care. 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.

It’s difficult to have these conversations. I've been doing this for a long time and I’m not perfect at it either, but once we practice and start getting comfortable with ourselves, then it gets a lot easier to be comfortable with patients.

Anna: Modeling this type of communication during a detailing visit is key. It can help clinicians and staff feel more comfortable having the same conversations with patients. Can you share a story from the field about a positive response or reaction from someone you detailed?

Rocko: There was an agency we worked with that hired a new physician, testers, and medical assistants for their mobile medical and HIV testing unit. They had never worked with this patient population, so our team did several trainings and 1:1 detailing sessions where we role played conversations with patients. We needed to bring them up to speed on how to have gender inclusive conversations and communicate with sex positivity. We had a lot of fun together.
​
The team ended up going to Phoenix Pride to do a big testing event. We were delighted with their success in providing testing to the community and creating a welcoming and safe environment for people interested in being tested. 

Anna: That’s a large event for the mobile unit team to tackle, while also succeeding in creating a safe space for all! Let’s talk a little bit more about the impact on patients. Can you share any data on the impact of your detailing work?

Rocko: We have anecdotal evidence that folks are benefiting from our services. My colleague and I are closely involved in the gay community and people often tell us about their care experiences. We’re in an enviable position because we know a lot of people and hear things in passing. It helps us do a better job targeting our services; we can work directly with clinics that we’ve heard would benefit from detailing.

I also recently connected with someone of trans experience who was tested at Phoenix Pride. They’ve had poor encounters in the past where clinicians and staff assumed the body parts they have. They shared that they had a positive experience with the mobile unit and felt comfortable throughout the visit. Being able to see our impact firsthand has been really motivating for me; it makes my heart sing.
​
Anna: It’s rare to be so closely connected to the community that’s being impacted by your detailing work. It’s clearly been beneficial for your detailing efforts and getting your program up and running. Let’s wrap up with a final question - what has made you most proud of this project so far? 

Rocko: I’m so proud of the way our team has come together and engaged with partners across the state. We’ve been able to leverage partnerships and community relationships to enhance program development, implementation, and dissemination.

I’m also proud of our creativity in choosing our program’s name, DISH AZ (Detailing Improved Sexual Health). We send out a Weekly Special 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, while using food as our motivator!
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Anna: That’s an innovative way to keep your network engaged! We’re looking forward to hearing about your program as your team continues to expand its network and positively impact more people in the community. Thanks for chatting with us today and sharing your experiences, Rocko! Your passion for this work is palpable. 

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

Biography. Rocko Cook serves as the Program Manager 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 Arizona Department of Health and Human Services. Rocko began working in the field of HIV in 1994 and is a community leader with over 15 years of experience implementing prevention and care programs in Arizona, Ohio, and Kentucky. In addition to his duties as a program manager, Rocko has served as a public speaker, presenter at local and national conferences, and as a consultant and leader for HIV community planning groups. Rocko has been living with HIV since 2002 and is passionate about improving sexual health for all communities.

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Meghan Breckling, PharmD, BCACP, Ambulatory Care Pharmacist and Academic Detailer, University of Arkansas for Medical Sciences and Arkansas Department of Health.
 
Tags: Detailing Visits, Opioid Safety, Harm Reduction, Evidence-Based Medicine

Anna: I can imagine having something tangible to give to patients makes clinicians feel more equipped to have these conversations. What other resources were you able to share with clinicians?

Meghan: We encouraged clinicians to utilize a new, free mental health resource called AR ConnectNow. This program provides immediate virtual care to all Arkansans dealing with mental health and substance use disorders. Clinicians were grateful for AR ConnectNow because mental health services are scarce in rural Arkansas; they’ve been sharing it with their patients frequently.

Anna: You must have been proud to be part of a project that had such an impact on both patients and clinicians. How did the harm reduction lens inform your detailing visits for this project compared to your prior pain management-focused visits?

Meghan: Many visits centered on communication with patients. 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.
​
We also focused on naloxone prescribing and administration. We gave out free naloxone kits to all clinicians that they could either keep in the clinic or give to a patient who was having trouble accessing it. Clinicians were open to the idea of prescribing naloxone to patients who were at risk of overdose and open to keeping kits in their clinic in the event of an overdose. Our team had a lot of clinicians say during follow up visits that they felt more comfortable prescribing naloxone and were prescribing it more to patients and family members. 

Anna: It’s impressive how you were able to clearly shift your focus from opioid prescribing to harm reduction and prioritize the relationship between the clinician and patient. Did you receive any pushback from clinicians on harm reduction?

Meghan: Clinicians understood the need for harm reduction services but were more inclined to refer patients out rather than providing services within their clinics. For example, we found that a lot of clinicians were resistant to prescribing Medications for Opioid Use Disorder (MOUD), either because they were uncomfortable with the steps to do so, or they were told by leadership that they should not prescribe MOUD at their practice.
​
It can sometimes take an hour or more for patients in rural areas to access specialty services that offer MOUD. We’re looking at future projects where we can utilize pharmacists to increase MOUD prescribing in partnership with primary care providers. For instance, a primary care clinician could diagnose SUD and prescribe MOUD, while a pharmacist could monitor the patient throughout treatment. It would take a lot of burden off the clinicians and could possibly make them less resistant to prescribing it. ​

Anna: Using pharmacists as an integral part of the care team is an excellent idea – you’ll have to let us know if you receive additional funding for this work! Let’s wrap up with a final question. If another program decided to do a detailing project on harm reduction, what advice would you give them before they went out into the field?

Meghan: You need to take a step back and remember that there isn’t going to be instant behavior change among clinicians. For a topic this complex, it’s critical to have follow-up visits and continue to be a resource and support for clinicians.

Also, be understanding of clinicians and their experiences. They’re dealing with a lot and it’s not easy to change things all at once. Building a relationship and getting a clinician to commit to just one key message is a huge win.
​
Want to learn more? Read about the harm reduction key messages used for this project and the development of those messages on our previous blog post.

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

Biography. Dr. Meghan Breckling is an Ambulatory Care Pharmacy Specialist at the University of Arkansas for Medical Sciences (UAMS) and is a trained Academic Detailer through the National Resource Center for Academic Detailing (NARCAD) within the Center for Health Services Research (CHSR) at UAMS’ Psychiatric Research Institute (PRI). She previously completed a PGY1 Pharmacy Residency and PGY2 Ambulatory Care Residency at the Central Arkansas Veterans Healthcare System (CAVHS). Currently, she is a part of a multidisciplinary academic detailing team comprised of a pharmacist, physician and physical therapist that provide evidence-based solutions, tools and support for chronic pain management to primary care providers across the state of Arkansas. ​

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Shuchin Shukla, MD, MPH, Faculty Physician, Mountain Area Health Education Center (MAHEC), NaRCAD Training Facilitator
 
Tags: Harm Reduction, Detailing Visits, Evidence-Based Medicine, Opioid Safety

Anna: Welcome to the DETAILS blog, Shuchin! You wear many hats - you’re an addiction medicine physician, an academic detailer, and an academic detailing trainer. Tell us how you got started with academic detailing.
​
Shuchin: I had an interest in marginalized populations and did my residency in the Bronx in New York City. I was a clinician in HIV care for several years before moving with my family to Western North Carolina. Soon after we moved, I began working at our Area Health Education Center (AHEC) and it was evident that addiction was the primary public health and clinical issue that was causing the most harm in my community.

