By: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: Detailing Visits, CME, E-Detailing
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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​

Aanchal Gupta,  NaRCAD Program Coordinator

Tags: Conference, Detailing Visits, Stigma, ​E Detailing, ​Opioid Safety
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​Take a peek at the NaRCAD2021 conference materials on our Conference Hub.

An interview with Kelsey Genovesse, PA-C, MPAS, Public Health Detailer and Clinician, AIDS Education Training Center (AETC), University of Utah Infectious Disease. The public health detailing program at the AETC is currently focused on expanding pre-exposure prophylaxis (PrEP) throughout the state of Utah and educating clinicians on STI prevention and guidelines for correct treatment.

by Anna Morgan, MPH, RN, PMP, NaRCAD Program Manager

Tags: Detailing Visits, ​E Detailing, ​PrEP

​Anna: Hi Kelsey! Thanks for joining us on DETAILS today! Can you tell us a bit about your background, your current role, and your program? 
 
Kelsey: I’m a physician associate (PA) by training and previously worked in family practice with underserved communities, including migrant farmworker populations and patients in federally qualified health centers.
 
Our program in Utah is tiny; our AETC only has three or four employees. I do the outreach, schedule the detailing sessions, detail the clinicians, collect the data, and evaluate the program. We’re fortunate that our first year was so successful and we’re looking forward to continuing to expand our program over time. This year, we were even nominated for a Utah Telehealth Education Award!
 
Anna: That’s incredible – what a great accomplishment! Your program is unique in that it started with e-Detailing right from the beginning. Can you tell us a little bit about that?

Kelsey: We attended an in-person Public Health Detailing Institute run by the San Francisco Department of Public Health in partnership with NaRCAD in March of 2020. We had planned to focus on in-person detailing only in Northern Utah because we didn’t have the capacity to drive all over the state. Shortly after we left the training, the pandemic shut everything down and we had to move our program to a virtual platform. We couldn't put the program off because our funding timeline wasn’t changeable, so we gave e-Detailing our best shot.
 
Anna: Your attempt at e-Detailing turned out to be quite successful. Can you tell us more about the nitty gritty of pivoting to e-Detailing?
 
Kelsey: Absolutely. When it became clear that we were moving to e-Detailing, we had to recreate our entire plan. We began with strategizing about outreach to clinicians.
 
Nobody in Utah knows what public health detailing is - this is not a model that has been used here before. We had to get creative about spreading the word about our program. We connected with experts on our topics and clinicians who were already doing a lot of training on PrEP and asked them if they wanted to do a detailing visit with us. This was extremely successful, and we received referrals and warm handoffs to other clinicians from those initial visits.
 
We also used a lot of listservs so that we could contact multiple clinicians at once. We worked with the Utah Department of Health and gave them a flyer we created about our program that was sent to all the clinicians on their listserv. We even connected with local medical groups, like the Utah Medical Association, a PA Association, and a Nurse Practitioner Association. These approaches brought in a lot of clinicians for detailing visits and helped us spread the word.

​Anna: Rather than emailing each clinician and sending out hundreds of individual emails, you targeted hundreds of clinicians at once – I love that approach! It sounds like you also had some great AD champions in your network.
 
Kelsey: Yes. I found that I was also doing a lot of e-Detailing sessions with folks who were not clinicians but were involved in the healthcare system in another capacity. I discovered that when I was connecting with these folks, whether it be someone at the health department or a representative from a health-based community program, they were wonderful champions who knew a lot of clinicians. Visits with these non-clinicians also helped spread the word about our program and open access even more. 
 
Anna: Many programs have faced challenges when gaining access virtually, but you were able to overcome many of these challenges with your innovative approaches. Has your program faced any other challenges with e-Detailing? 
 
Kelsey: We frequently detail clinicians who are short on time. I’ve tried to create a schedule where I have a little bit of availability, almost seven days a week, so that there are more options for clinicians whose schedules are busy. I also try to keep the detailing visits focused on the topics that clinicians are most concerned about. I always send them a comprehensive follow-up email with the resources they've asked for after the visit. 

Anna: Clinicians’ limited time is a common challenge for detailers—these strategies are helpful to employ when this challenge arises. Do you see specific opportunities with e-Detailing that you wouldn't see with in-person visits?
 
Kelsey: Yes! Within our first year, we connected with providers in rural areas that may have taken us a longer time to gain access to using an in-person approach.

Anna: That’s a great point, especially for a state as large as Utah. Do you envision incorporating any in-person detailing in the future? 
 
Kelsey: We’ve had a few clinics that have asked for us to come in person, but as we just discussed, it can be time-consuming. However, there is something to be said about showing up and seeing what a town or clinic looks like in order to understand a community structure better. We’re going to try adding it in in the future.
 
Anna: Being physically present in a clinic can certainly help with assessing the needs of a clinician. You mentioned earlier that within your role you’re not only doing outreach and detailing visits, but you’re also working on your program’s evaluation. Can you share a bit about that?
 
Kelsey: Kristefer Stojanovski, MPH, PhD, the Evaluation Specialist from San Francisco Department of Public Health, has helped us tremendously with our evaluation work. We have pre- and post- surveys for clinicians to fill out with each detailing visit to collect data related to their knowledge around the clinical topic. It has an open format at the end to allow clinicians to request certain information prior to their first visit and leave feedback and comments. I'm hoping that as our sample size increases, that the data starts to look a little bit more robust.
 
At the end of last year, we also sent an email asking clinicians to give us feedback on how they felt their experience was and if they felt like this was a program that was worth continuing. At least a third of our detailed clinicians sent back responses, and all of them were very positive. Most of the feedback reflected on how useful the information was when it was tailored and directed to their personal practice. A couple of clinicians noted they felt they were practicing to the standard on the topics, but detailing helped them gain knowledge they were unaware they were missing. It was nice to see that folks felt that it was useful.

​Anna: We’re excited to hear more about your evaluation as you gather more data. We'll wrap up with our final question: what’s one piece of advice you'd give to other programs that are just starting out, specifically with e-Detailing?
 
Kelsey: Be flexible in your approach – group detailing sessions or detailing sessions with non-clinicians can be extremely effective, and can lead to 1:1 clinician visits. Also, stay organized! Keep track of who you're reaching out to and who you're following up with. Having all that information tracked over time will help with your evaluation down the road.
 
Anna: That's fabulous advice, Kelsey. We’re looking forward to continuing to watch your program grow and succeed!

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

Biography. Kelsey Genovesse is a Physician Associate with the AIDS Education Training Center and University of Utah Infectious Disease Department. After eight years in underserved family medicine Kelsey started the Utah Public Health Detailing Program to expand support and education to providers throughout the state of Utah on evidence based practices surrounding STIs and PrEP. She also provides care in the Free HIV PrEP Clinic with the University of Utah offering in person and virtual services to help expand access to HIV Prevention throughout the state of Utah, specifically to those without insurance. In June 2021 she was Nominated for a Deborah LaMarche Telehealth Excellence Award for her work with the Utah Public Health Detailing Program.

An interview with Ashley Allison, Lead Training Coordinator, Oregon AIDS Education and Training Center (AETC). Ashley works with health departments and clinic systems to coordinate HIV-related training across the state ranging from prevention to care and treatment. She also oversees the detailing program where their main goal is to expand PrEP access in Oregon.

by Anna Morgan, MPH, RN, PMP, NaRCAD Program Manager

Tags: COVID 19, Detailing Visits, E Detailing, ​HIV/AIDS, ​PrEP

​​Anna: It was so nice to catch up on your team’s progress at our recent virtual training with the San Francisco Department of Public Health! Your program launched about two years ago and really took off when you pivoted to e-Detailing. Can you tell us more about that?
 
Ashley: Our program started with in-person visits and we would send our detailers out with a little briefcase of materials and an iPad full of slide decks—it was pretty “old school”. When the pandemic began, we had to take a hard look at our entire program to successfully pivot to e-Detailing.
 
As we began e-Detailing, we developed an outreach process and approach that has been working well for us. Here are a few of the steps and considerations that you can share with other new programs:

• We start by mailing out packets to clinicians with our state’s endorsement letter, a very simple explanation of our program, and detailing materials.

• Our materials are bright and colorful, and we made sure they align with the state's HIV campaign branding colors.
• We also include a card with a QR code that clinicians can scan to schedule an appointment directly with a detailer. (If a clinician doesn’t respond, we send a follow-up email with information about our program and links to schedule an appointment.)
• If a clinician schedules an e-Detailing visit, we then send digital copies of our materials in advance of the visit. However, we continue to believe in the value of having hard copies that they can keep in their lab coat and pull out as needed. It’s also much easier for our detailers to reference the hard copies that we mail with our packets during their virtual detailing visits.
• Throughout our outreach process, we track how we’re targeting each clinician that engages with us (e.g., through a referral, through a training, or through the National Clinical Consultation Center’s (NCCC) line on PrEP). By tracking this information, we’re able to evaluate where we’re finding success in connecting with clinicians, and where we need to try a different approach.

 
We’re trying to find new ways to engage clinicians who’ve received the materials but haven’t yet scheduled a detailing visit. We want to provide multiple entry points and make our detailing visits more accessible. 

Anna: Thanks for outlining this process and giving us a better understanding of how your program gains access to clinicians! What do you do to connect with clinicians who have yet to set up an appointment?
 
Ashley: 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. The detailer slowly shifts the clinicians who attend office hours into a detailing relationship by creating opportunities to meet again 1:1 to further discuss certain topics.
​
Anna: That’s such an innovative approach in gaining access. Can you discuss some of your team's other recent successes as it relates to virtual detailing?

Ashley: Virtual detailing has allowed us to increase our number of detailing visits due to the decreased number of resources and time required to complete an e-Detailing visit, including scheduling. 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.
 
