This interview features Carla Foster, MPH, who leads the conceptualization, implementation, and evaluation of Public Health Detailing as an Epidemiologist within the Bureau of Alcohol and Drug Use Prevention, Care and Treatment (BADUPCT) at the New York City Department of Health and Mental Hygiene (NYC DOHMH). She is currently activated for the COVID-19 emergency response as Lead Analyst managing the Reporting Unit within the Integrated Data Team of DOHMH’s Incident Command System.
By Winnie Ho, Program Coordinator
Tags: Data, Detailing Visits, Evidence-Based Medicine, Health Disparities, Program Management, Stigma, Substance Use, Training
Winnie: Hi Carla! You’ve certainly had a lot on your plate with so many diverse campaigns. Can you walk us through the conceptualization process for your detailing campaigns, and how your team came to choose cocaine use as your current detailing topic?
Carla: We can start with some data on this. In 2018, more New Yorkers died from drug overdose than from homicide, suicide, and motor vehicle crashes combined. Cocaine – in both crack and powder forms – has played an increasingly prominent role in this crisis. The mortality rate from overdose deaths involving cocaine more than doubled between 2014 to 2018, amounting to 52% of all drug overdose deaths in NYC. Some of the associated risks are serious - increased exposure risk to fentanyl, cardiovascular disease events and death.
W: That’s stunning data. Especially in the midst of the opioid crisis, it’s important that we don’t lose sight of other substance use issues going on right now. I’d love to learn a little more about the challenges and lessons that your team has learned by detailing on cocaine use.
C: First, we have to be aware that fentanyl, a powerful opioid 50 to 100 times stronger than morphine may be found in many substances, including cocaine. We’re very concerned about fentanyl and cocaine because people who use cocaine do not have tolerance to opioids and are at even higher risk for overdose.
It’s also important to address the perception of who is most impacted by high mortality rates. There’s this idea that cocaine use is more prominent in younger populations, but our data show that it’s actually impacting an older population more than many might expect. In particular, residents age 55-84 in the Bronx Borough have experienced the largest increase in cocaine overdose death rates in New York City from 2014 to 2018.
That’s why it’s critical for us to raise awareness in an effort to mitigate misconceptions and stigma around risky use and those who may have a substance use disorder (SUD). In addition to shame, there are still very real potential socioeconomic and legal consequences from disclosing substance use, which can deter folks from even seeking help.
We take into account the unjust consequences of policies applied unevenly according to race, and how this impacts implicit biases in terms of which patients are thought to use substances, which types of substances they might use and even more critically, which type of treatment, if any, they are offered. Implicit biases combine with the effects of systemic racism to compound these consequences. It’s important to note that it’s not race that drives poor health outcomes, but racism.
W: Challenging stigma is one of the most powerful ways that detailing campaigns can combat the damage done by the War on Drugs, because stigma can make the difference of whether or not people receive dignified care. With a campaign so focused on addressing stigma and with a topic this important, how do you prepare your detailers for this task?
C: We devote a significant amount of time towards training our detailing reps – a week-long training, 8 hours a day. We spend a large amount of that time talking in detail about stigma as related to cocaine use. It’s critical to us that our detailers are comfortable and knowledgeable when speaking about this topic, because it sets the tone for the providers who then set the tone for their patients.
We ensure that our representatives are prepared to respond to a wide range of questions or comments, because this builds the provider-detailer relationship and enhances the value of the detailing visit. We’ve found during our follow-up visits that this support has led to high provider engagement with the campaign and providers reporting incorporation of the key recommendations into their daily practice, which is the aim of our public health detailing campaigns.
W: How have providers responded when detailed on a topic that carries so much stigma?
C: The good news is that we’ve found NYC healthcare providers to not only be receptive to our work on substance use, but they’re eager to partner with us to support their patients once they learn about the severity of the issue.
Our team provides statistics that relate to the provider’s specific neighborhoods and specialty, giving them real-time pictures of what’s happening with the patients they see. We know that it’s still a difficult topic to bring up, so we help address this with our action kit resources on stigmatic language and counter-top brochures that signal to patients that the provider’s office is a safe place to discuss these issues.
W: It gives me tremendous hope to hear about that there’s been enthusiastic response from providers. It means that things are changing.
Let’s also talk a bit about program sustainability. Your team has worked extensively on campaigns across multiple topics. What have you learned from implementing past campaigns?
C: Each public health detailing campaign is different, but we’ve learned some key strategies that support the growth and success of subsequent campaigns:
Our overall goal is to do everything we possibly can to improve the health of our fellow New Yorkers. I like to remind our detailers of this James Baldwin quote that informs our public health detailing mission: “Not everything that is faced can be changed, but nothing can be changed until it is faced.”
Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!
Carla Foster, MPH is an Epidemiologist at the New York City Department of Health and Mental Hygiene (NYC DOHMH). Her research focuses on the implementation and evaluation of public health detailing campaigns across New York City with the aim of reducing overdose mortality. Prior to joining the NYC DOHMH, she led development of clinical practice guidelines at the American Urological Association. She received dual Bachelor of Arts degrees in Africana Studies and Neuroscience from Wellesley College. Carla also obtained her Master of Public Health Degree in Epidemiology from Columbia University.
An interview with Sarah Ball, PharmD, Research Assistant Professor, Division of General Internal Medicine, Medical University of South Carolina and Megan Pruitt, PharmD, Clinical Pharmacy Consultant, SCORxE Academic Detailing Service and Assistant Professor, Department of Clinical Pharmacy and Outcomes Sciences, Medical University of South Carolina
by Anna Morgan, RN, BSN, MPH, NaRCAD Program Manager
Tags: COVID-19, Opioid Safety, Stigma, Substance Use, Training
Anna: Hi Sarah and Megan- thanks for taking the time to chat! Can you tell us a bit about your program, SCORxE, and how your AD work has concentrated on improving opioid safety?