Fast forward a few years and one of my colleagues received a Centers for Disease Control and Prevention (CDC) grant and asked if I could attend a NaRCAD training to learn more about AD. The medical board and one of our pharmacists at the Department of Public Health were very interested in using AD for overdose prevention. We started with a pilot where we detailed 10 clinicians and slowly built our program. We now have multiple AD grants we’re working on, including one on adverse childhood experiences (ACEs) and one on harm reduction. ​

Anna: It’s definitely critical to have a community that supports the way you practice, as well your program’s AD messaging. Can you share a final tip for other detailers who are working on harm reduction?

Shuchin: Harm reduction is an emotional topic for a lot of people, especially folks who are in frequent contact with people who use drugs, like emergency room clinicians or people with lived experience in their families.
​
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. 

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

Biography. ​Shuchin Shukla, MD, MPH, was born and raised in New Orleans, Louisiana. He completed medical school and public health school at Tulane University and completed a residency in family medicine at Montefiore Medical Center in the Bronx, New York. He worked in the South Bronx for 5 years following residency, providing primary care for adults and children, as well as for adults living with HIV. He also served as medical director for Montefiore Project INSPIRE, a primary care-based Hepatitis C treatment program. He then moved with his family to Asheville, North Carolina, where he currently serves at Mountain Area Health Education Center (MAHEC) as faculty physician and Clinical Director of Health Integration.

​He is an associate clinical professor of medicine in the Department of Family Medicine at the School of Medicine, University of North Carolina in Chapel Hill, and is a Diplomate of the American Board of Preventive Medicine, Board-Certified in Addiction Medicine. Additionally, he is a Robert Wood Johnson Clinical Scholar. He leads on various initiatives and projects around addiction, HIV, Hepatitis C, homelessness, and the criminal justice system. His main experience as a detailer has been focused on improving evidence-based provider interventions related to opioids, pain, and addiction.

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Jennifer Carefoot, BSc, Pharm, Academic Detailing Pharmacist, BC Provincial Academic Detailing (PAD) Service.
 
Tags: Conference, COVID-19, Detailing Visits, Evidence-Based Medicine

Anna: Hi, Jen! Thanks for joining us on DETAILS today. Earlier this year, your team developed a detailing campaign in one week for the new COVID-19 treatment, Paxlovid, and presented on your work at our NaRCAD conference. I’m excited to learn more about this campaign. Before we jump in, can you give us some background about your organization?
​
Jen: The British Columbia Provincial Academic Detailing Service (BC PAD) launched in 2008 and provides academic detailing to the province of British Columbia. We have 12 full-time pharmacist detailers for the entire province. The program is publicly funded by the BC Ministry of Health and our topics are chosen based on their relevance to primary care clinicians. Here are some quick facts about our program:

• We’ve covered 21 topics since 2008
• We typically conduct about 1,400 to 1,800 academic detailing sessions per year
• We see about 3,500 to 5,000 clinicians per year in a 1-to-1 or small group format 

Jen: Paxlovid was getting a lot of press in the media at the time- it was the first oral treatment readily available for COVID-19. Clinicians knew they would have to know about this medication since their patients would be asking about it.

Anna: New information was coming out every day in the media, which isn’t very common for other detailing topics. How was your team able to stay up to date on the emerging evidence on Paxlovid and continue to keep clinicians up to date?
​
Jen: Our team was able to stay up to date through the excellent communication between our PAD director, Terryn Naumann, the CTC, and the Ministry of Health. We would receive updates via email or video conference daily. We also frequently met internally to share questions, successes, and challenges that we were experiencing in the field.

To keep clinicians up to date, we chose to not provide them with the PowerPoint presentation from the detailing visits because the information and evidence was constantly changing. We’ve created 24 versions to date! Instead, we emailed a one-page resource to clinicians after our visits that included links to online resources that were updated in real time. ​

Anna: That’s one of the benefits of sharing resources virtually – the information can be updated and accessed quickly.

If you were told you had to create another campaign in one week, what would you do differently?

Jen: That’s a tough question! Would we have liked more detailers? Yes. Do I wish there were 24 more hours in my day? Yes. Would we have liked more clinical trial data? Yes. These are all things that are outside of our control. We did the best we could with the evidence and resources we had. I don’t know if we would do it any other way if we had to do it again under the same circumstances.
​
Anna: What you did worked. Do you have any evaluation data from clinicians that you can share? 

Jen: Our formal evaluation showed:

• 95% of clinicians agreed or strongly agreed that they felt more confident prescribing and/or making recommendations to support the safe and appropriate use of Paxlovid after our detailing visits
• For the treatment of mild to moderate COVID-19 and high-risk patients, the information that they felt was the most useful was:
  • the resource page
  • drug interaction checkers
  • trial evidence that we shared

Anna: I’m not surprised by these results! Your team has shown impressive data from myriad detailing campaigns. Before we wrap up, can you tell us how your partnerships and team helped make this campaign successful?

Jen: It’s important to partner with others who have expertise in the therapeutic area you’re detailing on. You don’t need to reinvent the wheel with evidence. Pull from data and evidence that other AD programs or reliable organizations have previously put together and be open to the idea that evidence changes.

Also, remember that it really does take a team! 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. Our team was excited, enthusiastic, and proud to have the opportunity to provide this education to clinicians in our province.
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Anna: Having a team that is open to a challenge and eager to stay up to date on evidence is so important. It’s not realistic for programs to have to create a campaign in a week, but if they ever find themselves in that situation, we know we can all turn to you and your team for support!

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

Biography. Jen is an academic detailer for the BC Provincial Academic Service since 2016 serving beautiful South Vancouver Island. She is passionate about translating evidence to practice, reducing polypharmacy and shared decision making. In her spare time, she enjoys running, gardening, travelling, and spending time with her family outdoors at the lake. ​

Tags: Conference, Detailing Visits, Stigma

Take a peek at the NaRCAD2022 conference materials on our Conference Hub.

Earlier this month, our team at NaRCAD hosted the 10th annual International Conference on Academic Detailing, “Celebrating 10 Years of Community Engagement.” We hopped on the virtual AD bus and heard from programs from across North America and beyond. This year, the conference featured campaigns focused on menopausal hormone therapy, initiation of antiretroviral treatment (iART), falls prevention, COVID-19, biosimilars, antiracist health care, polypharmacy, and opioids. The theme of community engagement was seen throughout the entire 3-day event, and we’re thankful to everyone who joined from around the world. Check out some of the highlights from our 2022 conference below.

Thank you for all your engagement and support throughout the last 10 years of NaRCAD annual conferences! We are humbled to see how much the AD community has grown and are excited to be able to feature innovations at our conferences that have informed your work over the years. Our team at NaRCAD will continue to provide space for everyone to come together to share ideas, ask questions, and network. 