We’ve also switched our evaluation from a handwritten survey to a digital version on Survey Monkey. We made our survey significantly longer when we moved it to Survey Monkey and pulled a lot of our questions from example surveys from other programs and the national HIV curriculum website.
 
Our questions are specific to knowledge, attitudes, and practice and allow us to distinguish if a clinician isn’t doing something because they don’t have the knowledge, they don’t feel comfortable, or they don’t see it as within the scope of their role. Despite the lengthier survey, our response rate has been much higher now that we can send follow-up emails with the survey link right in it.
 
Survey Monkey has also allowed us to quickly review the pre-evaluation data prior to detailing visits. If there are any red flags, we can highlight it for the detailers so they can customize which key messages will likely resonate with the clinician during their visit.
 
Anna: ​That's great. There are certainly advantages to using a virtual platform to conduct the different steps of the program process. What are some of your goals for the remainder of 2021?

Ashley: We want to start implementing a successful hybrid model of in-person detailing and e-Detailing while also training our new detailers in a robust and consistent way.
 
We want to continue with our main goal of increasing the number of PrEP prescribers in Oregon and making it more accessible across the state. We also want to start detailing pharmacists, depending on how the current legislation lands around providing supports for pharmacists to prescribe PrEP. We feel confident in our key messages for primary care providers. We’re excited to start crafting our key messages in ways that appeal to pharmacists and address the different barriers to implementation for them as well.
 
Anna: Those are excellent goals! What’s one tip that you would offer other academic detailing programs who’d like to replicate your success?
 
Ashley: Utilize e-Detailing; it’s a wonderful tool! Many developers are coming out with apps to serve this new digital landscape that can assist in implementing e-Detailing successfully. It’s just a matter of finding the right tools by taking a little bit of extra time and patience to experiment.
 
I would also say that it’s important to build a relationship with your state’s health department leadership and obtain an official endorsement letter from the state supporting your activities. Establishing a relationship not only positively impacts your program’s visibility and ability to gain access to clinicians, but it also helps to make sure you're aware of other outreach initiatives, which allows you to align efforts and not duplicate processes.  
 
Anna: ​Terrific advice, thanks, Ashley! You’ve given us such a unique perspective on e-Detailing. We look forward to continuing to hear about all of your team’s successes and groundbreaking ideas.
​
Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography. 
Ashley has been with the Oregon AETC since 2018 where she works to bridge the gap between local public health priorities and education and training opportunities available to providers.  Before joining the Oregon AETC, Ashley spent over two years working for local and international HIV focused CBOs in Johannesburg, South Africa. A majority of her work in Johannesburg focused on grant writing and managing the implementation of community-based HIV medication adherence models in partnership with provincial and municipal public health.  Prior to moving to Johannesburg, Ashley spent five years working at Planned Parenthood in Portland, OR occupying a variety of roles, including clinic assistant, phlebotomist, patient advocate, and call center representative.  Ashley credits her passion for supporting patient access to quality HIV prevention and care to the experiences she had with patients while providing HIV testing and counselling services at Planned Parenthood.   

Anna Morgan, MPH, RN, PMP, NaRCAD Program Manager

Tags: Conference, COVID-19, Deprescribing, Diabetes, E-Detailing, Elderly Care, Health Disparities, HIV/AIDS, International, Jerry Avorn, Mental Health 

Over 240 members of our worldwide community came together to be a part of something special--our 8th annual conference, and our first in a virtual setting. We were able to expand our reach and overcome barriers like travel time and financial constraints that have prevented our colleagues from attending previous conferences.
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There was a palpable sense of positivity, enthusiasm, and resilience, especially in a virtual space. We’re so proud of evaluations that cited a renewed sense of passion and commitment to AD based on the new lenses we applied to our programming, including comments about feeling “empowered” to continue this work in the year ahead (even amidst inevitable Zoom fatigue.) 

• Our director Mike Fischer reflected on how academic detailing can play a role in social determinants of health and health disparities.

• Presenters who’ve been working on diverse clinical interventions shared work and reflected on the ways AD can impact underserved patients, including veterans with mental health conditions and substance use disorder, as well as undocumented women who need access to comprehensive women’s health and related services.

• Interactive breakout workshops focused on peer-to-peer learning, with concentrations in AD for newcomers, using storytelling approaches with clinicians, and building program branding.

• A deprescribing plenary looked at the importance of specific approaches to detailing within long-term care settings to improve elderly patients’ health.

 

• In his annual “AD Talk”, NaRCAD co-director Jerry Avorn shared his perspectives on COVID-19’s impact on detailing, particularly a need to continue adapting to virtual AD sessions.

 

• For our e-Detailing panel, presenters shared nuggets of advice for those considering the pivot to virtual visits, including being flexible, having materials prepared ahead of the visit, and casting a wide net for provider recruitment.

• Another novel panel emphasized the key role of pharmacy to combat the opioid crisis, including a new lens on the impact of training pharmacy students in program planning and implementation.

• In a special presentation about detailing on Type 2 diabetes in ACOs and Community Health Centers, panelists reflected on the importance of preparing organizations for an AD campaign knowing your community’s unique identity, as well as highlighting community resources for providers AND patients.

• Three experienced detailers participated in a “live interview”, answering audience questions on recruitment, gaining access, defensive clinicians, how to maintain positivity, and more.

 

• A special presentation on HIV prevention and treatment gave attendees a look at robust data from the CDC, a new perspective on AD and HIV treatment through iART (immediate antiretroviral treatment), and evaluation strategies and results of a sexual health AD campaign.

 

• Global field presentations shared new perspectives on researching one-to-one visits vs. group visits in Norway, pivoting quickly to a COVID-19 campaign in Canada, and using the principles of academic detailing for patient education in Australia.

 

• Our new “Yearbook” session featured three new programs who have made impressive strides in their work over the past year, sharing 2021 plans for continued success.

With so many of you expressing a continued need around more of our peer working sessions, we’ll be focusing largely on that in 2021—we can’t wait to support your work this year. In the meantime, tell us what you need to make next year a success.

See you in 2021.
​

The NaRCAD Team




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

Overview: The DETAILS blog presents a special two-part series of what it takes to build a strong provider-detailer relationship from the perspective of a long-time academic detailer and  from one of her local physician partners that she's detailed for almost 15 years. 

In Part One, we speak with Amanda Kennedy, PharmD, BCPS, who serves as the Director of the Vermont Academic Detailing Program and has been an active detailer since 2002. The Vermont Academic Detailing Program sees about 450-500 providers a year on 1-2 clinical topics. In Part Two, we hear from Dr. Robert “Bob” Schwartz, a Vermont family physician who reflects on his experiences with academic detailing visits with Amanda. Stay tuned for Part Two!
 
An interview with Winnie Ho, NaRCAD Program Coordinator.

​Tags: COVID-19, Detailing Visits, E-Detailing

Winnie: Amanda, thank you for taking the time to reflect on the relationships you’ve built through the years with local providers. What would you say are the key elements for building a strong provider-detailer relationship, and why?
 
Amanda: Trust and mutual respect. If the clinician doesn’t trust you, then it’s going to be very hard to make recommendations for practice change. Mutual respect goes both ways. As much as I am providing a service, I also expect the clinician to show up and be engaged in our visit, because only then can we have the kind of conversation that gets at the heart of the behavior change we hope to see.

​W: Engagement is such a key component of these visits, especially for creating a safe space for providers to be open and honest with the detailers about their concerns and needs. I want to take you back to the start and ask you to reflect on what it was like to be brand new to AD. What advice would you give to a new detailer in those shoes?

​A: Confidence is key. You can study and practice everything with your team, but at some point you have to get out there and just do it. Building that relationship requires confidence and the belief that you have something valuable to offer. When you only have a few opportunities a year to meet with clinicians, you have to capitalize on those moments.
 
It can be difficult to establish that rapport and trust when contact is infrequent. It’s about persistence, patience, and continuing to show the clinician that you want to be helpful. Some things can get in the way, such as not having the same clinical background as the provider you’re working with, and not always feeling qualified. But remember, you wouldn’t have been hired in this role you weren’t qualified!
 
W: That’s certainly important to keep in mind. You were also recently introduced to a new playing field – virtual visits. Compared to traditional in-person visits, what’s it like starting new relationships through e-Detailing?

​A: Virtual visits can be efficient, because we eliminate the cost of travel, we can reach more people and more often. Most of the content of that first call is the same as in person. On a first visit, most of what you’re doing is the introduction of your work and your program. I’m transparent about everything with them.
 
I don’t bring up my materials or share my screen until that clinician has had the opportunity to ask me any questions they have. I give them a chance to see me as a person first, without distractions. This takes a few minutes longer virtually than in person, and it can be harder to gauge body language, but it’s an important first step in establishing a relationship.
 
W: That’s a good piece of advice for many programs making that transition into e-Detailing, as I know it was a big concern about starting these relationships over a new medium. Do you have an example of how maintaining these relationships can support better health outcomes for patients?

A: Yes. While our team was putting together information on a COPD campaign, I was meeting with Dr. Schwartz on a different topic. At the end of our visit, I told him about the next topic and asked him what was concerning him about it. He asked for more information on benzodiazepines and patients with COPD. While this specific information wasn’t included in the overall COPD campaign, I’ve personally been looking for good articles that would be helpful for his particular interest. In attending to this specific request, I’m showing him that I’m listening to and addressing his need.
 
W: That’s some strong needs assessment! And I’m sure that information will be put to good use. You’ve been in this field for 18 years - have you seen how your support has resulted in clinical behavior changes over the years?
 
A: The most rewarding thing for me is going into a clinic and seeing a tattered version of a handout we used five years go, or a clipped out table taped up on a board. That’s how you know your information has stuck around and has had a long-term impact.

​Also, on visits, if a provider is struggling to think of how to incorporate a behavior change into their practice, I have stories from other providers and can provide suggestions and ideas that have worked for them. I can leverage a community of long-term relationships.
 
