This press release originally appeared on publicnow.com and was written by UCSOP. Tags: LOOPR, Opioid Safety, Rural AD Programs, Substance Use, Training The University of Charleston School of Pharmacy (UCSOP) is partnering with the Centers for Disease Control and Prevention (CDC) to pilot the National Resource Center for Academic Detailing (NaRCAD) program at the Boone County Health Department in Southern West Virginia. Academic detailing is a one-on-one outreach education technique which allows pharmacists, pharmacy students and other health care professionals to educate prescribers on the dangers of overprescribing opioids and also recognize the signs of opioid abuse. UCSOP participants include student pharmacists Angela Withrow (class of 2019), Amy Bateman (class of 2018), Joshua McIntyre (class of 2021), Jami Swift (class of 2021), and assistant professor Dr. Sarah Embrey. These individuals make up five of the seven selected persons being trained for the program. A two-day training will kick-off the program on March 14-15, 2018. 'Participation in this important pilot project is just one more way UCSOP students and faculty work to educate and serve communities throughout West Virginia on opioid use/abuse by sharing best prescribing practices, delivering prevention education, and encouraging recovery and treatment,' said Dr. Susan Gardner Bissett, Assistant Dean for Professional and Student Affairs. NaRCAD was founded in 2010 and is a national resource center that supports clinical outreach education programs across the United States. The goal through its trainings and program support is for clinical educators to have a greater impact when visiting clinicians and aiding those clinicians on making evidence-based decisions. Interventions supported include reducing opioid abuse, HIV/STI screening and prevention, prenatal health, smoking cessation, chronic disease management, and more. For more information, visit https://www.narcad.org/.
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The National Academic Detailing Service’s Opioid Overdose Education & Naloxone Distribution (OEND) Program Guest Blog Authors: Melissa Christopher, PharmD, National Director Mark Bounthavong, PharmD, MPH, National Clinical Program Manager Tags: Data, Detailing Visits, Evaluation, Opioid Safety, Substance Use In 2015, the Department of Veterans Affairs (VA) invested in the National Academic Detailing Service to improve the health of our Veterans to address the call to action for the opioid crisis. Through the Opioid Overdose Education and Naloxone Distribution (OEND) Program, our goals were to reduce harm and risk of life-threatening opioid-related overdose and deaths among Veterans. Key components of the OEND program include raising awareness about the epidemic, 1:1 academic detailing visits with clinicians to provide education and training regarding opioid overdose prevention, opioid overdose rescue response, and issuing naloxone products. We developed direct-to-consumer marketing and other e-resources, including a video, Introduction to Naloxone for People Taking Prescribed Opioids. We also created implementation tools, including population management dashboards to aid staff in evaluating risk factors of their patient population and distributing naloxone accordingly. Academic Detailers demonstrated to VA providers these resources to help raise awareness of opioid overdose risk for their patient panel. Decision-makers believed that funding this program would yield a good return on investment. As part of the National Academic Detailing Service, it’s our responsibility to collect data and supply decision-makers with evidence on the value and success of our program. In other words, we’re accountable for answering the question, “Is academic detailing worth it?” To answer this question, we performed several program evaluations of the National Academic Detailing Service from 2015 to 2017, one of which we just published in the Journal of American Pharmacists Association (JAPhA) (Trends in naloxone prescriptions prescribed after implementation of a National Academic Detailing Service in the Veterans Health Administration: A preliminary analysis.) The evaluation found that our program improved naloxone distribution rates at a seven times greater increase for Veterans at risk for opioid overdose. These results provided key empirical evidence that VA’s strategy of academic detailing was working. Just as important, these findings also gave decision-makers what they needed—proof that their investment in an area of high risk to Veterans’ health paid off by improving care. But we learned that another group of stakeholders was just as important as the decision-makers who funded the program—the clinicians that academic detailers visited to provide outreach education as a service. Academic detailers work with clinicians to help them change practice patterns, focusing on improving health outcomes in alignment with balanced, current evidence. As clinicians commit to sustainable behavior change, these providers need to hear the feedback about how the time they’ve invested with their patients ultimately improves outcomes and, in this case, saves lives. Sharing program results with the clinicians in this intervention also encouraged these providers to share their own results, many of which were stories of patients returning to the clinic to relate their experiences of using naloxone to reverse an overdose. These stories, along with reversal reports from the field that tracked the outcomes of