We look forward to seeing you in 2023. 
​
-The NaRCAD Team

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with José Peña Bravo, PhD, Health Educator, Florida Department of Health in Duval County.
 
Tags: Detailing Visits, Evidence-Based Medicine, Opioid Safety, Data

Anna: Hi, José! Thanks for joining us on our DETAILS blog today. Your journey that led you to the academic detailing community is unique – can you share that journey with us?

José: Yes! My background is not originally in public health. I’m a biomedical researcher by training, specifically preclinical research using animal models. My dissertation work was on understanding the neurophysiological changes and different brain regions involved in behaviors related to substance use.
​
My intention was to stay in academia and start my own lab, but my plans changed during COVID-19 and the opportunity to work with the public health department in Duval County presented itself. It’s been a learning curve for me to switch my perspective from preclinical research to public health—it’s been an enjoyable journey so far!

Anna: I’m sure your biomedical research skills have a positive impact with clinicians during your detailing visits too, especially when clinicians want to discuss the neurobiology of substance use disorder. Speaking of visits, your detailing work is funded through CDC’s Overdose Data to Action (OD2A) grant, which seeks to prevent overdoses. Can you tell us about what the work for this grant looks like in Florida?

José: The OD2A project is a team effort across three CDC-funded jurisdictions in Florida. The health departments share that funding with various community organizations, and we all work toward linking patients with substance use disorder to treatment, mental health care, and care coordination services.

Our detailing team is closely connected to organizations and resources within our community, and we share these resources with clinicians during our detailing visits. We also have access to aggregate prescription data from our jurisdiction and are continuing to find ways to present and incorporate this data at our visits with clinicians. We share this data and other resources across our three jurisdictions.

Anna: We’ve found that many AD programs have been successful when they are closely connected to community resources. NaRCAD recently hosted a detailing training for OD2A recipients that you attended. What was it like to train with other jurisdictions working on the same project?

José: It was helpful to hear from other jurisdictions because they’ve all approached their AD work differently based on the gaps in care in their own communities. I was able to hear from AD programs in rural areas and the specific challenges that their patients face with lack of access to care (long travel times, stigma, etc.).
​
I also enjoyed practicing my detailing skills in a space where I felt comfortable making mistakes. It’s valuable to try things out and see how they’ll go before going out in the field. I learned a lot at the training and am excited to try out some of my new skills at my next visit. ​

Anna: Hearing from other detailers who are doing this important work with you is so helpful as you continue to think about and grow your own program. What advice would you tell other detailers working on the OD2A project?

José: 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 better be able to represent what is happening in the community and the resources that exist when you’ve done your research first!

Anna: That’s terrific advice – a key piece of being an effective detailer is understanding the patient experience for the clinical topic you’re detailing on. So, what’s next for your work and Duval County?

José: We’re currently working with our epidemiology team to collect population-level data and present it concisely. We want to be able to efficiently share this data with clinicians in a way that gets their attention and has them compare it to what they’re experiencing in their clinics to ensure an interactive dialogue during detailing visits.
​
Anna: Using data to tell a story helps clinicians see the impact that they have in preventing overdoses and starts a conversation about organizations and resources that exist within communities for patients with substance use disorder. Thanks for sharing your OD2A work with us, José. We look forward to connecting with you and the other OD2A recipients at our conference in November! 

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

Biography. José’s background is in Neuroscience preclinical research with over 10 years of experience in the field. His graduate work focused on the study of rodent models of substance abuse and the neurophysiological changes associated with controlled-substance experience. He has additional experience as an undergraduate and graduate level lecturer in different biomedical research topics. José recently transitioned to a position as health educator as part of the Overdose Data to Action (OD2A) program at the Florida Department of Health in Duval County. His role involves the implementation of the academic detailing program including outreach to clinics, integrating novel data and information to education materials, and keeping track of different metrics associated with outreach and AD sessions.

Tags: Training, Detailing Visits

We are proud to announce that our team at NaRCAD has trained over 1000 people in the techniques of academic detailing. We’ve conducted 60 trainings for detailers working on an amazing range of clinical topics since our first techniques training in 2011. Thank you for growing with us as we’ve expanded from two trainings a year to offering eight trainings in 2022. In honor of reaching this milestone, we’ve compiled testimonials from some of our trainees over the past 11 years.

"Just the right amount of didactic, practice, then putting it all together—I'm ready to develop materials & try it.”

“I now have the confidence to carry out a successful educational visit!"

​“The small groups were perfect for interacting, getting to know each other's backgrounds, and
made conversations and learning enjoyable."

“I came away with refined communication skills and improved clinical knowledge, thanks to the outstanding facilitators.”

“This was fantastic! I learned so much and [am] definitely more comfortable with detailing. It was friendly and open to mistakes, and I really appreciated it.”

“I walked away with great feedback, knowing my strengths and where I can improve.”

“It gave me great insights on the skills I need to be a successful detailer!”

“This training provides the opportunity to learn about AD in an interactive way that allows for growth though practice.”

We look forward to continuing to work with all of you. Read more testimonials on our testimonial page or share your training experiences with us below!
​
-The NaRCAD Team

An interview with Nicole Green, BSP, RPh, ACPR, DPLA, Director of the Ambulatory Pharmacy Services Program at ThedaCare, a healthcare organization based in northeastern and central Wisconsin serving both rural and urban areas.

By: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: Program Management, Detailing Visits, Opioid Safety

Aanchal: Hi Nicole, thank you so much for talking about your program with us today! You’re a pharmacy director at ThedaCare—tell us more about the academic detailing component of your programming.

Nicole: During the past four years working at ThedaCare, I’ve been studying ways in which pharmacists could serve as academic detailers to support opioid stewardship initiatives in order to positively influence prescribing. I was able to collaborate with other physician leaders as well as executive leadership who supported the program, gather data on opioid prescribing, and work on a proposal for academic detailing.
​
We created our first formalized detailing project, called the Ambulatory Pharmacy Services Program, in January 2021. We had four detailers kick off our program and we’ve now doubled our team with a total of eight detailers that have all been trained by NaRCAD. Our detailers are ambulatory pharmacists who are embedded in ThedaCare’s family medicine and internal medicine clinics, serving as both medication experts and pharmacy consultants for patients and providers.

Aanchal: It’s incredible how quickly your program grew! Can you tell us more about the areas you’ve been focusing on for academic detailing?

Nicole: Opioid stewardship is our main focus area for our detailing initiative. Our detailers identify patients who are candidates for Naloxone and work with clinicians to provide education to patients and their family members. The detailers also assess patients who have been on opioids for a long time and determine if they still need to be on them or if tapering should be considered.

The second focus area is comprehensive medication management services for our self-insured population. This includes having our detailers identify chronic disease management gaps and partner with our state employees to optimize care for patients to reduce cost and readmissions.
​
Our last focus area is to support our new heart failure clinic. Patients are referred to this clinic if they’ve been discharged from the hospital with heart failure or if they’ve been referred by a cardiologist. On initial visits, patients see a cardiology provider followed by an ambulatory pharmacist. Our role is to review the patient’s chart and provide recommendations to the team, as well as education to the patients. Our goals are to decrease readmissions and improve guideline-directed medical therapy.