Sarah: SCORxE began in 2007 as an academic detailing service at the South Carolina College of Pharmacy and is now part of the Medical University of South Carolina (MUSC) College of Pharmacy. Our current efforts are around addressing the opioid epidemic. We’re fully funded by the South Carolina Department of Health and Human Services, and our agreement talks about bringing together quality initiatives for safer opioid prescribing and expanding access to MAT.
We’ve been able to effectively bring together quality initiatives from different state agencies that span prevention and treatment. This braiding has been a unique experience for our academic detailing service. Regardless of the specific topic, our detailers promote opioid risk reduction strategies, help recruit and support MAT providers, and work to reduce stigma around MAT. We’re currently shifting our focus from chronic pain to acute pain. We’ll be detailing both primary care providers and surgeons on post-surgical pain.
Anna: Detailing surgeons is a unique approach – we’d love to hear about the results of that process in the future. And you’re working on other topics outside of opioid safety, too – tell us more.
Sarah: Our providers always welcome new topics. While our focus is on the opioid epidemic, we try to expand our content reach when possible. We recently detailed on depression and anxiety screening, and touched on alcohol use disorder in our topic on naltrexone. We’ve always offered CME credits and our current strategy is shorter and more focused visits that offer a half hour of CME credit, as opposed to one or two hours of credit. This allows us to have multiple visits with each provider and to individualize next topic selection.
Megan: As a detailer, it’s helpful to have a menu of shorter topics that providers can choose from – it makes our visits more flexible.
Anna: Speaking of flexibility - how are you continuing to detail and run your program given the current COVID-19 pandemic?
Sarah: We haven’t previously engaged in virtual visits or e-detailing. We’re planning to reach out to our network of academic detailing colleagues who’ve had e-detailing visits in the past to see what their experience has been like. It’s times like these that show how valuable it is to have a network of academic detailing services. Being able to share ideas and find out what other folks have done will help us determine what will work best in our state.
Megan: We’ve been using the past few weeks to work on creating materials and scripts for upcoming topics. It’s been a good time to refresh on a lot of our content and update various internal documents. I’m going to begin reaching out to providers within the next few weeks and gauge their interest and comfort level in using a virtual platform.
Sarah: We know this is a difficult time for primary care providers, so it’s important for us to be compassionate in how we go about scheduling visits. We want to be sensitive to our providers’ time and respect what they’re going through, while still offering our detailing service around topics related to the opioid epidemic.
Anna: You’re not alone in figuring out this balance! You also mentioned that peer learning is an important component to a successful intervention. Can you tell us about your own peers on your team, and how they enhance your overall detailing service?
Sarah: Our program is under the College of Pharmacy, so we’ve recruited all our detailers from there and they’ve all been clinical pharmacists. We’re fortunate to have pharmacists because they’re well-respected among providers we visit. We have two full-time detailers, which is a privilege, and they’re very passionate about their work. Being able to have two people fully commit to detailing is far greater than the number implies. Both of our detailers have different personalities and different experiences to share – I think they complement each other very well!
Detailing can be lonely, though. When you have more detailers in your program that add up to two full time equivalents, what we have had in the past, you have more people sharing experiences during debriefs and more people to bounce ideas off; there are pros and cons to both scenarios.
Megan: My colleague, Lauren, and I come from different clinical backgrounds. When we work on our content development and role playing, we’re able to help each other consider things differently. It’s been fun to work with somebody who differs so much from me!
Anna: It sounds like you balance each other out well. How are the detailers in your program trained?
Sarah: All of our detailers have gone through pretty intense academic detailing training on the marketing of evidence-informed clinical ideas. Our most recent hires have gone through NaRCAD training, but before there was a NaRCAD, our pharmacists went through a training developed by a group in Australia. That training gave us a step up on everything when we first started our program, as NaRCAD also does with programs just getting started. We garnered our baseline of how we develop content, how we develop our supporting materials, and essentially how we put together our whole intervention.
Anna: It sounds like the detailers in your program are trained well and prepared for the field. Do you have certain strategies for getting in the door? Are there key stakeholders who your program has connected with that have helped you to do this?
Megan: Showing up at the office has repeatedly proven to work for us. We bring a letter to share with the first gatekeeper at the front desk, so that we can get face-to-face time with the providers for introductions. We’re usually able to schedule a meeting fairly easily after that. If we can’t meet with the provider face-to-face, we try to speak with the Office Manager.
Recently, we’ve been leveraging our group presentations at clinics to get more 1:1 visits. We try to promote our detailing visits during our presentations and grab contact information from providers afterwards. We’ve also found that it’s been helpful to stay in the break room at an office after a visit - we might stay there all day and introduce ourselves to a number of providers who end up wanting to either schedule a visit that day or in the future. We’ve found great success in being present for providers when they’re ready.
Sarah: When you can get face-to-face with the providers for a brief introduction, it’s a beautiful thing-it’s how we’ve gotten most of our visits over the years. When we first started, gaining access happened in different ways. 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.
Anna: I’m sure having providers in the area know about your detailing service has helped to build your program. Can you tell us more about how your program is working towards sustainability?
Sarah: We’re more sustainable than we’ve been for a while. Part of that is due to the funding that we have for opioid-related topics, but it’s also been due to the effort our program has put into effectively bringing together different quality initiatives over the years. We’ve had funding come in from multiple sources in that process.
One agency asked us to take on the topic of naloxone for pharmacists--our ability to respond to such requests helps up strengthen relationships, and may help us with future sustainability. It is also important that our interprofessional teams at MUSC see value in academic detailing.
Additionally, our detailers help us with sustainability through their visit documentation and tracking. The data they collect is included in our reporting and helps illustrate the value of academic detailing. Our clinical pharmacists are amazing people, and they both bring so much to what we do in the academic detailing world– programs are only as sustainable as the strength of their individual detailers!