W: Have you found that these strong relationships allow you to get more out of a detailing visit, especially when there are some difficult conversations?
 
A: Yes, absolutely. It’s important to know, especially right now, that we’re suffering a community-wide trauma because of COVID-19. Out patients need their providers, but those providers have their own challenges going on too. There are family issues, financial issues, and community issues. Our jobs as detailers is to be a support as much as we can, and to help providers make beneficial changes for patients that are rooted in evidence.

​We’re currently doing a topic on managing stress related to COVID, but before we get into how providers can help their patients, we pause and ask them how they’re doing. I’ve had providers share deeply personal information with me that can be important in understanding how to best support them in addition to them supporting their patients. They know that they can trust us.
 
W: As we wrap up, what would your final advice be to other detailers looking to replicate your success?
 
A: My advice? It doesn’t take 18 years to build a relationship with someone. It just takes enough of your effort to show that you’re really trying and taking opportunities to be of service. It means showing that you’re trustworthy, and that you’re going to respect and support them just like you’re promising them that you will.
 
(Part One of Two).

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

Amanda Kennedy, PharmD, BCPS, is the Director of the Vermont Academic Detailing Program at the University of Vermont’s Office of Primary Care. She has also been an active academic detailer for nearly 20 years. Amanda regularly serves as a faculty facilitator for NaRCAD’s Academic Detailing Techniques trainings.

​In addition to her role with academic detailing, Dr. Kennedy is a Professor of Medicine at the University of Vermont’s Larner College of Medicine. She currently serves in the Department of Medicine Quality Program, teaching and mentoring physician residents, fellows and faculty in quality improvement and health services research.

An interview with Vishal Kinkhabwala, MD, MPH, HIV Prevention Activities Coordinator, HIV Prevention Unit, Michigan Department of Health and Human Services. The overarching goal of the HIV Prevention Unit is to expand access to PrEP for patients throughout the state of Michigan.

by Anna Morgan, MPH, RN, PMP, NaRCAD Program Manager

Tags: Conference, Detailing Visits, E-Detailing, HIV/AIDS, PrEP

​Anna: We’re so happy to be catching up with you today, Vishal! Can you tell us a little bit about yourself and how you got into the work of academic detailing?
 
Vishal: My background is in both public health and medicine. After finishing medical school, I realized that as much as I loved the clinical aspect, I wanted something that combined both my passions of public health and clinical medicine. My first job after graduating was in New York where I linked newly-diagnosed HIV patients into care. About a year later, I found an opportunity at the Michigan Department of Health and Human Services that fit with what I ultimately wanted to do, HIV prevention.
 
My current work is focused on ending the HIV epidemic in Wayne County. One of my favorite parts of my job is detailing, which I do part-time. Our program officially began detailing in September of 2019. We’re in the process of making the jump to e-Detailing, but we’re still in the planning stages.

​Anna: Before we chat about how you and your team have been preparing for e-Detailing, let’s talk about how clinicians in Michigan have received your messages around PrEP. Were clinicians receptive to your detailing efforts when you were conducting in-person visits?
 
Vishal: Most clinicians that we detailed were either already familiar with PrEP or had that enthusiasm to learn about it. Many of the clinicians were excited about helping with MDHHS’s overall goal of increasing patient access to PrEP and talking about the associated HIV prevention counseling.
 
Clinicians were typically familiar with PrEP but weren’t aware of the nitty-gritty details of how to prescribe and manage it. A big part of what we discussed during our detailing visits was identifying which patients are candidates for PrEP. Our program’s purpose is to increase access, even if it’s just for one or two patients.

​Anna: It’s wonderful that the clinicians you’ve detailed have been supportive of your program’s goals. Transitioning to e-Detailing will certainly be easier knowing that you have support from clinicians. What have you learned so far from planning for e-Detailing?
 
Vishal: It’s been fun prepping for e-Detailing with our team. The big thing I’ve learned through networking with detailers from other jurisdictions is to be flexible and be prepared for any situation, especially in the virtual environment. You might have one idea of how your session will go, and it could go in the opposite direction, which is part of the charm of detailing. It’s about forming a connection and tailoring your methods to what the clinicians' and practices' needs are. I’m a relationship-oriented person, and I feel like that’s one of the most rewarding parts of doing this.
 
One of the things that also excites me about virtual education is the access to information right at your fingertips. For example, I was detailing a clinician about PrEP and HIV prevention last year who asked me, "Well, I have this issue with a lot of patients with STDs. Can you talk to me about STD treatments?" It was an in-person visit, so I only had the materials that I had brought with me, which were all focused on HIV.
 
The beauty of doing e-Detailing is that you can have resources pulled up and can get the information for the clinician almost instantaneously. As I said earlier, detailing is all about having that relationship, meeting the clinician where they're at, and serving their needs. Virtual education gives you another tool to be able to do just that.

​Anna: What a positive spin on e-Detailing! Speaking of sustainability, that’s the theme for our upcoming conference. You attended our conference last year in Boston and will be presenting at our virtual conference this year. What were some key takeaways from last year’s conference that you were able to bring back to your program and implement?
 
Vishal: Last year’s conference was my first exposure to NaRCAD and the world of detailing- it was honestly one of the coolest experiences I’ve ever had. It was great to be exposed to e-Detailing through the virtual detailing panel before it was even brought to the forefront during COVID.
 
Because I was hired a few months prior to the conference, I had not attended a training yet. I joined the “AD 101” breakout group, which was supremely helpful.  When I got home, I did mock detailing sessions with my colleague and reviewed all the resources on the NaRCAD website. I also practiced detailing on the stress balls I have in my office!

​Anna: It’s so nice to hear how impactful the conference was for you as a new detailer. We strive to include a diverse audience of new and veteran detailers each year. What are you looking forward to most about this year’s conference?
 
Vishal: There are so many absolute rock stars in the field of detailing. I’m looking forward to getting to see familiar faces and meet new faces over the virtual platform. I’m excited for the exchange of ideas, programs, and concepts. So many people have given me ideas for our program in Michigan.
 
It’s such a good feeling when I can say that not only have I received help from others, but that I’m able to inspire other people. It’s also comforting to know that this is such a passionate group of people that no matter the adverse situation, the work continues getting done. I’m counting down the days until the conference in November!

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Jerry Avorn, MD, Co-Director, NaRCAD

​Tags: COVID-19, Detailing Visits, E-Detailing, Jerry Avorn

​​The pandemic has changed everything about our lives and our work. Some occupations have been able to adapt to the new abnormal, such as programmers and financial traders. Others have found it harder to do their jobs as before, like brain surgeons and academic detailers. For the latter, in a socially-distant, avoid-human-contact world, how can we pursue an activity that has as its very definition in-person, interactive communication?
 
Academic detailing programs around the country and the world have been grappling with this challenge. And unlike our colleagues the brain surgeons, we have been able to come up with some plausible solutions, even if nothing is quite the same as being up close and personal. We’ve been learning about the virtues and limits of Zoom/Skype/WebEx.  If we’re paying attention, using them can bring into sharp focus the central aspect of interactivity, on steroids. It’s a little like becoming a better runner by strapping weights on your ankles (or so my athletic friends tell me). A non-adept academic detailer can mis-use a Zoom encounter even worse than a face-to-face one: “Sit still for 20 minutes while I do this presentation at you.” That will fail on a platform even more calamitously than it does in person. (One clue is when the prescriber mutes their video to read their e-mail.)  But if we’re open to it, the e-encounter can focus our attention even more on whether we’re learning where the clinician is coming from, getting feedback, actively asking what sub-topics they most want us to cover.

​The artificiality and forced intimacy of a screen-to-screen encounter, and the reason we currently have to do our work like this, can also focus us even more on another key aspect of academic detailing, empathy. “How are you holding up?” or “I bet COVID has really changed your practice” are opening statements that can address the 800-pound virus in the (virtual) room, acknowledging the obvious strangeness and discomfort that afflict so many conversations in these awful times.
 
On a more concrete level, pandemic-style education is also forcing us to come up with new ways to use our educational materials. What to do when you can’t focus a practitioner’s attention on a particular graph or table you’re showing them because they’re dozens of miles away? Displaying a PDF of a document and whizzing around your cursor is one easy, but primitive solution. What about presenting a list of topics hot-linked to a detailed display for each? Or completely re-formatting our materials (stop moaning) for better adaptability to a computer screen?

​Those of us who also used to teach in classrooms have learned that with a little work (ok, a lot of work) coronaeducation can even be better than what we’ve been used to doing: using links to video clips or animations, real-time interactive polling, techniques that maybe we could have been using in the classroom, but weren’t.
 
Another key advantage of academic e-Detailing, if we can figure out how to make it work well, is the prospect of having a virtual visit with a clinician without the sunk time of getting to their office – a major enhancement in working with practitioners who may be an hour’s drive or more from the educator’s base. The benefit for our field in productivity and cost-effectiveness could be considerable.
 
Contrary to naïve beliefs that “Soon everyone will be protected by the vaccine and we can get back to normal,” this virus probably won’t let us return fully to the old ways any time soon. Instead, it will force us to mutate our work to cope with it. And in the process, not only will we be able to continue our work, we may even discover better ways of doing it.
 
Be strong and stay safe.

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An interview with Julie Anne Bell, MPH, Program Manager of Clinical Operations, Bureau of HIV, New York City Department of Health and Mental Hygiene. The mission of the Clinical Operations and Technical Assistance Program (COTA) is to provide innovative, culturally responsive, needs-based technical assistance and training to organizations and individuals working with people impacted by HIV.

by Anna Morgan, RN, BSN, MPH, NaRCAD Program Manager

Tags: Detailing Visits, E-Detailing, HIV/AIDS, Materials Development

Anna: Thanks for joining us today, Julie Anne! Can you tell us about yourself and what brought you to your role as Program Manager of Clinical Operations at the New York City Department of Health and Mental Hygiene?