Aanchal: Wow - your team’s impact is tremendous. You previously mentioned that you were able to double your detailing team in less than a year. What characteristics do you believe are needed to have a strong detailing team?

Nicole: Having in-depth knowledge about the clinical topic is extremely important. Detailing is also about building trust and strengthening the relationship with confidence. Detailers need to be confident, especially when they’re first starting out and are meeting with providers that they have yet to build a relationship with.
​
Detailers also need to be prepared to respond confidently and in a way that will still engage the providers in an open conversation. Providers typically don't understand that ambulatory pharmacists’ jobs are to assist patients to meet medication-related goals. There have been assumptions about why we’re delivering this service or why we’re meeting with clinicians. Clinicians ask questions such as, “Is it because I’m being targeted?” or “Is it because of my prescribing practices?”

Aanchal: Agreed; at NaRCAD, we know that having both clinical expertise and confidence communicating is essential to detail successfully. We know what makes a successful detailer – now let’s talk about what qualities you believe make you successful as a leader.

Nicole: The first quality that comes to mind is passion. I lead with energy and show my team how exciting this work can be. I think that's important because previously we didn’t have pharmacists embedded in primary care and patients didn’t have an option to book an appointment with a pharmacist for consultation. Our pharmacists are delivering a service that was not there before. They need to promote themselves and make others aware of how they can help.

Also, I like to be a strong advocate for my team. I constantly raise my hand saying that we can help with different initiatives or that certain projects are right up our alley.

​Finally, 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. ​

Aanchal: These are all core elements in building a strong team. Some situations can feel defeating and having a strong leader that has your back is so important. Lastly, what advice do you have for someone who is new to managing a team of detailers?

Nicole: Prepare your detailers for the field with the most up-to-date clinical content so that they can interact with clinicians confidently.

Also, provide your detailers with training opportunities and use resources like NaRCAD. 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.

Aanchal: Yes, having support and receiving feedback from peers is an important element of building a strong team. Thank you so much for sharing your perspectives with us, Nicole! We look forward to continuing to see your team grow and feature your work at our upcoming conference!  

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

BIOGRAPHY: Nicole Green completed her pharmacy education at the University of Saskatchewan, Canada followed by a hospital residency. She practiced for over a decade as a Clinical Coordinator primarily in the area of cardiology. She has completed year-long learnings through the AIMM (Alliance for Integrate Medication Management) collaborative as well as the ASHP PLA (Pharmacy Leadership Academy). She is the Director of Ambulatory Pharmacy with ThedaCare. She leads the comprehensive strategic plan to embed pharmacists within family and internal medicine clinics as providers and vital members of the primary care clinical team.  She has served as an Executive panelist with GTMRx (Get the Medications Right) and the Institute for Advancing Health Value.

Her program utilizes Academic Detailing as a means of building professional relationships, establishing credibility and influencing prescribing improvements. Much of her team’s work is related to Quality improvement initiatives in medication stewardship and safety as well as maximal performance in Pharmacy related ACO measures.

Nicole has worked with the ThedaCare cardiology team to build a collaborative Heart Failure Clinic where patients see both a cardiology provider and am ambulatory pharmacist.    

This series features tried-and-true practices from our AD experts. This week’s guest blogger is Zack Dumont, BSP, ACPR, MSPharm a NaRCAD Facilitator and Academic Detailer at RxFiles Academic Detailing Service.

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

Tags: Detailing Visits, Stigma, Training

Model the compassion you expect from others.
​
In recent years, the academic detailing community has been trying to recognize the harmful role of stigma in many clinical settings and to include stigma reduction in our detailing messages. In applying this framework, we encourage an empathetic view of people who experience stigma. They don’t choose to have addictions, exhibit certain behaviors, or to be ‘villainous’. We can all agree they don’t deserve harsh judgment and criticism. 

I invite you to bring forth your most charitable mindset for a moment and apply that same framework when you encounter stigma during a detailing visit. 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.
​
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.

Balance and refine your self-reflections.

Alone or with a colleague, find a quick and easy way to debrief after each visit – save the more intense feedback for quarterly or annual reviews. Maybe it’s asking two simple questions like, “What went well?” and “What could have gone better?” and taking a moment to reflect on each.
​
And, just like AD visits which are 90% prep and 10% execution, the more the better when it comes to ‘prepping’ your self-reflection questions. So, “What went well?” could be more specific to one of your strengths:

• How did I bring my warmth and friendliness to the visit?
• What did I do that helped explain the evidence as well as I’m known for?

Your “What could have gone better?” question could focus on an area of improvement unique to you:

• Did I remember to listen more than talk? How many minutes did I spend doing each?
• Did I embrace the prescriber’s skepticism, or did I shy away from it again?

This isn’t easy, but it’s low risk with the potential for big reward… so I encourage you to jump in! 

Want more tips?
Stay tuned for the next installment in our Words of AD Wisdom series, and reach out to the NaRCAD team, subscribe to our network, or check out our discussion forum to hear more tips and ways to train your brain!

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Lexie Hach, Regional Health Specialist, Bureau of HIV, STD, and Hepatitis, Capacity Extension Program, Iowa Department of Public Health.
 
Tags: Detailing Visits, Evidence-Based Medicine, Stigma, Rural AD Program

Anna: Those are some impressive numbers across both the clinical and community settings. Thank you for letting us feature your detailing work and learn more about the impact your team is making in your state!

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

Biography. Lexie Hach holds an Associate Degree in Nursing, Bachelor of Arts degree in Health Promotion and Women’s Health, and a Master of Arts degree in Community Health Education. Lexie is currently a Doctoral student in Public Health (DrPH) with an Epidemiology concentration at the University of Nebraska Medical Center (UNMC). 

Lexie has held positions in nursing, health education, public health, and healthcare marketing. Lexie has been with the Bureau of HIV, STD, and Hepatitis Capacity Extension Program at the Iowa Department of Public Health for over five years as a Regional Health Specialist (RHS). Lexie was previously with the bureau as a Disease Intervention Specialist (DIS). 

Lexie was instrumental in developing and implementing the RHS program in Iowa’s rural communities. In her RHS (academic detailing) role, Lexie educated a variety of different stakeholders on best practices related to HIV, STIs, and Hepatitis in central Iowa. Lexie has helped support the Sexually Transmitted Disease (STD) Program as a DIS due to COVID-19 and also helped as a COVID-19 contact tracer. Lexie was the previous workforce health department co-chair for Iowa’s statewide strategic plan to stop HIV in Iowa (Stop HIV Iowa). Lexie recently returned to her roots in the STD program and now serves as an Integrated DIS and Special Projects Coordinator, but continues to work alongside her fellow RHS colleagues.
 

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Sandeep (Sonny) Singh Bains, PharmD, BCPS, Clinical Educator, Alosa Health. Alosa Health is a national leader in developing and implementing academic detailing programs to improve prescribing.
 
Tags: Detailing Visits, Evidence-Based Medicine, Primary Care, Training

Anna: Hi, Sonny! It’s wonderful to connect with you today and hear about your work as a clinical educator at Alosa Health. What has your clinical pharmacist journey looked like to date?
 