Sarah Ball, PharmD is a Research Assistant Professor in the Division of General Internal Medicine at the Medical University of South Carolina (MUSC), with a focus on patient-centered care, patient safety, and educational outreach. She has had direct involvement with academic detailing for over twelve years, beginning with the development and implementation of the SCORxE Academic Service under the SC College of Pharmacy in 2007. Current efforts include the integration of research and programmatic opportunities to identify interventions that change prescriber behavior to reduce the risk of opioid overuse, misuse, abuse, and overdose. Dr. Ball is currently leading the MUSC team partnering with the South Carolina Department of Health and Human Services for the provision of drug utilization review (DUR) services, which includes educational outreach to primary care providers and surgeons. Dr. Ball has twenty plus years with a career focus on improving patient care through the application of technology and effective communication of clinical knowledge, information, and data-derived findings. She is a graduate of the Medical University of South Carolina, where she received both a B.S. in Pharmacy and Pharm.D.
Dr. Megan Pruitt is a South Carolina Offering Prescribing Excellence (SCORxE) clinical pharmacy consultant and assistant professor in the Department of Clinical Pharmacy and Outcomes Sciences at the Medical University of South Carolina in Charleston, South Carolina. She received her bachelor of science in health science from Clemson University and her doctor of pharmacy from the South Carolina College of Pharmacy. She has published an Amazon ebook, Catalyst (pharmD): The Next Generation Pharmacy Student, and has previous experience as a community pharmacist at Federally Qualified Health Center in South Carolina. In her current role as a SCORxE clinical pharmacy consultant, she provides academic detailing visits to primary care providers on monitoring practices to promote safe opioid use and to reduce the risk of misuse and abuse in South Carolina.
An interview with Brandon Mizroch, MD, MBBS, Provider Network Supervisor, Louisiana Department of Health
by Anna Morgan, RN, BSN, MPH, NaRCAD Program Manager
Tags: Hepatitis C, HIV/AIDS, PrEP, Rural AD Programs, Sexual Health, Stigma, Training
NaRCAD: Thanks for chatting with us today, Brandon! We’re excited to be catching up with you. Can you tell us about your program at the Louisiana Department of Health and the work you’re currently doing?
Brandon: Absolutely. I was hired to do work around PrEP and PEP, detailing providers across the state of Louisiana, in 2017. Since then, my role has expanded and I promote education for providers about syphilis, congenital syphilis, and Hepatitis C. Our department now has 3 detailers, including myself.
Louisiana became the first state in the country to undergo an incredibly revolutionary Hepatitis C Elimination Plan, which has caused my detailing focus to shift. There’s been huge advancements in the drugs that treat Hepatitis C, but they’ve been inaccessible to much of the population due to cost. We negotiated a fixed rate price for Hepatitis C treatment and can now treat 100% of the population, compared to the 3% of the population we could treat previously. There’s been a big push to identify and train providers who’ve never previously treated patients with Hepatitis C. I’ve been leading the charge by getting the word out, running symposiums, and working with the marketing team that’s creating our statewide campaign.
NaRCAD: Wow, that sounds like innovative and exciting work. Can you explain your program’s approach a bit more?
Brandon: I try to blend a few different approaches together. I attended the NaRCAD training during my first year as a detailer. NaRCAD built the foundation of detailing for me. I always use the NaRCAD methodology to get my foot in the door and identify providers who can be champions within their practices. I find it much easier to follow up and do longer didactic sessions about complex clinical topics when I use the techniques of academic detailing during my first face-to-face visits with providers.
I connect with about 20 providers in this 1:1 model each month. I also work with residency programs, hospital systems, and present at Grand Rounds to expand my reach. There’ve even been instances where I’ve attended dinners for physicians that are hosted by pharmaceutical companies to network and identify new clinics that would benefit from detailing.
NaRCAD: We’re happy to see that you’re blending academic detailing with other approaches. Do you provide follow-up to providers after your visits?
Brandon: Follow-up is incredibly important, no matter what approach is being used. I like to send an email after each visit that includes digital resources for both providers and patients. I also offer providers the ability to call, text, or email me because of the apprehension that exists around topics where the knowledge base is still growing. Maintaining relationships with providers also ensures that we have a strong provider network that we can continue to educate on other clinical topics down the road.
NaRCAD: Building a connection with providers is imperative, especially as you move into different clinical topics. Your program spans the entire state. Do you find that there’s a difference when you provide clinical outreach education in rural vs. urban communities?
Brandon: Yes, there’s certainly a difference. The providers in urban areas tend to have a higher knowledge base when it comes to PrEP and syphilis, perhaps due to marketing efforts or higher patient loads. This makes starting the conversation a bit easier. Additionally, urban communities have access to navigators, who help with non-medical aspects, like transportation issues, lack of health insurance, and long commute times that all prevent folks from getting the treatment they need. Providers in urban areas are also busier and easily distracted during 1:1 visits, which can make detailing a bit difficult.
On the other hand, rural communities are quite the opposite. Providers tend to have more time in their schedules and are excited to sit down with somebody from the state office. They’re eager to learn, but there’s typically less of a knowledge base, making it slightly more difficult to start the conversation.
I’ve also learned about patient barriers as well, which affect access and provider care. Patients in rural areas are often friends or family with those throughout the community, including those who work at clinics. The notion that you would know the receptionist or provider at a clinic is enough to deter folks from seeking medical care around a topic like sexual health. To encourage access, our state has created a TelePrEP program that offers PrEP services to anyone via telemedicine. Consultations take place over the phone, labs are obtained at third party lab companies, and medications are mailed right to the front doors of patients. It was originally created to help folks in rural communities who face stigma-related barriers, but we’ve expanded the program across the entire state of Louisiana. It’s a great referral service that I can share with providers.
NaRCAD: It’s wonderful that you’re able to identify these challenges and have resources and tools to address them. What’s one piece of advice you’d give to folks who are detailing on a similar clinical topic or have a large geographical region to cover?
Brandon: It’s important to have several different ways of presenting information to the providers you’re detailing and to use varied approaches depending on the barrier(s) they’re facing. I typically focus on emotional connection, financial concerns, and the evidence and science behind the key messages I’m delivering. I’m also ready for provider resistance, and am prepared to address it, which is something I learned from NaRCAD.