Julie Anne: My first position out of graduate school was as a research assistant in the HIV program at the State University of New York. I’ve moved through a lot of sexual health work and have been with the Bureau of HIV at the New York City Department of Health and Mental Hygiene for three years.
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I love the programmatic work that I do in my current role. I deliver training, tailored technical assistance and public health detailing to clinical and non-clinical providers who care for people with HIV. Being a content expert and bringing the information directly to the clinics to support them is rewarding and, most of all, fun. 

Anna: It sounds like your career path has led you to a wonderful position! What detailing topic is your program currently working on?

Julie Anne: We’ve been focused on developing a public health e-Detailing campaign to support and strengthen providers’ initiation of immediate antiretroviral treatment, or “iART”.  iART is for people newly diagnosed with HIV or returning to care after a long lapse. It recently became a standard of care in New York. Immediate initiation of ART is associated with several health benefits for people with HIV, including a significant decrease in the time to viral suppression, which ultimately, reduces the risk of disease progression, morbidity, and mortality for people with HIV as well as onward transmission and new HIV diagnoses. Prescribing ART immediately versus waiting for the patient to return after all lab work/genotype results come back can feel like a paradigm shift for providers, but HIV medications have advanced so much in terms of their high threshold to resistance and there is no longer a need to wait.
​
Anna: Your team recently completed a campaign on strengthening the integrated care approach, which is a team-based approach where mental health care and medical care is offered to patients in the same setting.  How did your previous campaign help shape your new iART campaign? 

Julie Anne: During our previous campaign, we brought providers an array of materials and resources to help them meet New York City’s Ending the Epidemic benchmark. We included HIV-specific materials and resources, as well as additional tools to address substance use, housing, and mental health in order to strengthen their integrated care approach. Among those HIV-specific materials and resources was information about iART. During our detailing sessions, providers were consistently reporting the same barriers to implementing iART in their clinics. Barriers that were reported were lack of clinic workflow for iART, not knowing how to get the medications covered/paid for immediately, and feeling uncomfortable prescribing ART before receiving a lab based confirmatory HIV test and genotype testing result. We began to realize that the providers needed more support around this topic.

Because our work is heavily data driven, we used the feedback we received from providers on the barriers they were experiencing around implementing iART to create our iART campaign and associated public health detailing action kit. The tools and resources in our detailing action kit highlight each component of iART, including HIV testing, payment options, genotype testing, and example clinic workflow. In the past, our program developed the public health detailing action kits and would hire consultants to do the detailing. For these campaigns, my colleague and I wanted to deliver the messages to the clinics ourselves and focus on relationship building.
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Anna: Having strong detailer-clinician relationships is an integral piece of a successful academic detailing program. How have you been able to build strong relationships with clinicians?

Julie Anne: We visited over 100 clinics that provide HIV services in New York City during our last detailing campaign, and we now have friendly relationships with these providers because of the trusting relationships we’ve built with them through our previous detailing work. Our team also attends regional group meetings for HIV providers to bring more awareness to our work and continue to build relationships and connections. 

We recently hosted a virtual launch event for our iART campaign and we had over 200 providers register. We provided an overview of COTA, our services, and e-Detailing. We wanted the providers to know exactly how we’ve pivoted during COVID-19, why this work is still important, and that we would reach out to them in the coming weeks for an e-Detailing visit.
​
Being with the health department, we know where people are getting their care for HIV in New York City. We’d love to reach everyone who’s working with people who are impacted by HIV, including non-clinical providers. Since iART is an integrated care approach, both clinical and non-clinical providers are an integral part of the process.  The first steps in the iART process begin with a positive HIV test which can happen in a non-clinical setting, such as a community-based organization. The next steps include looping in a medical provider with the addition of non-clinical support, such as benefit navigation, social work, and peer navigation. It can take multiple providers of different training and expertise to work together to achieve iART seamlessly. 

Anna: Wow! You’re certainly connected to a lot of clinics and it doesn’t sound like you’ll have issues recruiting clinical or non-clinical providers for your upcoming e-Detailing visits. How has your team prepared for e-Detailing?

Julie Anne: When the reality of the pandemic hit, the idea of transitioning our detailing program to a virtual platform was overwhelming. We did a deep dive into the existing literature to see how programs have done virtual detailing in the past. NaRCAD has also been an amazing resource to learn from and we continually check the website for new resources on e-Detailing.
​
We then developed a Standard Operating Procedure (SOP) for our iART e-Detailing campaign. We worked as a team to create a step-by-step guidebook that includes our key messages, how to do a needs assessment, and how to address barriers that we expect might come up. We’re currently working on doing mock e-Detailing sessions with our colleagues and with providers who are iART champions in New York City. Our SOP will help guide us during these mock sessions and help prepare us for our field visits this fall.

Anna: Creating a Standard Operating Procedure is a great idea and will be extremely beneficial to prepare for field visits. What are some challenges that you expect to face when you begin your e-Detailing work?

Julie Anne: We’re expecting the usual technical problems like poor internet connection and access issues, but we’re working on strategies to overcome this. We also expect that providers will be experiencing burn out, so they may be hesitant to make some of the changes in their clinic to implement iART, such as establishing a new clinic workflow.
​
However, the resources we’ve selected and created for our iART detailing action kit are a direct result of what providers reported that they needed during our last detailing campaign.  We’re hopeful that the tools we’re providing will enable an easy transition for providers to adopt our key messages related to iART.

Anna: It’s remarkable that you’ve been able to create your e-Detailing campaign based on the specific needs of the providers in your community. How else is your team working towards sustainability?

Julie Anne: iART is a sustainable practice because once providers understand the “why” and “how” to do it and the steps involved, there is no reason to go back to waiting to initiate a patient with HIV on ART.  It’s important that people with HIV are given the opportunity to start ART immediately because it provides individual and public health benefits. iART is the new standard of care in New York, which encourages providers’ commitment to the practice, and the iART detailing kit will introduce tools and resources to increase the knowledge and confidence of providers to prescribe ART immediately.
​
Additionally, COTA offers ongoing technical assistance at the request of the providers and full-day trainings on iART for new providers.  We’re currently focused on our iART e-Detailing project, but it’s always an open-door relationship with providers.  Right now, it’s iART, but providers can reach out to us about anything they’re struggling with and we’ll work with them to overcome the challenges they’re facing.

Biography. Julie Anne began working at the NYC Health Department in 2016 with the Bureau of Sexually Transmitted Infections in a research role. She transferred to the Bureau of HIV in 2017 where she focused on health policy work, and was promoted to her current role with the Clinical Operations team. She now manages the team that focuses on providing data-driven technical assistance to clinical and non-clinical HIV providers across New York City on HIV specific and supportive topics that address social determinants of health for people with HIV. Julie Anne is currently preparing to conduct e-detailing visits with NYC providers to support and strengthen practices for initiation of immediate antiretroviral treatment (iART) for people with HIV.

Winnie: Hi Tara! It’s been a crazy year so far, hasn’t it? We want to check in with you and the University of Illinois, Chicago (UIC) team about your experiences in navigating the pandemic. Can you tell us a little more about yourself and your role in the ADVANCE academic detailing team?

Tara: I was hired about 7 months ago as the research coordinator, and it’s been one heck of a 7-month run. The majority of my work is focused on implementation, so I do all the scheduling and outreach to hospitals to talk to providers. I develop and establish relationships with office managers and providers, and I assign detailers to visits.

W: Our team at NaRCAD has been lucky to have worked with the UIC and ADVANCE team for a while through our trainings and your presentations at our conferences and our webinar series, and we’re excited about the research intervention that had been planned. Can you tell us a little bit more about the mission?
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T: Our intervention is a CDC-sponsored, three pronged approach that’s built off a pilot program that we started in 2018 for Chicago-land providers. We have a team of about 30 detailers who are now trying to cover as much of the state as possible. We wanted to follow-up with providers to get a sense of whether or not the ‘dosage’ of AD made a difference, but we also wanted to expand the providers we worked with, and to introduce updated topics like the new features of the Illinois PMP or opioid alternatives. The third prong is creating a toolkit to give programs a blueprint and resources of what was effective for us. We would love to make the “how to” of AD more accessible to other groups.

W: Compared to other programs, you have quite a large and robust team at UIC. It must have been difficult for the pandemic to hit right in the middle getting your program launched.

T: It really impacted our recruitment as we had called providers from the end of January through early March 2020. There are a lot of things going on right now. Even a small ask, such as 15 minutes of their day, can feel like a big ask for providers.

W: Right, and interventions are very carefully laid out and planned ahead of time. COVID-19 has disrupted everything – especially those on the frontlines who are both detailing and being detailed. Can you tell us a little bit more about how else the impact on your original plans for the intervention?

T: We had been so focused on ramping up that by the time we hit mid-March, we had many people on deck reaching out to providers. We started hearing “No, we can’t do this right now” or “this is a really bad time” often.
​
Once the stay-at-home order came through, we stopped contacting offices for about 2 months. We had to sort out so many protocols and even our IRB to make amends for virtual visits. What we’ve found since we’ve resumed virtual visits in May is that there’s a lot of variability – some offices have capacity because they aren’t seeing many patients, while others have providers that have been transferred to hospitals and have no idea when they’ll be available. We’re also talking about layoffs and burn-out and low morale.

W: There are many of considerations on how best to proceed safely right now. One is looking at the impact on the critical work you’ve done on opioid safety. Unfortunately, the pandemic has only exacerbated the overdose epidemic. What progress has been made on your opioid initiative?

T: One of the ways our team has shifted has been moving to virtual visits. We knew that these would have its own difficulties, such as concerns about “no-shows”. But our team is relatively tech-savvy, and now my job is making sure they’re all familiar with how to troubleshoot the technological pieces of virtual visits. 

​There are a lot of tech issues that can interrupt a visit. So we do mock detailing and have the detailers practice with each other, where we introduce certain needs and obstacles, maybe even a tech problem for instance, we role play a provider not turning on the webcam, or not being able to see your screen. Practice to strengthen adaptability and resilience become important in ensuring the detailers are prepared.