Sonny: I’ve been working for over a decade in hospitals and primary care. I completed my residency in hospital pharmacy, and as I continued to do administrative and clinical work in hospitals, my interests shifted more towards primary care and population health.
 
I’m originally from California where it’s common to have pharmacy involved in primary care. When I moved to Pennsylvania, a lot of clinicians didn’t understand why a pharmacist would be in a primary care setting and were skeptical of me and my role within the clinic.
 
Fast-forward 10 years, and almost every health system in Philadelphia has a pharmacist on their team within their primary care network. I’d like to think that I can take a little bit of credit for paving the way for pharmacists on primary care teams throughout our state!
 
Anna: That’s definitely something to be proud of. How did you end up being a detailer? ​

​Sonny: I’d been noticing a lot of overlap in the work being done in our primary care clinics by different members of the team. I ended up creating protocols to automate certain things for different chronic conditions and people would say, “Wow, this is brilliant.” It really wasn’t brilliant; I was using the same set of guidelines in the literature I was reading and was communicating that to clinicians to make workflows easier. 

​I didn’t know about the strategy of academic detailing at the time, but I knew I needed to educate clinicians. I was fortunate enough to be connected with Alosa Health and I now work for them as a full-time consultant. I work as a detailer and also help hire, interview, train, coach, and mentor new detailers on the team.
 
Anna: You were meant to be a detailer before you even knew what it was! Alosa has been working on diverse clinical topics over the years including, antiplatelets, atrial fibrillation, immunizations for elderly, serious illness conversations, chronic obstructive pulmonary disease (COPD), heart failure, dementia, atherosclerotic cardiovascular disease (ASCVD) prevention, diabetes, acute pain, chronic pain, and opioid use disorder. What have been some of the campaigns where you’ve felt you’ve made an impact?
 
Sonny: It’s a lot of fun to be working on so many different campaigns. Many of the topics fit right into my wheelhouse with my hospital and primary care background. Diabetes has been my favorite topic. I’ve been able to make a large impact for patients and care providers. We’re able to improve lives of patients (prevention of stroke/heart attacks) and improve outcomes for providers and health systems (financial incentives, quality ratings, etc.).
 
I’m also proud to be part of the pain modules. The opioid epidemic has impacted all of us in America and I’m glad to be able to do my part in helping to bring resources and evidence-based treatment to local providers in our community.

​Anna: It sure sounds like you’ve been able to make an impact! How has your work with Alosa evolved over the years?
 
Sonny: Alosa Health has been expanding and we have several new partnerships and collaborations throughout the United States. We started detailing only in the state of Pennsylvania and we’ve now expanded to numerous states. It’s been exciting to be part of the leadership team to help coach detailers, as well as create creative partnerships with local health systems to improve outcomes for patients. 
 
Anna: What challenges have come up as your program has continued to expand?
 
Sonny: The biggest barrier we’ve experienced, like many detailing programs, has been access to clinicians and the ability to set up visits. I’ve had relationships with clinicians and clinic staff in the past where I could have walked into any office at any given time, but I’ve lost a lot of those relationships with COVID and staff turnover. I’ve been working hard to reestablish relationships in the field and teach new detailers how important strong relationships are to our work as detailers. 

Anna: What approaches have you taken to reestablish relationships, as well as to gain access to new clinics?
 
Sonny: I like to partner with colleagues that I’ve worked with previously. I recently connected with a former colleague who’s a VP at a large healthcare organization and we quickly realized we could help each other improve patient outcomes and reduce cost. From this connection, I was able to get buy-in at the administrative level and accessed hundreds of prescribers. They even gave their clinicians a monetary incentive to meet with our detailers.
 
We’ve also 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.
 
Anna: It might take more time to get buy-in from administrators, but it opens so many doors once it’s done successfully. As we wrap up, can you tell us some tips to help our readers be effective detailers and communicators?
 
Sonny:

• Listen to the clinicians you’re detailing; if you're talking more than 50% of the visit, you're probably talking too much.
• Remember that you’re there as a service for clinicians to improve patient outcomes, so try to frame your visit as what’s in it for them, rather than how many key messages you need to get through.
• Clinicians who believe in your service will invite you back and refer you to colleagues. We all love being in the field and educating clinicians, but we can’t get there without first building strong and trusting relationships.

 
Anna: It’s so important to put the work in to build solid relationships with clinicians in order to be an effective detailer. Thanks for joining us on the DETAILS blog, Sonny - our AD community will gain a lot from the insights you’ve shared today!

Learn more about Alosa’s work: alosahealth.org/clinical-modules

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

Biography. Sandeep is a clinical pharmacist with extensive clinical leadership experience in both acute care and ambulatory healthcare settings. He completed post-graduate training at Einstein Medical Center in Philadelphia and has since worked in clinical pharmacy leadership with large healthcare systems in the greater Philadelphia area. He is also the principal consultant at Bains Rx, LLC, a healthcare consulting firm dedicated to improving outcomes while reducing costs.

An interview with Rachelle Woods, MSN, RN, Nurse Consultant at the Colorado Department of Public Health and Environment (CDPHE).

By: Aanchal Gupta, Program Coordinator, NaRCAD
​
Tags: HIV/AIDS, PrEP, Detailing Visit

Aanchal: It's important to leverage others in the community to provide the best care and support to patients. Tell us about CDPHE’s prior successes with HIV PrEP detailing.
​
Rachelle: We had a public health detailer a few years back that focused on PrEP rollout. Between 2014 to 2019, PrEP use increased from 383 to 3,659 among Coloradoans. We’re now working on expanding our public health detailing program and have been focused on partnering with other local agencies to bring the best evidence to clinicians. The Denver Health and Hospital Authority has helped us disseminate relevant updates to providers so that we can better meet the needs of Colorado’s most vulnerable populations. ​

​Biography:
​
Rachelle Woods, MSN, RN brings an expansive clinical, leadership, and professional development background deeply rooted in OBGYN, STI/HIV, Family Planning, Transgender Health, and Infection Control to the Public Health Detailer role at CDPHE.  Rachelle’s passion for all things infectious has afforded her a career rich in opportunity to meet people where they are and engage in robust discussion surrounding STI/HIV transmission, prevention, biomedical interventions and resources, and personal wellbeing. Her audiences have spanned multiple platforms and have included clinical and non-clinical staff, patients/families, teens, and students. Rachelle is looking forward to applying her skills and experience in support and growth of the Public Health Detailer role at CDPHE.

Anna: Hi Trish! Thanks for joining us today. Your team has been working on a number of AD campaigns including, falls prevention, type 2 diabetes, benzodiazepine use in older adults, chronic non-cancer pain (CNCP), and opioid use disorder (OUD). Can you tell us about some of the other recent work you’ve been doing at CEP?

Trish: Our team’s academic detailing work is a big part of what we do, but CEP has other supports as well. We create clinical tools and resources on myriad clinical topics where practice gaps have been identified. Our most popular resource has been our COVID-19 Resource Centre to support primary care clinicians in adapting their practice during the pandemic. It’s become a massive resource that has had over 140,000 downloads.
​
Anna: Wow! That’s an impressive amount of downloads. One of the other priority areas where your team has identified practice gaps is OUD. This topic often has a lot of stigma associated with it. Is this something you’ve experienced with the opioid detailing campaigns?