When it comes to detailing over a large and diverse geography, it’s always necessary to plan ahead. My general rule of thumb is that however many hours it takes to drive to a location, that’s how many providers I want to meet with while I’m there. I typically try to use larger educational events, like meetings with clinics over lunch, as my anchor point for longer trips. After I have that scheduled, I search for smaller clinics around the area where I can meet with providers 1:1. It’s all about maximizing your time.
Brandon Mizroch received his MD/MBBS from the University of Queensland/Ochsner Clinical School Program in November of 2016. Since taking over as the PEP/PrEP Provider Outreach Specialist at the Louisiana Department of Health in August, 2017, he has worked with hundreds of doctors statewide on HIV prevention best practice. Since then he has expanded his educational base and now serves as the head of the academic detailing department at the Louisiana Department of Health, Office of Public Health, STD/HIV/Hepatitis program. As the Provider Network Supervisor he has helped lead the provider Outreach for the state’s first-in-the-nation Hepatitis C Elimination program. From grand rounds presentations at LSU-Shreveport Hospital and Baton Rouge General, to state-wide symposia and conferences, to one-on-one counseling encounters at dozens of clinics all over Louisiana, he has helped spread awareness and education on HIV prevention, syphilis screening and treatment, and HCV screening and treatment through evidence-based care.
An interview with Tony de Melo, RPh, Director of Clinical Education Programs, Alosa Health
by Anna Morgan, RN, BSN, MPH, NaRCAD Program Manager
Tags: Detailing Visits, Opioid Safety, Program Management, Training
NaRCAD: Tony, thanks for chatting with us today about your role at Alosa Health! What’s been the most exciting part of the work that Alosa has done this year?
Tony: Our partnership with Aetna, a managed health care company and health care insurer. We’ve been working with them to provide educational outreach to providers on chronic pain, acute pain, and opioid use disorder (OUD); supporting them in managing pain using non-opioid drug options; appropriately dosing opioids when they need to be used; tapering down patients who are on existing high doses of opioids; and helping to identify patients that may have opioid use disorder. We’re now working in Pennsylvania, Virginia, West Virginia, Ohio, Illinois and Maine.
NaRCAD: That collaboration does sound exciting! Now, let’s talk a little about your role at Alosa. You actively detail, you manage academic detailers in the field, and you lead trainings at Alosa. Which aspect of your role is your favorite, and why?
Tony: When I’m training and managing detailers, I see myself more as a coach than a trainer. I’ve always liked educating and teaching—I enjoy helping others develop their skills and seeing them improve. Training folks and coaching them in the field is rewarding to me because I feel that I’m impacting what they’re doing in their own communities. It brings me happiness to see others succeed.
NaRCAD: As a coach, how do you know when your work has been impactful?
Tony: When I work with detailers in the field, I can see firsthand that they are able to be impactful with the providers because they are bringing about behavior change with their message delivery and confidence. We can also measure how impactful our work is by reviewing our Salesforce data. I can see from the detailer’s visit notes when providers have agreed to a behavior change, and this is a true measure of our work being impactful.
NaRCAD: With success comes challenges. What are some of the major challenges you see academic detailers face in training and in the field?
Tony: The major challenge is teaching detailers to have a conversation with clinicians rather than a lecture. Making the visit more conversational doesn’t often come as naturally as presenting the information in a lecture format, but the conversation must be about understanding where the provider is now, what their needs might be, and how to deliver content to make behavior change.
In the field, the major challenge is access to providers. Many health systems have regulations and restrictions for those who want to meet with providers, because representatives in the pharma industry have bombarded and overloaded providers throughout the years. As a result, we’re often seen as an outside influence or an outside visitor, so we aren’t always given the opportunity to meet with a provider.
NaRCAD: With these challenges in mind, how do you instill confidence in academic detailers as a trainer and as a manager?
Tony: We spend a lot of time practicing and providing feedback during trainings. We practice individually, with partners, and with outside folks who are playing the role of providers. Practicing multiple situations, multiple times, over multiple days, builds confidence. We also videotape the trainees so that they can see what they’re doing well and what they can improve upon.
As a manager in the field, it’s quite similar. I usually sit down with each detailer after a visit and discuss what worked well and what they could do differently in their next visit, so that each visit becomes a learning opportunity. Providing feedback and being a mirror for the detailers helps them to build confidence and skills as time goes on. I also offer the detailers my perspective; having spent time doing this myself and observing others, I can share the tricks, skills, and wording I’ve heard throughout my time with the detailers.
NaRCAD: Those are all great ways to build confidence among detailers. What’s one piece of advice that you would give to academic detailers?
Tony: Don’t be afraid to ask for a specific behavior change, and remember to follow up to make sure that the behavior change occurs. One thing that I find to be hard for academic detailers is the “ask”, where detailers are asking for commitment or behavior change from a provider at the end of the visit. I always tell detailers to frame it as, “based on what you’ve heard today, what is one thing you’d do differently?” Follow-up then ensures that providers are committed to change and holds them accountable for what they said they would do.
NaRCAD: That’s extremely helpful advice for detailers. What’s the best thing a program manager could do to maintain high levels of engagement among detailers?
Tony: As a manager who’s coaching or guiding others, it’s important to build trust between yourself and the folks you’re coaching or managing. It can be lonely when you’re in the field detailing by yourself, so managers need to have touchpoints with their detailers. Building trust and having your detailers know you’re all working together helps them stay self-motivated; it makes them want to go out into the field and do a good job because they know someone is backing them up.
NaRCAD: Thank you for taking the time to chat with us today. We value your unique perspective on detailing, managing, and training!
Tony de Melo manages field staff and leads academic detailer trainings at Alosa Health. He attended Massachusetts College of Pharmacy and Health Sciences in Boston, where he received a BS in Pharmacy with a minor in Business Administration. This business interest led him to work for several pharmaceutical companies as a sales representative, account manager, training manager, district/regional manager, associate director of managed markets training, head of sales training, and development & marketing product manager. He has also worked for smaller businesses that were looking to grow their sales and marketing programs. Throughout his career, Tony has successfully sold, marketed, trained, led, designed, developed and executed solutions to meet business objectives.