W: There’s definitely no time like right now to test detailing skill and ability to think on your feet! As a research coordinator, what do you think you’ve learned in the past few months?

T: How to be flexible! There are all sorts of external pressures right now to keep our project on track, but the most important part is keeping the human aspect in check. Having some insight and empathy for providers is important to understand what they’re going through. We can get bogged down into the guide posts, the bench posts, or the numbers – but this era reminds us that it’s all about empathy.
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​W: At the end of the day, we want better for our patients, for our communities, and for health outcomes everywhere, right?

T: Absolutely!

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An interview with Kelsey Bolton, Continuing Professional Development Consultant, Gundersen Health System
​
by Anna Morgan, RN, BSN, MPH, NaRCAD Program Manager

​Tags: Detailing Visits, COVID-19, CME, E-Detailing, Smoking Cessation, Substance Use

Anna: Hi, Kelsey! Thanks for taking the time to chat with us today.  Can you tell us a bit about your academic detailing program in Wisconsin and your role?

Kelsey: I’m a Continuing Professional Development Consultant in the Continuing Medical Education (CME) Department at Gundersen Health System. Gundersen Health System is a teaching hospital with a multitude of specialties that serves patients in Wisconsin, Minnesota, and Iowa.

As part of my CME work, academic detailing stood out as an effective tool to disseminate our information and meet our clinicians’ educational needs. We started our detailing program last fall and have been focused on tobacco cessation.  The detailing intervention is a spinoff of a performance improvement project we are working on for diabetes.

I’m currently a one-woman show; I’m the program coordinator and the sole detailer.  I detail physicians, NPs and PAs across the health system. 

Anna: Wow, it’s incredible that you’ve been able to build your detailing program from the ground up! Can you tell us what that’s been like?

Kelsey: Academic detailing was a new concept to me prior to being introduced to it by my former manager, who sent me to the NaRCAD training in May 2019.
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Academic detailing is not a well-known concept in our hospital system.  It was difficult to get past the gatekeepers and “enlighten” them about academic detailing.  There are still misconceptions when I walk into a room for a meeting with a clinician – they often think that I’m a drug sales rep, that I’m an internal quality control person, or that I’m there for punitive reasons.  I must quickly refute that and explain that I’m there to support and unburden them, not to make judgments about their work.

Anna:  Those misconceptions are quite common when starting a new academic detailing program. How are you able to “enlighten” the gatekeepers?

Kelsey: It was bumpy at first and we tried a few different approaches, but I think we’ve finally been able to smooth it out. I have an advantage because I’m internal and I’m contacting clinicians from an internal email or phone number.  I’ve also had our medical program coordinator, the doctor who is partnering with me to learn the clinical information, send out emails to gatekeepers prior to my detailing visits.   
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Anna: Stakeholder buy-in is imperative when building a new detailing program.

Kelsey: Absolutely. Building relationships with key stakeholders has made all the difference.  The medical program coordinator I work with, as well as other experts in the organization, helped me curate my detailing aid and key messages. 

I practiced my detailing sessions with these stakeholders before going out in the field.  It was an easy way to build relationships and get them on board – it only took a 15-minute practice detailing session!

I’m also fortunate enough to have support from senior leadership. They’ve been able to open doors by letting people throughout the organization know that they support the academic detailing work I’m doing. 
​
Anna: It sounds like both managing your academic detailing program and being in the field has helped you be successful in getting your program off the ground. What has it been like to grow and manage your AD program?

Kelsey: It’s like herding cats! The detailing program is 25% of my workload, so completing all the administrative work plus the detailing visits is quite a commitment.  By the end of this year, I will have detailed over 200 clinicians. 

“Marathon detailing” has put me in a groove. It has definitely been challenging, but I appreciate that I know the ins and outs of it now – both the administrative tasks and the field work.  I feel prepared to help train others. I plan to start training one of my colleagues to become a detailer in the fall.
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Anna: When thinking about team expansion, it’s also important to think about the impact of COVID-19.  How has COVID-19 impacted your program?

Kelsey: We paused our detailing visits for about 3 months, and by the time we started talking about bringing them back, NaRCAD was putting out a lot of information about e-Detailing. 
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Before COVID, I had barely done anything with video calling, but getting thrown into working from home, we jumped into a lot of video calls. I learned how to work virtually on the fly, which made it easier to adapt to e-Detailing. 

I did a few practice e-Detailing sessions with my colleagues and I’ve now successfully completed several visits virtually.  The NaRCAD webinars were a lifesaver.  We plan to continue e-Detailing until it’s safe to return to in-person visits.
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Anna: A lot of academic detailing programs had to adapt quickly to e-Detailing during the pandemic.  What does the future look like for your program?

Kelsey: For the more near future, we are working on collecting data for the tobacco cessation campaign to eventually publish research on the efficacy of the academic detailing intervention.  We’re going to pull patient data from the EMR, as well as look at the qualitative data from the evaluation surveys. This research will help inform our organization on the benefits of academic detailing as an educational intervention.
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We would also like to continue the program with other strategic initiatives like substance use disorder, social determinants of health, and cancer screening.  I have a soft spot for topics similar to tobacco cessation that are sometimes discouraging to clinicians because they don’t feel like they can make a difference. I know that through detailing, I’m able to give them a fresh take on these topics, and reinvigorate them in providing the best care for their patients.

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You can head on over to our Discussion Forum to continue the conversation!

Biography. Kelsey Bolton is a Continuing Professional Development Consultant in the CME department at Gundersen Health System in La Crosse, WI and the program lead for its Academic Detailing program. She received her Bachelor of Arts degree in Communication Studies in 2015, Healthcare CPD Certificate in 2019, and is currently pursuing her Master’s in Organizational Leadership. She has completed over 100 detailing visits and is presently conducting a research project on the efficacy of tobacco cessation academic detailing.

Winnie: Thank you for speaking with us today Marlys! Can you tell us a little bit about your work with the RxFiles Academic Detailing team?
 
Marlys: Absolutely! I’ve been with RxFiles for just over 4 years as an Information Support Pharmacist doing both frontline academic detailing as well as co-leading various academic detailing training sessions, with the most recent being this past April. Our program covers Saskatchewan, Canada, but our website, app, and book are used outside of the province and Canada as well.

W: RxFiles is definitely one of the larger and more established programs we’ve had the honor of partnering with through the years. Can you tell me how maintaining the daily operations of your program have been impacted by COVID-19?
 
M: ​One of the bigger things that’s changed for our team has been moving our academic detailing training sessions online for our team of 12 detailers. We had to shorten our two-day in-person training, and shifted to hosting shorter sessions and offering more pre-training day and post-training day webinars to cover all of the content, including “how-to virtually detail”.

​W: No matter how well virtual substitutions are planned, it’s not the same as being together. We’re all really missing our colleagues, and it’s heightening a sense of isolation. How do you think your team has adjusted to moving the training online?
 
M: I think our team adjusted quite well to the training adaptations. We were able to give them enough notice about the shift. What came out from training days is that our team members really do miss being in-person and having that social interaction – even the chit-chat in between sessions. For in-person trainings, we typically have time for a team-building activity in the evening where people catch up. We’ve been trying to incorporate more games and fun into our virtual training to have that social aspect. Personally, I really miss debriefing with colleagues in-person after detailing visits.

W: It seems like keeping the team connected is a big part of your team culture. How has your team stayed connected through the pandemic?  
 
M: We typically do a roundtable at the mid-point of a detailing topic. We typically go around and share a little bit about our detailing experiences. Pre-COVID, no one wanted to turn on their cameras. It was never a requirement, but now everyone is turning them on. It’s been really nice just seeing people’s faces. Also, one of the things that’s been nice about going virtual is that we are able to open up staff meetings and invite more detailers to participate with us. We would have never been able to do that as easily in person.

W: We’ve seen opportunities like these spring up as teams need to be particularly innovative under tough circumstances that prevent in-person connection. Speaking of teams, dream teams don’t come out of nowhere. A lot of work goes into creating and maintaining a strong, positive, and connected team. At NaRCAD, we talk a lot about what makes a good detailer, but what are some of the hallmarks of a strong detailing team?
 
M: Team work is a really interesting thing to dive into. I reflected on this question, and think that a strong detailing team supports one another. That support can be helping each other out in the detailing session itself (e.g. co-detailing), or through communicating with each other about the providers we serve and in between detailing sessions (e.g. a prescriber moved from one detailing area to another). We want the team to be successful in moving towards our goals together. Another thing that COVID brought to my attention is that a strong detailing team also has a positive attitude. I really feel that during our transitions, everyone has been really positive and embraced the changes.

​W: You’ve shared a lot of examples of how your team regularly communicates at various points during a detailing campaign, which shows a culture of checking in and making sure no detailer is left out. Can you speak a little about how that culture’s been built up at RxFiles and how you maintain it?
 
M: I think Loren Regier, who is in charge of Projects, Transitions and Training, has been such an asset in the development of our program, has really emphasized checking in. He really showed us the value of that, and not only does he talk about it, he has made it very easy for someone to approach him and talk about how the detail went, both the successes and challenges.

​W: Having access to mentorship, and making sure a team-based approach is emphasized by leadership is key. It’s clear that the RxFiles team is doing well in adapting to these challenges faced by so many detailing teams. Maintaining positivity and seeing challenges as opportunities for growth is something that’s critical for teams to continue to have an impact.

​​Biography. 
Marlys LeBras is a clinical pharmacist with the RxFiles Academic Detailing Program at the University of Saskatchewan. She completed her Bachelor of Science in Pharmacy at the University of Saskatchewan, her Hospital Residency with the former Regina Qu’appelle Health Region, and her post-graduate Doctor of Pharmacy (PharmD) degree at the University of British Columbia.