​Anna: I can see how talking about OUD might make some clinicians feel uncomfortable. What types of resources has your team developed to support both clinicians and their patients to feel more comfortable having these conversations?  

Trish: For our academic detailing visits on opioids and CNCP we developed a resource called Talking Points with Patients, which includes scripts for clinicians to handle different scenarios. For example, one of the scenarios is about a patient asking for a dose increase for an opioid, but the clinician not agreeing that a dose increase will help manage their pain. We also have a Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) Goals resource to help clinicians set goals with their patients by taking the focus off the pain number scale and focusing on actions like, “What activities would you like to do if you had less pain?”

Anna: It’s clear that your team works hard to develop and tailor resources to support clinicians and patients. What kinds of local resources from your community are available for detailers to share with clinicians?

Trish: We often help clinicians find local resources through a program called The Healthline, which is a website that connects patients with social supports, like counseling, food, and safety. We’re also lucky to have Rapid Access Addiction Medicine (RAAM) clinics in our community that are a one-stop shop for patients with OUD where they’re assessed, given support and a plan for tapering, and referred to other community services.
​
Anna: It’s so important for clinicians and patients to be linked to local resources and know that they have a community supporting them. Can you share some data about how clinicians reacted to the opioid-specific campaigns overall?

​Trish: Absolutely! I can share some key findings from our opioid campaigns.
 
Opioid therapy for CNCP AD campaign (n=475):
After the detailing sessions, clinicians indicated they were confident in their ability to have a conversation about tapering when appropriate, even when the discussion was challenging (93.5%).
​
Non-pharmacological and non-opioid alternatives for CNCP AD campaign (n=323):
Clinicians indicated that after the detailing sessions they were confident in their ability to help patients: 

• Set practical (SMART) goals (92%);
• Work through a trial of non-opioid pharmacotherapy (96%);
• Work through a trial of non-pharmacological therapy (93%).

OUD AD campaign (n=250):
Clinicians indicated that the detailing sessions enabled them to support patients with OUD by:

• Referring to local supports and resources (74%);
• Referring to a specialist clinic (61%);
• Initiating opioid agonist therapy (51%); 
• Maintaining opioid agonist therapy (63.5%).

Anna: That’s incredible. It’s obvious that your campaigns have made a huge impact on clinicians. What advice would you give to other AD programs who are supporting clinicians in reducing stigma, especially as it relates to opioids?

Trish: I would recommend remembering three key points:
 
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.

Make space for clinician experiences: It’s important to remember to be sensitive to the clinician perspective. There have been times, especially with opioids, where clinicians have had painful experiences with patients overdosing. Be aware of their perceptions and respectful of the trauma they may have experienced.

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.
​ ​
Anna: That’s beautifully said, Trish. Thank you so much for sharing about your important work in reducing stigma around OUD.  

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

Biography. Trish Rawn is the Clinical Service Director for the Centre for Effective Practice Academic Detailing Service. She is a hospital pharmacist who has been detailing for 6 years on topics such as antipsychotics in the elderly, opioid tapering, chronic pain, diabetes, falls prevention, and benzodiazepine deprescribing.

 
By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Adrienne Butterwick, MPH, CHES, Senior Improvement Advisor and Academic Detailing Project Manager, Comagine Health. Comagine Health is a national, nonprofit, health care consulting firm that works collaboratively with patients, providers, payers and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system.

Tags: Detailing Visits, Evidence Based, Substance Use, Opioid Safety

Anna: Hi Adrienne! We recently saw you present on a panel where you spoke about your academic detailing project with dentists on opioid safety. Can you tell us a little more about how your team got started with this work?

Adrienne: In 2018, the CDC released funds to states through the Overdose Data to Action (OD2A) grant and the state of Utah selected academic detailing as one of the interventions they wanted to use. AD is one of the many different modalities that we use within my organization to reach clinicians to educate them and have an impact on the kind of care they provide.
​
The state began looking at specific regions and populations to target after we received the funding. Utah is unique in that it has a high number of adolescents undergoing surgery for wisdom teeth removal, which is one of the most common instances where controlled substances are prescribed.

A first prescription can be a huge turning point to potentially becoming addicted to a substance, especially at a young age. That’s when we decided to put together a team of two detailers to detail dentists. I was lucky enough to attend each detailing visit and collect data through pre- and post-surveys and answer any administrative questions that came up. ​

Anna: A detailer who can build empathy with clinicians and who has personal experience with a challenging topic is an important asset to have in a detailing program. What obstacles did you face as your team implemented this project?

Adrienne: Connecting with dental offices, in general, was tough. We first started by working with dental associations to get relationships in place. We submitted newsletter articles, attended meetings, presented at the regional conference, and sent our program’s information via their listservs.

We also Googled practices and found ones that had more than one dentist working in the office at a time. We’d cold call those offices and say, “It looks like you have a big operation – is there a way we could bring training in for your team for continuing education credits?”

Before leaving the visits, we’d ask the dentists for referrals to other clinicians and leave flyers behind. Relationships grew organically over time.

Anna: It sounds like the project began to build on itself fairly quickly. Did your team experience any barriers from the dentists during the detailing visits?

Adrienne: We had a lot of dentists who thought the opioid crisis wasn’t relevant to their practice and we knew that we had to find ways to tie it into their profession. Fortunately, dentists have historically been involved in public health movements because they hold a different type of relationship with patients that is closer than a typical relationship with a primary care provider. They see patients more frequently and can detect small changes in health quickly.

The dental profession was incredibly important in the tobacco cessation movement in the 1990s. They were instrumental in getting individuals to reduce or completely stop using tobacco. Dentists are also starting to be trained in domestic violence and human trafficking.
​
For the dentists who were hesitant about the relevance of our detailing visits, we would say, “You have this amazing relationship with patients that we don’t see in other parts of healthcare—here’s how you can make a huge difference!” or “I can understand how there would be a lot of fear to step out of your comfort zone; we have a lot of resources and materials to support you.” ​

Anna: Dentists truly have a unique relationship with patients that can be used to promote countless public health initiatives. Can you think of a time your team was able to empower a dentist to change behavior and encourage them to see their relevance in combatting the opioid crisis?

Adrienne: There was a dental group in a rural part of the state that had one dentist and a big support staff. We came in for a detailing visit and had a conversation with the entire office. 

After the meeting, one of the dental assistants pulled me aside and told me that a patient who had recently completed substance use rehab had visited the office in need of a procedure that would warrant prescribing an opioid. No one in the office knew what to do for pain control and they were all unsure how to approach the patient given his history. She said that because we came, she felt like she now knew how to have a conversation with him about the procedure and his safer, alternative options for pain management.

The dentist also shared that prior to our visit, he often didn’t know how to handle conversations about pain management and opioids and wasn’t sure if it was his job to do so. After our visit, he said he felt comfortable and confident doing this, and shared an anecdote of being able to create a safe space for an ongoing conversation with a recent patient.