Director's Letter | Mike Fischer, MD, MS, Director of NaRCAD
Tags: Director's Letter, HIV/AIDS, Opioid Safety, Training
As NaRCAD enters its 10th year as the only national resource center dedicated to clinical outreach education, we’re ready to take our collaborations with you to the next level. The strength and sustainability of NaRCAD has grown from the hard work we’ve done together with you, our community members in the field.
We’re committed to continuing to provide the technical assistance you need to make your programs innovative, efficient, and successful. As we kick off 2020, our entire team at NaRCAD invites you to join us in leading our field forward through strategic partnerships, resource-sharing, and peer learning, all to implement important initiatives that will have a significant impact on clinicians and their patients.
The nature of our role as a resource center has continued to grow in parallel with increased recognition of the importance of academic detailing as a strategy to address multiple clinical challenges. We’ve been especially excited to see the effectiveness of AD enhanced when aligned with other initiatives to improve the quality of care.
Responding to this growing demand, we’ve dramatically expanded our reach, conducting 20 trainings in 15 different states across the US in the past two years alone, and 2020 looks to be no different. With the increased demand for AD technical assistance, we have a busy year ahead of us, from capturing your successes and sharing them via our DETAILS Blog to training your detailers to be ready for field work (and troubleshooting challenges along the way.)
Along with continued trainings across the US to improve opioid safety in partnership with states supported by the CDC’s Overdose Data to Action (OD2A) grants, we’ll also continue the important work of training new detailers to educate clinicians about using HIV PrEP to reduce the risk of new HIV infections, also through CDC-funded programming.
We’re equally excited to have launched a new CDC research grant in collaboration with the Oregon Health Authority to rigorously evaluate the impact of their OD2A intervention and to develop a model for pragmatic assessment of similar efforts in other states. If you’re also interested in evaluating the impact of your AD program, reach out and let us know—we’re eager to hear from you.
Although we have been conducting more trainings recently, we see the demand for them continuing to grow at an even faster pace. As we grow, so does our core team, and all of us are dedicated to amplifying the impact of the important work you do. We’re already starting to plan for NaRCAD2020, our 8th annual conference, and we invite you to consider submitting your ideas and innovations when we start accepting submissions on March 1, 2020. But you don’t need to wait until then—we’re here to offer you customized support to strengthen your program, as you plan for success in 2020 and beyond.
Happy New Year!
Michael Fischer, MD, MS, Director, NaRCAD
Dr. Fischer is a general internist, pharmacoepidemiologist, and health services researcher. He is an Associate Professor of Medicine at Harvard and a clinically active primary care physician and educator at Brigham & Women’s Hospital. With extensive experience in designing and evaluating interventions to improve medication use, he has published numerous studies demonstrating potential gains from improved prescribing. Read more.
Guest Blog Interview: David O’Riordan, MPharm, MPH, PhD
Senior Pharmacovigilance Officer
Pharmaceutical Care Research Group
University College Cork, Ireland
Tags: Detailer Visits, International, Training
NaRCAD: Thanks for speaking with us, David! Tell us a bit about your professional background in healthcare, and how you became involved in academic detailing.
David: I am a pharmacist by training, and a couple years ago I decided to carry out a PhD in Clinical Pharmacy at the University College Cork. As part of the PhD, I completed a systematic review examining how pharmacists can be utilized to optimize prescribing in primary care, including through academic detailing. After finding NaRCAD’s resources through a Google search, I registered for the NaRCAD conference in Boston. Dr. Fischer, Dr. Avorn, and all the other attendees at the conference were very encouraging.
I left the conference determined and enthused to lead an academic detailing intervention back home. Dr. Avorn and Dr. Fisher put me in touch with Eimir Hurley, a PhD scholar in Ireland, who formerly worked in academic detailing at Alosa Health, and who ended up being a great help in executing the intervention.
NaRCAD: That’s terrific—it sounds like you had a great team at your disposal to begin this work. Can you tell us a little about the unique characteristics of the Irish health system?
David: Ireland has a public and private health system. Public patients are more likely to wait longer for appointments. Private insurance is a substantial cost to individuals, though. The health care system is quite fractured unless you’re a private patient. Pharmaceutical drug representatives are also allowed to visit primary health practices here.
NaRCAD: In April, you published a study titled “Pharmacist-led academic detailing intervention in primary care: a mixed methods feasibility study” in the International Journal of Clinical Pharmacy. Why did you choose urinary incontinence as a clinical topic?
David: As this was a feasibility study, I decided to use one topic as part of the intervention. I organized a meeting with a group of general practitioners (physicians) who would be involved in the academic detailing intervention. The topic of urinary incontinence was chosen by the physicians because they highlighted that it was a topic not discussed regularly among themselves, and currently their only source of information is provided by pharmaceutical drug representatives.
NaRCAD: What barriers to success did you come across in your feasibility study?
David: For this project, I was the only academic detailer. I started detailing after going to the two-day Basics Academic Detailing Training in Boston in May 2016. In some cases, during the roll out of the intervention I found it difficult to get past the practice manager, but luckily I had learned strategies on getting in the door in Boston 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 came down to how well you know the physicians. I was lucky that they trusted me when I spoke to them. When I did get to meet with physicians, they all seemed very enthusiastic.
NaRCAD: Can you talk a bit more about how receptive physicians were to academic detailing?
David: Absolutely! This was a mixed methods study, so my colleague Eimir Hurley carried out focus groups after my detailing sessions to evaluate the feasibility of the intervention. Eimir conducted the focus groups on my behalf to reduce bias. The physicians liked that I wasn’t from a pharmaceutical company and that the sessions only lasted 10-15 minutes. They liked that local physicians had chosen the topic, and I wasn’t coming with my own agenda.
NaRCAD: How are you or others going to use your feasibility study results to implement across the country?