An interview with Mary Liz Doyle Tadduni, PhD, MBA, MSN, RN, Education Consultant, Independent Drug Information Service and Expert Training Consultant, National Resource Center for Academic Detailing
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by Anna Morgan, RN, BSN, MPH, NaRCAD Program Manager

​Tags: Detailing Visits, E-Detailing, ​COVID-19

Anna: Hi, Mary Liz! We’re excited to learn more about what the pivot to e-Detailing has been like for you as an expert academic detailer for over 16 years and a NaRCAD training facilitator.  Can you tell us briefly how your role as an academic detailer at Alosa Health has changed since the COVID-19 pandemic began?

Mary Liz: The restrictions on in-person meetings has resulted in all of my detailing visits switching over to phone or video calls. The number of providers I’ve been detailing has also considerably decreased due to time constraints and office restrictions related to COVID-19. In terms of the topics I’ve been detailing on, our team has been maintaining focus on delivering our planned modules, but I do discuss the impact of COVID-19 quite a bit with providers.
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Our current topic for Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly (PACE) is dementia, which is important as it relates to COVID-19. Patients with dementia who reside in nursing care facilities in Pennsylvania can’t see their loved ones due to restrictive visiting policies. Primary care providers are dealing with the challenges and consequences of this every day – and academic detailers can’t ignore it.

Anna: It’s crucial that detailers understand the ways COVID-19 impacts the work of frontline care providers.
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Mary Liz: Absolutely. With COVID, healthcare delivery has changed dramatically and there’s been a large increase in telehealth visits.  Many providers in Pennsylvania are working from home and not going into the office or seeing only a limited number of patients in the office setting.  Even if they are seeing patients in person, the process of seeing a patient has changed.  The offices sometimes have front desk staff working from home and require patients to wait in their cars before entering the building. Primary care providers are still trying to adjust to all of this. You need to consider what is really happening on the ground for providers during your detailing visits – it’s part of your needs assessment. The needs of the primary care provider right now differ greatly from the pre-COVID era. 

Anna: Assessing a clinician’s individual needs is an integral piece of a traditional academic detailing visit.  How have you been able to implement AD in its intended form when detailing virtually?

Mary Liz: The original model of academic detailing with Dr. Jerry Avorn has always been 1:1, face-to-face encounters, but that doesn’t mean you can’t have a productive visit virtually. It’s just another venue to deliver the evidence.  I really do believe that it’s better to be in person, but delivering the evidence, no matter what the platform, is better than having a provider not know what they need to deliver the best care.
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Anna: You’ve carried out this traditional, in-person model for over 16 years – what challenges have you faced when detailing providers virtually, especially during the pandemic?

Mary Liz: Time has been a barrier due to the overall stress on the healthcare system.  There are also more distractions when visits are done virtually because providers are taken out of a controlled office setting. A provider could be home with their kids, or even driving in a car during a visit.  You never know where a provider will be during a virtual detailing visit.

Some offices in my area also aren’t picking up their phones, so you can’t have conversations on the phone or "stop in" for a cold call.   Having a scheduled in-person visit with a provider is much easier than trying to connect with a provider over Zoom.  You add another step to your process when you have to work through technology glitches.
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Virtual platforms or telephone calls can also be difficult for providers who are visual learners.  You need to be creative with the way you share materials. But there are many similarities to in-person visits; no visit is “one-size-fits-all”. You need to consider the provider, their situation, and their environment and decide what will be the best way to deliver the evidence. 

Anna: You’re right! It’s never one-size-fits-all when it comes to academic detailing.  This has become even more evident as programs around the world have pivoted to e-Detailing. Do you believe that virtual visits can be as effective as traditional, in-person visits?

Mary Liz: I do. It may not be as personal as an environment, but if you have a relationship with the provider, it shouldn’t matter whether it’s in person or virtual. I would continue to detail virtually in the future if a provider requested it, but I do favor in-person visits – it’s what I’ve done for so many years and I’d rather see the providers face-to-face. You get even more out of a detailing visit when you have that interaction.
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Anna: There’s certainly something to be said about the impact of the original model’s focus on in-person, 1:1 interactivity; it’s what has been studied for many years as effective and impactful.
In a time where being flexible is critical, what are some tips you would offer to detailers during this time?

Mary Liz:  It’s crucial that you’re attentive to the provider you’re detailing. Continue to focus on the needs assessment. While you need to communicate your key messages, if you aren’t doing a proper needs assessment, you aren’t operating under the guidelines of academic detailing, which is all about listening and being interested in how someone is practicing.  This leads you to be able to provide the evidence in the most effective way.

Also, remember to be patient with providers! They’re still adjusting to this new world and they may even have questions about the impact of COVID-19 on the future of healthcare, as well as on their place within the healthcare system. 
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Mitigate that impact by offering providers community resources that will support them through the pandemic – if you do that, then you’re fully realizing the true purpose of academic detailing as a supportive service that’s customized to real-world challenges.

Biography. 
​Dr. Mary Liz Doyle Tadduni’s background has included critical care and medical-surgical nursing, nursing administration, and hospital administration in major university teaching hospitals in the city of Philadelphia. Dr. Doyle Tadduni is a training facilitator at NaRCAD, and an academic detailer with the Independent Drug Information Service of the Alosa Foundation.
Dr. Doyle Tadduni is a BSN graduate of DeSales University. She completed her MSN, with a concentration in Nursing Administration, from Widener University.

Dr. Doyle Tadduni was awarded the MBA degree, with a concentration in Healthcare Management Services Administration, from Widener University where she was the recipient of the Healthcare Management Services Administration’s Student Excellence Award. Following her graduate work in both nursing and business, Dr. Doyle Tadduni completed her administrative residency at the Hospital of the University of Pennsylvania in Philadelphia. She completed her Ph.D. in Nursing from Widener University. Dr. Doyle Tadduni presented her doctoral research, “Terrorism Preparedness: Perceptions of Connectivity of Emergency Nurses of the Emergency Nurses Association,” at the 10th Annual Interdisciplinary Research Conference in Dublin, Ireland.

​The past few months have represented incredible and unexpected challenges to the world of AD, encompassing everything from adjusting to brand new work routines, transitioning AD materials into a virtual format, and deciding exactly which corner of your workspace had the best lighting for all the videoconferencing meetings being scheduled in place of face-to-face ones.

The pandemic has largely disrupted many of the best laid plans of 2020 for a majority of us. However, through all of the obstacles that the COVID-19 pandemic has represented, the NaRCAD team has also seen incredible resilience and adaptability from the AD community as we take on these challenges together.

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An interview with Ramona Shayegani, PharmD, Program Lead, Academic Detailing Service, Veterans Affairs Southern Nevada Healthcare System

by Kristina Stefanini, NaRCAD Project Manager

Tags: E-Detailing, International, Materials Development, Opioid Safety, Substance Use, Rural AD Programs

Kristina: Programs are transitioning their academic detailing (AD) efforts to e-Detailing or virtual detailing amid the COVID-19 pandemic. As part of your role at the Veterans Health Administration (VHA) Academic Detailing Service, you’ve completed e-Detailing visits, which you presented on at the NaRCAD 2019 conference. I wanted to interview you today, Ramona, to learn more about how you transitioned to e-Detailing. First, how did your program decide to do e-Detailing?
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Ramona: Thanks for interviewing me! We heard about an e-Detailing pilot project from our national office and we were excited to participate as our region is spread out and rural, covering Nevada, northern California, Hawaii, and Manilla, Philippines. We felt this would be an excellent setting in which to incorporate video calls into our communication with clinicians. As a result, e-Detailing has allowed us to reach our full potential as a service.

Kristina: Amplifying a program’s impact and reach through e-Detailing is something many other programs want to experience. Have providers been receptive to e-Detailing visits given the current COVID-19 pandemic?

Ramona: I think it varies by site, but for the most part, providers are very eager to learn about the VHA’s telehealth program. Initially, when we started e-Detailing, we launched a campaign to encourage clinicians to complete telehealth visits with patients. Now providers remember our names, and they reach out about setting up telehealth meetings with their patients and figuring out how to conduct video calls. It’s very rare for providers to reach out to academic detailers for help. We usually have to initiate outreach requests.
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Kristina: That’s terrific that clinicians are the ones reaching out for the service. When you’re getting ready for an e-Detailing visit, do you prepare the same way as you would for an in-person visit? What materials do you use, and how do you use them?

Ramona: The campaigns we’re working now are so fast-paced, so we’re sharing materials via PowerPoint presentations on a video conferencing platform; we also use electronic PDFs.

In addition to showing providers electronic materials, you can still model an approach as you would in person by holding up some of the materials on the camera. For example, with naloxone education, we have naloxone spray “dummy” versions that I show providers on video; I ask if they have ever seen what a naloxone spray looks like, and whether they would be interested if I sent a model version, which they usually say yes to.
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Kristina: That’s something we try and tell detailers who are pivoting to e-Detailing, which is that much of the interactive approach of an in-person visit is still accessible via video! Many detailers who are trying this out for the first time are eager to find ways to build a meaningful, trusting relationship with clinicians--do you have any advice for strong relationship-building approaches during e-Detailing visits?

Ramona: Sometimes, especially if it’s a new provider, I try to remind myself that I might not get to talk about any of the key messages. It’s really important to take that time to introduce yourself and your service. I don’t feel like it’s anything different than meeting someone face-to-face for the first time. However, detailers need some time to try this with each other, their team, or providers that they have a good relationship with. Detailers need to build that confidence before they go out and try these video calls with people they’ve never spoken with. The more I do it, the more confident I feel, which is key in building these relationships.