naloxone kit distribution and subsequent use, also created a tangible “return on investment” for everyone involved. We encourage other academic detailing programs to prioritize program evaluation as we have at the VHA—no matter the size of your program, if you’re thinking, “we can’t afford to do program evaluations,“ we stress that you can’t afford not to do them. Measuring program work builds a case not just for the success of one academic detailing intervention, but for the success of future programs—a case for sustainability. Evaluation measures the quality of a program, analyzing results to look at a program’s impact, and allowing for process improvement adjustments to be made to streamline efforts and strengthen that impact. Evaluation cannot be optional, especially when lives are at stake. We also recommend that the results from program evaluations are shared with other stakeholders, such as clinicians, in order to encourage and sustain their behavior changes. Leveraging results from well-designed evaluation is essential for academic detailing interventions to illustrate success, share value, and provide stakeholders and community members with a clear “Yes!” in answer to their overarching question: “Was the investment worth it?” Resources:
Biography. Melissa Christopher, PharmD National Director, Academic Detailing, US Department of Veterans Affairs Central Office, Pharmacy Benefits Management (PBM) Academic Detailing Service Dr. Christopher is the National Director of VA Academic Detailing Services, overseeing the implementation efforts for academic detailing expansion across all Veteran Integrated Service Networks since 2014. She received her Doctor of Pharmacy from Duquesne University, Pittsburgh Pennsylvania. She completed a Pharmacy Practice Residency and Post Graduate Year 2 in Pharmacoeconomics and Formulary Management at VA San Diego Healthcare System. Dr. Christopher conducted research in health outcomes and pharmacoeconomic analysis for several chronic disease management areas. In recent years, Dr. Christopher has embraced the mission to expand efforts for educational outreach by clinical pharmacists for improvement of evidence based care in Pain Management, Depression, Schizophrenia, and Posttraumatic Stress Disorder as well as other substance use disorders. Most of her program efforts focus on development of educational materials, outcome monitors, provider specific electronic audit and feedback tools to trend practice patterns with implementation efforts for the newly developed as well as fully implemented AD programs. Mark Bounthavong, PharmD, MPH National Clinical Program Manager, Academic Detailing Service, Veterans Affairs Dr. Bounthavong graduated from the College of Pharmacy at Western University of Health Sciences. He completed a PGY-1 Pharmacy Practice Residency at the Veterans Affairs Loma Linda Healthcare System followed by a fellowship in Outcomes Research and Pharmacoeconomics at Western University of Health Sciences. He started his career at the Veterans Affairs San Diego Healthcare System as a pharmacoeconomics clinical specialist. During his tenure at the VA, Mark worked on identifying cost-effective strategies and formulary management; directed the PGY-1 Managed Care Pharmacy Residency; and completed a Master of Public Health from Emory University. Mark left the VA in order to pursue a PhD in the Pharmaceutical Outcomes Research and Policy Program at the University of Washington. He recently accepted a position at the VA as one of the National Clinical Pharmacy Data Program Managers in the Academic Detailing Service. An Interview with Frank Leone on Treating Tobacco Dependence with AD Dr. Leone directs Penn’s Comprehensive Smoking Treatment Program and was a former trainee with NaRCAD. Tags: Detailing Visits, Smoking Cessation, Substance Use, Training NaRCAD: Tell us a bit about yourself. How did you get into academic detailing? Frank Leone: I’m a pulmonologist, and have been focused on the treatment of tobacco dependence for over 20 years. In my early years, I had always been amazed at how infrequently my colleagues would approach the literature for solutions when facing this common problem in the clinic. It seemed to me that they relied heavily on “common sense” approaches and techniques derived from misunderstandings, rather than consulting published guidelines and available standards. I became interested in the behavioral economics of tobacco treatment decision-making in the clinic, and realized that traditional approaches to changing physician behavior might be inadequate for dealing with a cultural problem this well-entrenched. We initially turned to NaRCAD for advice on Academic Detailing in 2011, and found the approach to have just the right potential to both meet the needs of the target audience, and allow us to deliver our message in a cost-effective and scalable way. We were also given an opportunity to work with the Philadelphia Department of Public Health as they started up their efforts to influence the local provider culture around tobacco, and we’ve been “off to the races” working within our community, creating positive changes, ever since. NaRCAD: What does your program focus on? (What health issue does it address, and what clinician behavior are you seeking to change?) Dr. Leone: Our Academic Detailing (AD) program focuses exclusively on tobacco dependence treatment. As you can imagine, that problem cuts across a number of different audiences. Our detailers work with physicians, psychologists, nurses, counselors