David: I am currently not involved in academic detailing, but I hope to be again in the future. If someone from another part of Ireland read my paper, they would recognize that physicians are very willing to take part in academic detailing. From my experience physicians didn’t feel threatened and really enjoyed the interaction. They liked the interactive style of the visits, and the way that that the evidence was delivered. My study provides a platform for other researchers to detail to a wider group of physicians in Ireland.
NaRCAD: Anything else?
David: I am very grateful for the NaRCAD team for providing the academic detailing training. I knew literally nothing about academic detailing, and through meeting their team members Sarah Ball, Amanda Kennedy, Mary Liz Doyle-Tadduni, and others, I felt encouraged to go back and detail. I was the only person from Ireland at the training, and the NaRCAD team gave me some useful feedback. I really enjoyed academic detailing, and I was especially proud when my paper was published. I discovered there is an appetite for this educational intervention in Ireland.
David O’Riordan, MPharm, MPH, PhD
Senior Pharmacovigilance Officer
Pharmaceutical Care Research Group
University College Cork, Ireland
David holds a Masters in Pharmacy (MPharm), Masters in Public Health (MPH), Post Graduate Certificate in Teaching and Learning in Higher Education (PG Cert) and a PhD in Clinical Pharmacy.
He has extensive experience as a community pharmacist. He previously worked as a Lecturer in Clinical Pharmacy in University College Cork (UCC). While there, he contributed to and assisted in the delivery of research-led teaching at undergraduate and postgraduate level. He also supervised on a number of research projects. He was a clinical trials pharmacist involved in the Thyroid Hormone Replacement for Subclinical Hypo-Thyroidism Trial (TRUST). This was a randomised placebo controlled clinical trial comparing levothyroxine to placebo in community dwelling older adults (≥65 years) with subclinical hypothyroidism (SCH). He is also a tutor on the Irish Pharmacy Union (IPU) Academy. This educational initiative was developed by the IPU to support pharmacist engagement with Continuous Professional Development (CPD). He is currently the Senior Pharmacovigilance Officer at the HRB-Clinical Research Facility, UCC.
Tags: Conference, Training
Summer's officially here, and we're excited for what lies ahead in public health, especially when it comes to what clinicians can do to improve their patients' health. Here at NaRCAD, our work encourages front line care providers to think differently when it comes to opioid safety, sexual health and STI prevention, cancer control, reducing overmedication for the elderly, and much more.
For health educators who provide 1:1 outreach to clinicians, NaRCAD provides hands-on, intensive training, so that these educators can make an impact when bringing the best evidence to front line staff. If you haven't been to one of our trainings, we've just opened registration for our September 23 & 24th, 2019 session here in Boston, where you'll spend 2 days with us, learning how to effectively and persuasively communicate with doctors, nurses, and pharmacists, helping them to increase the chances that their patients will have better health outcomes.
Space fills up fast, so register today, and join other health professionals from across the US who are looking to strengthen clinician care in their communities. After the training, you can bring the interactive interpersonal communications skills of academic detailing back to your health system or local health department to roll out interventions to support chronic disease management, substance use disorder, HIV prevention, and many other critical clinical topics.
And if you're already in the field doing this important outreach work with providers, we want to hear from you, and feature you on the DETAILS Blog. Better yet, join us this November 7 & 8, 2019 at our 7th Annual International Conference on Academic Detailing and share your work with our community. Meet others who are advancing the field, infusing clinical care with the best evidence-based tools and approaches in health care.
Want to hear from our community members? And keep your eye on our Twitter feed, and check our News & Media Center for our latest e-news and CoRE Podcasts, or browse the DETAILS archives to the right for more stories from the field.
For our part, we'll be adding new stories this summer on successes and challenges in implementing academic detailing in partnership with our colleagues at CDC and NACCHO to support patients dealing with opioid use disorder and pain management. and we'll be hitting the road to train new detailers in Kansas this August. Stay tuned!
The Team @ NaRCAD
Share your work in public health with us. What's happening in your community around the opioid crisis? HIV prevention? Patient education? Have an idea you'd like to hear more about on our next Podcast? Want to share new ideas or challenges related to public health detailing? Sound off below.
An Interview with Johnathan Goree, MD
Director of Chronic Pain and Opioid Stewardship
University of Arkansas for Medical Sciences
NaRCAD Training Alumnus
by Kristina Stefanini, Program Coordinator at NaRCAD
Tags: Detailing Visits, Opioid Safety, Training
NaRCAD: Thanks for talking with me today! Can you tell me a little bit about yourself and how you ended up in pain management?
Johnathan Goree: I’m from Arkansas originally. After completing college at Washington University in St. Louis, medical school and residency at Cornell, and a pain medicine fellowship at Emory, I was recruited to start the chronic pain division at the University of Arkansas for Medical Sciences – 2 miles away from where I went to high school. I’m proud to work in Arkansas; Arkansas is such a poor and rural state, so we don’t often have the resources that other states have.
I went into anesthesiology because I wanted to be the best prepared doctor for an emergency, but I moved into pain medicine because I missed the 1-on-1 patient contact and longitudinal patient care. Here are some other things that lead me into pain medicine. After getting my wisdom teeth removed, I was given too much fentanyl during the procedure resulting in being given Narcan to wake up.
That was the first time in my life I experienced 10/10 pain. It allowed me to understand how pain can completely dominate someone’s consciousness. I am also passionate about pain management in minority communities. Many in those communities feel that their pain is undertreated, and evidence backs that up.
NaRCAD: As a physician, what are some of the barriers that detailers may have talking to clinicians about pain management? How can these be navigated?
Johnathan Goree: Every physician will say the number one barrier is time. While most physicians are excited to learn about anything that will improve patient care, unfortunately, physicians are usually not in control of their schedule.
NaRCAD: How can clinicians act as champions in an academic detailing campaign?
Johnathan Goree: One way physicians can help is with the crafting of educational materials. Physicians know how physicians think and can help by crafting a message that may better catch attention.