Anna: It seems like your team has had such an impact by using one of the core elements of detailing – building relationships through empathy, validation, and support. Can you share some encouragement for readers who are considering having these conversations with dentists?

Adrienne: Be flexible and don’t come in with your own agenda – be sure to let the dentists drive the conversation and let them teach you along the way. It can be a rewarding yet challenging experience – don’t forget to celebrate the small wins on your journey!
​
Anna: Thanks for sharing this innovative approach to detailing, Adrienne! We’re looking forward to hearing about your continued impact with the dental community and beyond.

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

Biography. Ms. Butterwick is a Senior Improvement Advisor at Comagine Health. She is currently working on quality improvement efforts directed by the Centers for Medicare & Medicaid Services (CMS) to improve quality of care for residents living in post-acute and long term care as well as assisted living and home health. She's also working on an initiative to increase advance care practices in those settings.

In addition, through a subcontract with the Utah Department of Health, Ms. Butterwick currently provides educational support for opioid prescribing to family medicine and dental providers. Her work with this contract has earned national recognition and has been presented at the RX Drug and Heroin Abuse Summit in April 2020 and the American Public Health Association’s annual conference in October 2020. She is currently also collaborating with faculty from the University of Utah regarding telehealth and advance care planning initiatives through the Utah Geriatric Education Consortium and Geriatric Workforce Enhancement Programs.

She completed her Bachelors of Science degree in Behavioral Science and Health at the University of Utah in 2007 and her Master's in Public Health at Westminster College in 2014. She has also earned recognition as a Certified Healthcare Education Specialist (CHES).
​
In her 15 years of public health project management she has also worked in rural health research, provider education programs and care management. She has a strong passion for quality improvement and public health. 

Words of AD Wisdom is a series that features tried-and-true practices from AD experts. Our guest blogger this week is Chirag Rathod, PharmD, a NaRCAD Facilitator and Academic Detailer at Illinois ADVANCE.
 
Tags: Detailing Visits, Evidence Based Medicine, Materials

​Simplify your messaging!
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.

​Focus. Focus. Focus.
Resist the urge to cover too much content in your detailing aid during an AD visit. A more focused discussion on one section of your brochure can be more fruitful than trying to cover every key message during a single visit.

​Open-ended questions will set you free!
There is limited usefulness in asking closed-ended questions (e.g., confirming something about the clinician’s practice). The use of open-ended questions can help you gain layered insight into the clinician’s practice and tailor the visit to them. Asking open-ended questions allows opportunities for the clinician to speak about their experiences in detail and for you to listen and deliver supportive, relevant key messages.

Prime your “AD Kitchen.”
In cooking shows, hosts show you how to prep a meal, pulling out the final, cooked meal from the oven in the following scene. For an AD visit, you should think about how you can prep your ‘ingredients’ for clinicians by making sure you’re well-versed in your materials and are ready to teach your clinicians how to adopt something practical and usable into their practice. Have a tool to share? Test it in advance of your visit, so you can confidently demonstrate effective use of the tool, leaving more time to discuss applying the tool successfully in practice with patients.

Biography. ​Chirag is a clinical pharmacist, academic detailer and instructor with Illinois ADVANCE at the University of Illinois-Chicago (UIC). He graduated with a Doctor of Pharmacy degree from Midwestern University in 2012 and has been working at UIC ever since. During his time at UIC, he has been involved in a number of collaborations with the College of Pharmacy, College of Dentistry, and College of Medicine in addition to teaching Medical Improv, which utilizes the techniques of improvisation to improve communication skills amongst current and future healthcare practitioners.
​
He has also been focused on academic detailing, including program planning, presentations to recruit organizations, creating educational material, training staff, facilitating role plays and providing individualized feedback, and detailing prescribers. He trained with NaRCAD in 2019 during their Spring Training Series to develop his skills as an academic detailer and has also presented at the NaRCAD annual conference. His interests include performing improv, podcasting, sports and hanging out with his sister’s dog. Fun fact: Chirag hiked Mount Kilimanjaro in February of 2022. 

We’re featuring a snapshot from academic detailer, Carolyn Wilson, a Senior Health Program Coordinator at Ledge Light Health District.
 
By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
Tags: Substance Use, Detailing Visit

Anna: Hi Carolyn! Can you walk us through how you gain access to clinicians?

Carolyn: Absolutely! When it comes to finding clinicians and getting them interested in our program, it’s really all about word of mouth. The clinicians quickly learn that the information I share is valuable and that I’m respectful of their time. I say things at the end of our visit like, “if you really enjoyed this session, the best compliment that I can receive is a referral to somebody else.” A referral or warm handoff always seems to work for me when gaining access.

I also do a little bit of cold calling on LinkedIn - I share information about our program and attach our flyer. I make sure to mention our continuing education credits, referral gift cards, and swag. Clinicians absolutely love our insulated travel mugs. We’re fortunate enough to have the funding to provide these incentives through our grant.  

Once I’m 1:1 with a clinician, I always try to set the stage during our first meeting, especially if I don’t have a relationship with them. I let them know that I’m a non-clinical health educator and that I have a background in public health. I like to say that I’m a health promoter, not a clinician.
​
I tell the clinician I’m working with that they know how to do their job, but I’m there to support them. I always thank them for their interest and time, which helps to build that relationship and open the door for follow up visits.
​
Bottom line - entice people and let them know your value! At the end of the day, you want clinicians to know that you’re there to help them and that they can access you whenever they need support. 

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

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:
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• “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:
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• “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:
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• “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)

• 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​

An interview with Cheryl Radeloff, Senior Health Educator at the Southern Nevada Health District in the Office of Disease Surveillance.

By Aanchal Gupta, Program Coordinator, NaRCAD

​Tags: Detailing Visits, HIV/AIDS, PrEP

​Aanchal: Hi Cheryl, we’re looking forward to hearing more about your experience in the NaRCAD Peer Connection Program! How did you hear about the program and what encouraged you to sign up?
​
Cheryl: I found out about the 2021 Peer Connection Program from a NaRCAD e-blast and was intrigued with the idea of joining a learning community. I instantly knew that I wanted to sign up since it would be a place where I could feel comfortable asking questions. I gravitated to the fact that I would be communicating with other peers in the field during cohort gatherings and learning about approaches that we could emulate in our program. 

Aanchal: Yes, having that 1:1 time with your peer, as well as the cohort gatherings where other participants in the program come together, are added ways to network with the detailing community. Would you recommend this program to others that are interested in signing up?
​
Cheryl: Absolutely! You should sign up even if you're a seasoned academic detailer or new to detailing. You're going to get tips, insights, and resources to get you started in a welcoming environment. This is a field where you never stop learning so it’s not only an opportunity to share lessons learned, but to learn from others as well. There are people from across the world who have different experiences and expertise that you can take back to your program. 

Aanchal: One of the special aspects of the program is the sharing of resources and ideas. Are there any conversations that you had with your peer that made an impact on your detailing work or changed the way you thought about your program?
​
Cheryl: The time spent with my peer was invaluable. During changing times with COVID-19, it can be daunting, and you tend to wonder if you’re doing things right or where you should even start. She was so generous in talking through challenges such as funding, recruiting providers, and more with me. She even shared a PowerPoint that they developed to educate pharmacy students about academic detailing.
​
During the mid-point peer connection gathering, I was able to learn about a program in Chicago. They were very innovative; if they didn’t have an approach in place for their program, they designed it. Although my clinical topic may not be the same as others, there are still concepts and tools that I can model after these programs. 