and others to impact the rate at which tobacco treatment services are delivered in our area. We use AD to address the limits in knowledge base around pharmacotherapy, as well as to shape the core assumptions about effectiveness of treatment in key patient populations (e.g. those with established lung disease or serious mental illness). NaRCAD: Tell us about some of the growth you’ve seen and been a part of as it relates your program. Dr. Leone: Our AD program has grown every year since its inception. We started out focused on primary care physicians in underserved parts of Philadelphia. From there, we expanded our target audience to include specialist physicians, nurses, and nurse practitioners. Most recently, our audience has expanded to include behavioral health practitioners in both inpatient and outpatient settings. Because of our success using AD to work with care providers from a variety of disciplines, we are currently exploring ways to extend AD principles to “system-wide” approaches to creating behavior change. NaRCAD: What would you say are the greatest challenges you see in implementing this intervention? Dr. Leone: Finding the right people to go into the field is imperative. Over the years, I’ve been impressed that success during the AD interaction is less about what degree a person has, and more about the ability to be gently directive, while willing to truly listen. Detailers need to be spontaneous and responsive to their audience, while at the same time keeping their inner eye on the target. This is a skill that takes a little time and training to develop. It sounds like it ought to be an easy thing to do, but we’ve found that an organized, logical, mentored approach to learning these skills is important to success. NaRCAD: How about what works well? How do you know when you’ve been successful? Dr. Leone: We always try to incorporate some sort of measurement tool into our AD projects. It might be about knowledge, attitudes, or behaviors, but having a metric to gauge our impact is important feedback ensuring we stay on mark. Our funders appreciate a concrete measure of change as well. If I could figure out how to capture this, my favorite measure would measure the “A-ha!” moments that happen so often within the audience. I love the look of epiphany in the clinician’s eye when a detailer has found a way to make the information relevant and transformative. That’s when I know we’re really making change for the long run. NaRCAD: You attended our Academic Detailing Techniques Training a few years back. What are the most useful resources or information that you’re still using today? Dr. Leone: Truthfully, the greatest resource has been the continuing relationship with the NaRCAD team. On multiple occasions during the conception and start-up phases of our project, we were able to touch base with professionals who had a large collective experience in diverse disciplines to get some great tips and suggestions. On one specific occasion, I remember sharing a written detailing piece with the NaRCAD team. We had developed it in hopes of getting some feedback. Not only did we get great advice, but it was professional advice – complete with references, examples, resources, and connections to the theoretical basis for the suggestions. To me, this is the kind of interaction that helps my team grow and learn over time. NaRCAD: What does future success look like for you? Dr. Leone: In twenty years, when you go visit your doctor for your annual check-up, and you hear him or her say, “Of course tobacco dependence is a chronic illness of the brain for which there are a number of effective treatments. It’s hard to believe we used to simply tell people to stop!” –then you’ll know we’ve done our job well. Biography: Dr. Leone received his medical degree from the University of Pittsburgh, School of Medicine, and completed his postgraduate training in both general internal medicine and pulmonary / critical care medicine at Thomas Jefferson University Hospital. He also received his masters degree in clinical epidemiology and biostatistics from the University of Pennsylvania School of Medicine. Dr. Leone directs Penn’s Comprehensive Smoking Treatment Program, a clinical program of the Penn Lung Center, located at both Penn Presbyterian Medical Center, and the Perelman Center for Advanced Medicine. The new program provides state-of-the-art and individualized treatment to smokers, including those with co-morbidities. Dr. Leone’s scholarship focuses on investigating advanced treatment strategies for tobacco use disorder, and on testing educational strategies for improving the care of the tobacco dependant patient. Dr. Leone is a member of several professional and scientific societies, including the Society for Research on Nicotine and Tobacco, the American College of Chest Physicians, and the American Thoracic Society. He has served the Commonwealth of Pennsylvania as a legislative appointee to the Governor’s Tobacco Use Prevention and Cessation Advisory Committee since 2001. Dr. Leone has been invited to speak at numerous lectures on topics of smoking treatment and pulmonary medicine, and has been published in a variety of clinical and research journals. He is board certified in pulmonary and critical care medicine. Learn more and review related publications on the University of Pennsylvania’s site. Read more: Behavioral Economic Insights into Physician Tobacco Treatment Decision-Making : Leone, Frank |
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