Another is by dedicating time to answer follow-up questions from detailers and other clinicians. In my field of chronic pain management, detailers that don't have a clinical background may not know how to answer questions on specific off-label situations or treatment of specific pains. A follow-up visit or call with a clinician can help with that.
NaRCAD: Anything else you’d like to add for our readers?
Johnathan Goree: More praise for you guys – your course is excellent! Really understanding the science and method behind academic detailing made me excited to be a part of it. I hope more physicians engage both as detailers and as champions. I think it’s really important.
Johnathan Goree, MD, Director of Chronic Pain and Opioid Stewardship
University of Arkansas for Medical Sciences
Board certified in anesthesiology and pain medicine, Dr. Johnathan Goree received his Bachelor of Arts in biology from Washington University in St. Louis. He then moved to New York City where he completed both his medical degree and a residency in anesthesiology at the Weill College of Medicine at Cornell University. Following his time in Manhattan, he completed a fellowship in chronic pain medicine at Emory University Hospital in Atlanta, Georgia. In 2014, Dr. Goree returned home to Little Rock, Arkansas to join the faculty at University of Arkansas for Medical Sciences where he serves as the Director of the Chronic Pain Division and an Assistant Professor in the Department of Anesthesiology. He primarily focuses on the treatment of chronic pain conditions using opiate sparing, minimally invasive techniques. His specific research interests include complex regional pain syndrome, neuromodulation, and the effects of opioid education initiatives on patient outcomes.
An Interview with Victoria Adewumi, MA, Community Liason, City of Manchester Health Department
NaRCAD Training Alumna
by Kayland Arrington, MPH, Program Manager at NaRCAD
Tags: Detailing Visits, Opioid Safety, Program Management, Training
NaRCAD: How did you get into AD? How was the Manchester team formed?
Victoria: I was very interested in community outreach and improving the health and well-being of families! I had cursory experience with substance use disorder management and had to jump in with both feet. It really helped having other detailers on the team that NaRCAD trained that I could lean on. The other detailers constantly provided support, and one helped open the door for me at her health system to speak with clinicians. She even provided me talking points that previously worked for her so I could walk into my first appointment feeling confident.
NaRCAD: What has your experience been as a detailer who does not have clinical experience but who does have public health expertise? Is someone able to be effective as an academic detailer without as much prior clinical training?
Victoria: My experience has been extremely positive! I care about community, and I thought this was a great opportunity to gain new expertise in this field. I’ve always felt that a community perspective is needed for us to be able to leverage our impact in this field.
The NaRCAD Academic Detailing techniques training was fantastic in helping me build tools to be able to speak well and motivate clinicians around medication-assisted treatment (MAT). My goal as an individual detailer is always to present myself as being on the same team as clinicians. I really see detailing as having a solution for clinicians, rather than simply trying to sell them an idea.
NaRCAD: Was there a time when a clinician presented pushback or obstacles that made it difficult to get your message across?
Victoria: Some clinicians seemed to have already decided whether they were going to be on board or not before I even met with them. I had to feel strong and confident in the skills that I have. When I meet with a clinician, I always frame it as “I’m coming in as a representative of the community. There’s a crisis in our community, and you, as a provider, are a key part of the solution. How can we get you involved?” and “What kinds of things can you tell us that we haven’t even thought about before?” We need everyone’s participation if we’re going to change the tide of the city of Manchester, and clinicians are a vital part of that.
NaRCAD: You have mentioned the power of the team of detailers--can you tell us how the Manchester AD came to be so strong and effective?
Victoria: I didn’t know any of the other detailers before the project. The NaRCAD training was great as an introduction to the work and to each other. We all had a sense of hope that was immediately apparent. We have the privilege of doing work that helps save lives and because of this attitude, there was a sense of camaraderie right away. We’ve been effective because our AD team is strong, and it was strong because we were intentional about building bonds. During the implementation period, we never went more than a month without checking in with each other, and sharing successes and challenges.
I don’t think I would have enjoyed the process as much if I didn’t have this amazing AD team of colleagues. We’ve had incredible success in building a team of detailers who are all committed to and excited about the work of connecting with frontline clinicians to improve patient care around opioid safety.
NaRCAD: How would you recommend other programs go about recruiting those people that are equally committed and excited?
Victoria: That’s a great question! I didn’t necessarily have an opioid response background, but I’ve always cared about communities. That desire to help others makes a great detailer. The trainings can teach the clinical content, but that element of wanting to improve people’s lives is the anchor of a strong AD team, and will resonate with the providers you’ll be detailing. I would then advise new sites to do the important work of helping their detailers to build strong relationships and a sense of teamwork right from the beginning. Those relationships will support everything, from good communication with clinicians, to a renewed sense of purpose in doing the work, which shields against burn out moving forward. Consistent opportunities to check in and connect between AD team members can’t be overemphasized—it truly made me feel that I was never in this alone; I was always working as part of something bigger than myself.
Victoria Adewumi, MA
City of Manchester Health Department
Victoria Adewumi is a Community Liaison with the Manchester Public Health Department. Victoria primarily helps coordinate and staff programming of the Manchester Community School Project, a model that facilitates better health for Manchester residents through place-based interventions. Victoria serves Manchester residents by linking them to partners in the health, social service, business, non-profit, and faith communities and by engaging community members in resident leadership and equity activities. Victoria also participates in efforts to serve refugees and newcomers in New Hampshire through both direct service and community-building initiatives. Victoria holds Bachelor and Master of Arts Degrees in Political Science from the University of New Hampshire.
New Year’s Resolutions at NaRCAD: Address HIV Prevention and the Opioid Crisis through Clinical Education
Kayland Arrington, MPH, Program Manager at NaRCAD
Tags: HIV/AIDS, Opioid Safety, LOOPR, Training
This New Year, NaRCAD has new staff, new partnership sites, and will be addressing critical topics in health. We’ve had a successful 2018, and we’re already working hard to improve patient health through clinician education in 2019.