Kristina: That makes sense—it’s about comfort and confidence as much as knowing the evidence. We’ve also encouraged detailers to know that it may take more time to build up to delivering the key messages than you’d like it to, and to be patient and focus on building the relationship when carrying out visits online. In your experience, have you seen any drawbacks to e-Detailing?
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Ramona: One thing is that detailers don’t have the luxury of getting a feel of what the clinic is like, which would be easy to observe in person. A lot of times when I am in a clinic, I get a chance to talk to an auxiliary support team, or I could just walk to the other room and talk to the nurse. I’ve found ways to adapt to e-Detailing to try and have more of the team’s perspective; I’ll often ask providers if they think it would helpful for the nurse to be on the call so we can have a group discussion. 

Kristina: It’s really about thinking outside the box and adapting the in-person approach, while trying to maintain connection. Is there anything else you’d like to share from your experiences with implementing e-Detailing?
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Ramona: Detailers should acknowledge that this is a brand-new approach; you may not feel like this is your preferred way to talk to providers. Remember that it will take some time to get comfortable with it. There’s a learning curve. Now that I use this approach full-time, I just love it, and I don’t want to go back! It’s just as effective, a lot more efficient, and it allows you to be flexible.

Biography.
​Ramona Shayegani is the program lead for VHA’s Academic Detailing service in northern California, Nevada, Hawaii and Manila. She received her Doctor of Pharmacy degree from Oregon State University in 2014 and has clinical background in mental health and addiction medicine. She was one of the first detailers to pilot e-Detailing at the VA and has completed over 400 virtual detailing visits.

An interview with Lindsay Bevan, MScHQ candidate, Project Manager, Primary Care Academic Detailing Service, Centre for Effective Practice 
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by Anna Morgan, RN, BSN, MPH, NaRCAD Program Manager

Tags: COVID-19, Detailing Visits, E-Detailing, International, Program Management

Anna: Hi Lindsay! Thanks for chatting with us today about the exciting work happening at Centre for Effective Practice (CEP) in Canada.  Can you tell us about your role and share some highlights from your team’s recent work?
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Lindsay: I’m the manager of the primary care academic detailing service at CEP.  We have a provincial service, which started in March of 2018 that serves family physicians across Ontario.  Prior to our current service, we have run services in long-term care to support appropriate prescribing as well as primary care to support diabetes management. Our current service is still growing, but we’ve served just over 880 family physicians to date.  Our focus has mainly been around opioids and chronic pain.  We were just about to launch a series of “visits” (campaign topics) on prescribing in older adults, but we quickly pivoted to meet the needs of family physicians and began working on a visit around managing primary care in the COVID-19 context.

Anna: It’s so important to understand and meet the needs of family physicians when it comes to academic detailing, especially during a tremendously stressful time. Can you tell us a little bit more about the COVID-19 visit and the process behind its launch?

Lindsay: Our provincial government declared a state of emergency in Ontario on March 17th, so we knew COVID-19 would be top of mind for our physicians and that they’d need more information.  We also knew that we’d have to deliver the visits virtually, which was a fairly new territory for us. 
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We had to modify our usual content development and detailer “upskilling” (bringing detailers up to speed on the content, key messages, and evidence around the topic) processes in order to meet the demands of family physicians by getting them information around COVID-19 when they needed it.  The content development process for our other visits typically takes six months, with the detailer upskilling taking the last month and a half of that six-month period.  COVID-19 turned everything upside down and made us rethink what we assumed was impossible. Within two weeks of the declaration of emergency, we started pulling together content for our COVID-19 resource centre (clinical tool for this visit, which is also available to all primary care providers), one week later we started training our detailers and within a month, we were delivering virtual visits to family physicians.  

Anna: It’s impressive how quickly your team was able to launch this visit. COVID-19 is different from other topics that your team has focused on because the information and guidelines are continuously changing.  How has your program kept detailers up to date?

Lindsay: The detailer upskilling process for other visits includes weekly webinars to review key messages and the surrounding evidence, and a two day in-person workshop where detailers get to practice their visit discussions with each other and family physicians prior to launching visits.  We also use a content development team for our detailing tools and bring those tools to the detailers to review when they’re about 90% complete.  We typically don’t edit or change those tools after visits have begun. 
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For our COVID-19 visit however, the detailer upskilling weekly webinars and the content development for our ever-evolving online COVID-19 resource centre have been continuous, ongoing processes. Our detailers have also taken on a larger role within both processes. Each detailer has been responsible for searching for, appraising and synthesizing information on a specific sub-topic of COVID-19, and then submitting this information for inclusion in our resource centre as well as presenting it at our weekly webinars to their fellow detailers.  Our detailers need to be up-to-date on the emerging and evolving evidence and jurisdictional guidance around COVID-19 because family physicians don’t have time to sort through all the information being made available to them daily during the outbreak.

Anna: It’s critical to provide physicians with the most up-to-date information, especially in situations like the COVID-19 pandemic where they’re bombarded with new recommendations and guidelines from multiple sources on a daily basis.  How many COVID-related visits has your detailing service provided to physicians during this time?

Lindsay: We’ve had 95 initial visits to date and approximately 12% of those visits have been with physicians whom we’ve never detailed before.  We’re just starting to reach back out to physicians to see if they would like a follow-up visit since evidence has evolved and challenges have changed since we first started.  The initial conversations were focused on testing, assessing and managing patients with the virus, and we’re now seeing those conversations shift to focus on resuming primary care services within the COVID-19 context.  The detailers have done an amazing job in transitioning their detailing conversations to ensure they’re always covering the emerging areas of interest and need for family physicians.
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We’ve seen little to no requests from physicians for detailing visits on anything but COVID-19 or on maintaining care in the context of COVID-19, which speaks to the impact this topic has had on family physicians.

Anna: Wow – it’s amazing that your service has been able to detail so many physicians on COVID-19 while also recruiting new ones. 

Lindsay:  Yes, overall, the visits have been well-received.  We were a bit more cautious with our approach to promoting our COVID-19 visit and recruiting new family physicians.  We didn’t want to add to the current noise at this time. 
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Instead, we took a more passive but strategic approach, like adding a banner to our website where family physicians can quickly sign up for a visit, and having our partners share our visit and resource centre with their membership base.  One of the neat things about this visit is that because we’re offering it virtually, we’re able to expand our geographical reach and provide our detailing service to more physicians.

Anna: Using a virtual platform certainly has its pros, especially within the world of academic detailing!  What has your program’s experience been like with integrating e-Detailing into your service?

Lindsay:  The transition wasn’t unsurmountable for our detailers because they are quick learners, and we’ve had a lot of support through the resources offered by NaRCAD and our partnership with the Canadian Academic Detailing Collaboration (CADC).  We also did internal virtual training sessions with our detailers where they were able to practice using all the features of the Zoom videoconferencing platform. Overall, it’s been a positive learning experience, and one that has furthered our team’s ability to be adaptable and enhanced our problem-solving skills.
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We do feel however that there’s been an impact on the detailer-physician relationship since we’ve transitioned to virtual detailing, especially for the 12% of family physicians who are new to our service.  When a detailer is in a physician’s practice, they can see how busy a waiting room is or how stressed the staff appear to be.  When family physicians join a virtual detailing visit, it’s much harder to gauge what kind of day they might be having and adjust the discussion accordingly.  Furthermore, the act of going into a physician’s practice itself can create goodwill that helps establish and strengthen the detailer-physician relationship, and that opportunity is lost during virtual detailing.

Anna:  That’s an excellent point.  Observing the waiting room and interacting with office staff is also essential to a detailer’s needs assessment.  Detailers lose this piece of a visit when the detailing is done virtually.  Is virtual detailing something that CEP will continue doing once COVID-19 related restrictions are lifted?

Lindsay: Our detailers and family physicians would like to return to in-person visits. There seems to be some conversations that lend themselves better to virtual communication, and others for which an in-person presence offers greater value and impact. When it comes to relationship building, in-person interactions still offer something special. 

We would also like to build off the momentum we’ve started with our virtual visits.  We’re exploring the idea of offering virtual detailing to family physicians who would otherwise have their visit rescheduled due to extreme weather or to family physicians located where we don’t already have a detailer covering the area.
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We’ve all done what we thought was impossible in providing the majority of healthcare visits virtually. I hope that folks across the healthcare system will continue to use that momentum moving forward to increase access to care.

Biography.
​Lindsay Bevan works for the Centre for Effective Practice (CEP) where she collaborates with a team of amazing individuals to develop and implement evidence-based supports and services to help narrow the gap between best evidence and care in Ontario. As a project manager, she oversees the planning and implementation of the CEP’s primary care academic detailing service, which serves family physicians across Ontario. Prior to joining CEP, Lindsay worked at the University Health Network in the infection prevention and control unit, where she updated internal infection control policies and developed patient and provider educational material. Lindsay is currently completing her Master of Science in Healthcare Quality at Queen’s University. 

Bevin K. Shagoury, Communications & Education Director
A Letter from Our Team

Tags: COVID-19, ​E-Detailing

To our AD Community:

By the time you read this, certain adjectives will have moved to the top of your frequently-used list. Words like “unprecedented”, “strange”, and “unsettling” are just a few that our home team has been using most commonly, and we’re sure that you, our community of AD peers, have been, too.
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During the COVID-19 pandemic, priorities are changing quickly and frequently—many of our public health colleagues have found themselves focused primarily, if not entirely, on the situation at hand, with critical response demands shape-shifting hourly.

​For those of us who spend our time more removed from frontline healthcare and have been focused on clinical outreach education or adjacent health improvement initiatives, challenging questions have arisen.
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• How do I sustain focus on the priority of improving outcomes for patients during other critical health concerns, like the opioid crisis or in HIV prevention, that need to take the ‘back burner’ to the global pandemic?
• How can I visit with clinicians during a time when non-critical face-to-face interaction is on hold?
• How can we stay on track with meeting project goals for grantors who want to see progress on deliverables we can’t carry out in person for the foreseeable future?
• How can we maintain a sense of momentum in the important work that we do while taking care of ourselves and our families?