Aanchal: It’s great to hear about these fruitful conversations you had and how there’s always something to learn from others in the detailing community. How would you describe your experience overall with the peer connection program?
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Cheryl: Every time I attended a peer gathering, I always learned something and never had to question what I was gaining from these meetings. I think it’s essential to hear about what’s going on in the field. It’s difficult as we’re all busy people, yet it’s important not only for learning and development, but a necessary element to have peers to consult.
​
I found the structure of this program to be helpful as we were given the reins to set up 1:1 meetings with our peer match over several months. In addition to that, there were gatherings where the entire cohort could come together and connect which I appreciated. 

Aanchal: Those are some great takeaways, and we are glad to hear about the impact the program has had on your work! To wrap up, we’d love to learn more about what you’ve been up to at the Southern Nevada Health District.

Cheryl: I’ve been with the Southern Nevada Health District for 13 years. Along with being a detailer, I’m also the public health co-chair for our HIV prevention planning group. We meet a few times a year to talk about HIV prevention initiatives, as required by the CDC. I also work with many of our community-based organizations to talk about the fundamentals of HIV.

Academic detailing has been an important strategy for the work that we do. Our main AD initiatives we've been working on are uptake of PrEP and PEP. We have two PrEP navigators who've been educating the community about these initiatives. Lastly, congenital syphilis has been a big topic for us as we’re currently fourth in the country for the highest rates of syphilis.
​
Aanchal: Thank you so much for sharing your experience, Cheryl. We’re so glad that the Peer Connection Program has had a positive impact on your detailing work and can’t wait to hear more about your program’s AD initiatives in the future. We look forward to continuing these connections with our 2022 cohort!

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

​Biography: Cheryl Radeloff is currently a Senior Health Educator with the Southern Nevada Health District Office of Epidemiology and Disease Surveillance. Formerly she was Disease Investigation and Intervention Specialist II. She is also an adjunct professor of Sociology at UNLV as well as Women’s Studies at the College of Southern Nevada. She received her Ph.D. in Sociology from the University of Nevada, Las Vegas in 2004. Her dissertation “Vectors, Polluters, and Murderers: HIV Testing Policies toward Prostitutes in Nevada” explored the development of mandatory testing laws for legal and non-legal sex workers in the state of Nevada. Her work duties include serving as the public health co-chair for the Southern Nevada HIV/AIDS Prevention Planning Group as well as training community providers on Rapid HIV Testing. She is the co-author of multiple editions of Transforming Scholarship: Why Women’s and Gender Studies Students are Changing Themselves and the World with Michele T. Berger for Routledge Press.

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

Tags: Detailing Visits, Evidence Based Medicine, Pediatrics, Primary Care

​As we’ve jumped right into 2022 programming, our team at NaRCAD continues to support detailing efforts that improve outcomes for vulnerable populations, recognizing that patient needs are complex and often informed by social determinants of health. One critical topic for which we’ve developed resources focuses on detailing to improve patient health as informed by both adverse and positive childhood experiences. We’re seeing an increased need from our community members to support detailing efforts related to this critical topic. We partnered with the National Association of County and City Health Officials (NACCHO), Centers for Disease Control and Prevention (CDC), and consultants from Brigham and Women’s Hospital and Tufts Medical Center over the past two years to develop academic detailing materials for clinicians working with both adults and children. 

​The CDC defines adverse childhood experiences (ACEs) as traumatic events that occur in childhood, including abuse, neglect, and family dysfunction. These events are linked to poor health outcomes in adulthood like chronic health problems, mental health conditions, and substance use. When considering the impact of environment on health, the CDC notes that children are likely to flourish when they have safe, nurturing relationships. These supportive settings create the opportunity for positive childhood experiences (PCEs). PCEs can mitigate the effects of ACEs and toxic stress, promote healing from traumatic events, and foster healthy development and learning in children.

Encouraging clinicians to consider both ACEs and PCEs is a natural fit for clinical outreach educators. There are many reasons that clinicians may not be prepared to have conversations with patients about childhood experiences. Perhaps the clinician doesn’t have a behavioral health provider to consult within their practice, so they don’t know who to turn to if a patient discloses a traumatic experience. A detailer can encourage a clinician to explore this concern, as well as provide a list of local behavioral health providers in the community. 

​Another barrier may be that clinicians could feel hesitant to approach discussions related to trauma, or may not have the skills to do so with sensitivity. In this case, detailers can offer tools that illustrate supportive language that creates a safe environment for patients to share their experiences. Supporting clinicians in using evidence-based tools to build trust with their patients signals that it’s not only okay to talk to patients about this sensitive topic; it’s vital for clinicians to lead these conversations in order to ascertain their patients’ needs and promote patient-centered decision making.   

A detailer can encourage clinicians to adopt new behaviors through specific key messages, including asking clinicians to take the following steps to support adult patients:

• Ask patients general questions about trauma such as, “have you had any life experiences that you feel have impacted your health and well-being?”
• Use supportive language with patients who disclose trauma or ACEs to help build resilience such as, “thank you for sharing that with me. Have you talked about this before?”
• Document patient responses and communicate patient-identified strengths to the care team. Avoid documenting the details of the trauma itself and focus on the impact the trauma has had on the patient’s health and well-being.
• Create a plan in collaboration with the patient that encourages self-advocacy.

When clinicians are supporting pediatric patients, detailers can deliver this set of evidence-based key messages, encouraging clinicians to:

• Identify positive experiences and strengths of the patient by asking questions such as, “which adult(s) besides your parents is/are important part(s) of your life?” or “who could you call to help if there was an emergency?”
• Ask about social determinants of health. Understanding how family and community environments impact growth potential helps to improve health outcomes. Questions can address:
  • housing security
  • food security
  • transportation needs
  • utility needs
  • interpersonal safety
  • employment
  • family and community support
  • education
  • mental health
• Use a screening tool to evaluate potential ACEs if indicated. Formal questionnaires provide a structured way to identify adverse and positive childhood experiences, but routine screening for all patients is not currently recommended.
• Evaluate ACE screens based on the child’s current health. If abuse, neglect, or family disruption is going on, there may be an immediate need to intervene. If the child is safe, provide resources to the family and patient.
• Explore collaborative interventions with patients and families. Effective problem-solving of ACE challenges can foster and encourage post-traumatic growth.

With evidence-based tools, successful AD interventions related to ACEs can result in multi-faceted support for patients, such as stronger connections with community resources, mental health supports, and more trusting relationships between clinicians and their patients.
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We hope to continue to explore this important and complex topic together as a community. If your program is currently working on an ACEs or PCEs AD campaign, or is interested in starting one, please reach out to us so we can support the development of your programming. We always love collaborating and learning more about the important work that you’re doing, and we hope to continue to build our resources and create toolkits in support of complex topics such as these that intersect with other behavioral health and prevention-focused AD campaigns.