​The answers to these and other questions are context-dependent, ever-changing, and don’t always have easy solutions. There are changes and disappointments to adapt to—for us, we’ve accepted the need to prioritize safety and postpone our March and June 2020 trainings (keep your eye on our Training Series page for reschedule dates), and we appreciate your patience as we wait to figure out next steps.

But we’re equally aware that there are just as many opportunities for growth. At NaRCAD, our goal right now is to support our colleagues as we all face the very real impacts of COVID-19. Concretely, we’re working hard to bridge some of the gaps that make the original, face-to-face model of AD temporarily impossible. We’re proud to share that we just launched our first e-Detailing Community of Practice, e-Detailing Toolkit, and are shifting focus on our 2020 Webinar Series this month to tend to the needs of those programs who must pivot to e-detailing and quickly.

​As such, we encourage you to complete our 1-minute e-Detailing Needs Assessment survey, so we can design tools and resources that fit your needs. Based on your responses, we’ll translate your needs into tailored support to help you realistically maintain the work that you can, rebalance your priorities, and focus on future programming efforts during a time when the present is hard to navigate.

NaRCAD: Terryn, thank you so much for speaking with us today about your experiences with detailing in the province of British Columbia. The BC Provincial Academic Detailing (PAD) Service certainly has a lot of ground to cover. Tell us about the program goals and geography.

Terryn: For reference, British Columbia is geographically larger than Texas, but the population of British Columbia is only about 5 million people. We provide our detailing services to family practice physicians, nurse practitioners, and a few other healthcare professionals. Our detailers each do more than 175 visits per year, and collectively, they see about 2000 providers per topic, which includes about a third or so, of all the family physicians in BC.
 
We have 12 detailers in total, half of whom are working in less densely populated areas. For example, the northern end of the province is mostly small communities with only 3-4 providers in each town. One year, one of the detailers drove over 17,000 km (10,563mi) for her visits alone!

NaRCAD: That’s an incredible amount of work that your detailers have been up to! And you yourself have been active in AD for a long time. What was your experience then like?

Terryn: I started in 1993 with the program that would one day expand to become the PAD service, and I detailed for about 7 years. I came back to academic detailing in 2008 as the coordinator of the provincial program. When I started in 1993, I had just graduated with my PharmD. I had read about AD and was excited to try something new.

You have to realize, at the time, technology wasn’t that advanced... I didn’t even have an e-mail address when I first started.  You couldn’t just send people a note and say “When would you like to meet?” It wasn’t simple to access people. 

​NaRCAD: How would you describe how AD has changed since you started?

Terryn: When I started, I was the first academic detailer in Canada. There were about 70 physicians that I would go out to visit for each of the topics I put together after having the content reviewed by a local physician specialist from within our own community. One of the things that has changed is the breadth of resources and the growth of the AD community. There are so many more people involved, content is more thoroughly researched, and the literature is more readily accessible through technology.

NaRCAD: Technology has certainly changed the way the world works, and it’s something that detailing programs are turning to more and more to tackle the challenges you’ve mentioned, such as trying to serve a large and scattered population with a limited team. We’ve seen the increased use of tele-communications to do detailing. What has your experience been with virtual detailing, also commonly called ‘e-detailing’?

Terryn: One of the things we value about AD is that truly interactive, face-to-face encounter and that ability to individualize sessions to the provider’s learning needs. Virtual detailing uses a different methodology altogether. I think there are advantages to virtual detailing, but sometimes I think that it’s not as simple as moving AD to a web platform. I worry about the personal elements you can lose, even when using a web platform where you can see each other. My detailers often end up making slides of the original materials, which sometimes turns the session into more of a presentation.

NaRCAD: Can you elaborate further on the nuances you’ve seen with this new approach?

Terryn: We started with something we called Technology-Enabled AD (TEAD) which was a limited study done to compare the efficacy of TEAD versus a traditional face-to-face visit. They found that there was an effective knowledge exchange during both types of sessions, but the time it took for TEAD was far shorter. However, when we added TEAD as an optional feature for our providers, we ran into multiple challenges, such as detailers and providers not being familiar enough with the technology. The large majority of our providers choose to meet in person when they have that option.

That said, virtual detailing has been useful considering BC’s terrain and rough winters. Some regions have winter 8 months of the year and travel is limited for safety reasons. We have used virtual detailing, but find that we need detailers that are tech-savvy and can guide providers through accessing the platform easily.

The key is maintaining the interactivity component and having the session not become a presentation. If we can embrace virtual detailing as its own, unique skillset, we may be able to take advantage of all of its benefits. I think that we’re also at a changing point in technology – the next generation of providers (and detailers) will have grown up with and be more comfortable using technology.

NaRCAD: There will be a lot of growth in detailing as we are able to incorporate more options into how we reach providers, with the emphasis being on building a strong relationship.

Terryn: The goal of AD has always been to have a clinician who values a discussion about the evidence, and then is able to incorporate the evidence into their own practice and drug therapy decision making. E-detailing is just another modality for doing that.

​We found that virtual detailing is most effective after establishing a prior relationship with the provider during a face-to-face visit. We received fantastic feedback from one provider who felt the virtual detailing session that he participated in from the comfort and privacy of his home allowed him to ask questions he might otherwise have avoided asking in a group setting. If we can use technology to build relationships like that, then ultimately isn’t that what we want?

​I would say that it is. 

Biography.
Terryn Naumann is the Director of Academic Detailing and Optimal Use at British Columbia’s Ministry of Health’s Pharmaceutical Services Division. She earned her pharmacy degrees from the University of British Columbia and completed a hospital pharmacy residency at St. Paul’s Hospital in Vancouver. Terryn began her career in academic detailing in 1993 when she worked at Lions Gate Hospital in North Vancouver as the clinical pharmacist for the Community Drug Utilization Program – the first academic detailing program in Canada.
 
Since 2008, Terryn has led BC’s Provincial Academic Detailing (PAD) Service, a team of 12 academic detailing pharmacists who conduct over 2000 academic detailing/small group learning sessions each year. She is a member of the Canadian Academic Detailing Collaboration, having served as chairperson and secretary. She has also been a facilitator at several of the Centre for Effective Practice’s Basic Academic Detailing workshops.

​Please refer to our Conference Hub page through narcad.org for all conference ​related videos and slides, which are available as of December 2nd, 2019.
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by Anna Morgan, RN, BSN, MPH, NaRCAD Program Manager

​Tags: Conference, E-Detailing, Jerry Avorn, Program Management

​​Our team at NaRCAD was proud to host the 7th International Conference on Academic Detailing on November 7th and 8th, 2019 in Boston to a sold-out crowd of health professionals engaged in clinical outreach education. With this year’s theme emphasizing collaboration and innovation, our Director, Dr. Mike Fischer, kicked off Day 1 of NaRCAD2019 by reflecting on the past decade of NaRCAD’s work, while also discussing our exciting plans for the future, and highlighting the importance of enhancing connection between attendees to support their work ahead. ​​​​

​Dr. Melissa Christopher, National Director for the Veteran Affairs (VA) Academic Detailing Services, was next to take the stage as the Day 1 Keynote Speaker.  She provided the audience with an overview of the current work by the Department of Veterans Affairs National Academic Detailing Service and how it supports a High Reliability Organization culture.  She also spoke of the future of academic detailing at the VA, which includes expanding their reach with virtual detailing (“e-detailing”) and advancing their electronic health records through ordering safety alerts and real-time PDMP data. 

​Other day 1 highlights included an expert panel presenting on the successes and challenges of implementing e-detailing within their programs, sharing stories and insights about when, why, and how to connect virtually with providers. Our small group breakout sessions explored the fundamentals of academic detailing, with sessions focused on the basics of an academic detailing visit, how to identify and apply the most reliable sources of evidence-based research, and how to successfully lead an academic detailing program.

​Day 1 also included our annual “lightning round” of Field Presentations, a session that highlights aspects of recent academic detailing interventions. Topics included the use of academic detailing to improve maternal and neonatal health through safer opioid prescribing, the effects of academic detailing on pediatric antipsychotic prescribing in the Medicaid population, and increasing access to Nalaxone in New York City through academic detailing.  The afternoon also included a talk on Aetna’s opioid strategy and ongoing initiatives, with a focus on leveraging provider and system relationships to incentivize physician engagement and catalyze behavior change. 

​Dr. Jerry Avorn, Co-Director of NaRCAD, ended the Day 1 presentations with his Annual Academic Detailing Talk, addressing the importance of moving beyond the silos that exist in most healthcare settings, and how academic detailing can encourage the integration and collaboration of roles and initiatives to create synergy. That collaboration and synergy was illustrated during our evening’s Networking Reception, where we launched our new Mentor Match Program to great success, pairing those just starting out in the field with mentors who are part of more established programs.

​Day 2 provided similar opportunity for exploration and dialogue about program expansion. We kicked off with Keynote Speaker Tupper Bean, Executive Director from the Centre for Effective Practice (CEP).  He discussed CEP’s journey to sustainability as an independent, not-for-profit organization, and reminded the audience that sustainability is a parallel process, not an “add-on”.  To further explore sustainability, our Day 2 Plenary highlighted capacity-building strategies, best practices, and opportunities for expansion in clinical outreach education programming. 

​Day 2 Field Presentations provided opportunities to learn about more active AD programs, including topics such as identifying barriers to opioid prescribing through academic detailing, a team-based model and approach to AD, and a new AD campaign exploring cannabis as an alternative tool for patients experiencing pain. Our afternoon wrapped up with workshops focused on relationship-building for program sustainability, understanding stigma when supporting patients with opioid use disorder (OUD), and building AD campaign materials with limited resources.  

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We’re grateful to all those who attended, and beyond the 2 days of connection at the conference, we at NaRCAD are committed to creating continuous opportunities for connection, support, and collaboration among all of you who make up our incredible network. Keep an eye out for our Annual Community survey, which we’ll send you in early December to find out what you need as you make an even greater impact in 2020!
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-The NaRCAD Team
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