One of the main topics we provide support on is HIV prevention for high-risk patients. While it is true that rates of HIV are declining in some populations, other groups are still very much at risk for developing HIV. According to the Centers for Disease Control (CDC), half of all black men who have sex with men will contract HIV in their lifetime. These statistics are staggering, and NaRCAD is doing everything we can to help by engaging directly with frontline providers who can communicate best options for prevention directly to their patients. We do this by training academic detailers to meet with clinicians to offer tailored, evidence-based clinician recommendations.
In December, we traveled to Las Vegas to facilitate an AD training to increase prescriptions of Pre-exposure prophylaxis (PrEP). PrEP is a daily medication prescribed to people with a high risk of developing HIV. The CDC reports that PrEP reduces the risk of getting HIV from sex by more than 90%; it also reduces the risk of contracting HIV from injection drug use by more than 70%. NaRCAD is continuing our work in 2019 to train health educators to talk to frontline clinicians about the benefits of prescribing PrEP to their high-risk patients. Our first training of 2019 is in February at the PrEP Public Health Detailing Institute in San Francisco, hosted by our partners at the San Francisco Department of Public Health.
We’ve also added on 2 new sites to our county-level LOOPR Partnership! We will be traveling to St. Francois County, Missouri and Ware County, Georgia in March. The CDC has identified 220 counties (5% of counties in the nation) that are at highest risk of HIV and/or Hepatitis C as a result of the opioid crisis. St. Francois County, MO is ranked 69 out of those 220 counties. Ware County, GA is located in the southeast corner of the state and doesn’t have as much access to resources as counties more centrally located. NaRCAD is excited to join both of these high-burden counties in their efforts to reduce harm from the opioid crisis.
One element that is a common thread with both HIV and the opioid crisis is the fact that these are both highly stigmatized clinical topics. Along with community stigma, clinicians themselves may be inadvertently biased against patients with substance use disorder and/or those at high risk for developing HIV. As the result of a fear of stigma, it’s also common for patients to refrain from sharing high risk behavior with their providers. To ensure that front line clinicians increase PrEP prescribing and work to treat pain in safer ways, the academic detailers we train this year will also explore ways to address clinician stigma.
Along with our county-level support, we’ll also travel to Tennessee, Oregon, and Maryland this year. And as always, we’ll hold our usual Boston home trainings in May, July, and September before our year comes full circle at our 7th Annual International Conference on Academic Detailing in November. No matter how we connect in the year ahead, our entire team is looking forward to supporting you in 2019—let us know how we can help, and stay tuned for more updates here on the DETAILS Blog.
Kayland Arrington, MPH | Program Manager, NaRCAD
Kayland earned her Master’s Degree in Public Health from Boston University, with concentrations in Health Policy and Law and Maternal and Child Health. She has experience coordinating suicide prevention and awareness programs. She also has experience in health promotion and education on topics ranging from substance use disorder to sexual violence. Kayland is passionate about improving access to resources, supporting population health programming, and is an advocate for evidence-based medicine. Read More.
Featuring: Carol Furlong, LCMHC, MAC, MBA, Director of Substance Use Disorders, Elliot Hospital
Jill MacGregor, APRN, Catholic Medical Center, & Katie Sawyer, LICSW, MLADC, Director, Integrated Treatment of Co-Occurring Disorders, Network4Health/Mental Health Center of Greater Manchester
Interview by Isabel Evans, Fellow, NACCHO, in partnership with NaRCAD
Tags: LOOPR, Opioid Safety, Stigma, Substance Use, Training
EDITOR'S NOTE: Manchester, New Hampshire, was the third site of four selected for a 2018 pilot program of the CDC (Centers for Disease Control and Prevention), NACCHO (the National Association of County and City Health Officials), and NaRCAD (The National Resource Center for Academic Detailing). This exciting pilot program focused on community-level work with local public health departments to develop customized interventions to reduce opioid overdose and death. Four sites experiencing significant public health problems related to opioids were selected to be trained in academic detailing; those trained health professionals then conducted 1:1 field visits with front line clinicians to impact behavior around prescribing, treatment referrals, and patient care, with Manchester’s team focusing primarily on access to Medication Assisted Treatment [MAT]. As year 1 comes to a close, we’re showcasing successes from the field.
Thanks for talking with us about your work in Manchester, New Hampshire. Can you tell us about your team? How were detailers chosen to represent the health department for this pilot project?
Carol: Tim Soucy, from the Manchester Department of Health, contacted representatives at each of our organizations and gave a little bit of information about the training. He asked if our organizations had particular people that might be interested, and my supervisor thought of me, since I was in the middle of developing a MAT program for my organization. I jumped at the chance to participate.
Jill: My organization received the same email, and as the primary care lead nurse practitioner, I was considered the most appropriate to participate.
Katie: The invitation came from the site that received the CDC grant (City Health Department). The invitation was disseminated among a number of local human service/health agencies who are part of a Network of agencies as a result of our 1115 Waiver partnership.
The NaRCAD team came to your site back in March, 2018, helping you get ready to be ‘in the field’ and talk to clinicians about the opioid crisis. Tell us how that went, and how you applied what you learned in training.
Carol: I’m a naturally shy person who dislikes being the center of attention, so I was incredibly nervous about the role plays during training. The turned out to be invaluable, since I use the skills I developed through practicing and receiving feedback during every visit. The role plays prepared me so well for meeting with providers, and I go into the conversations feeling confident and comfortable. When they ask questions, I feel that I know how to answer, or where to turn for more information, such as the wonderful handouts available on the NaRCAD website.
Jill: For me, learning how to hold a discussion as a detailer was the most important element of the training. I learned how to frame a conversation using open-ended questions, which allows the discussion to progress. Understanding how to simultaneously get a provider’s perspective, while also giving them the information they need, is a critical detailing skill.
Katie: We were able to role play, which has proven very helpful out in the field to stay focused, on topic, and empathetic to the position of each clinician that I speak to. The handouts that NaRCAD provided have easy to read information and great graphics, so they have also proved useful for staying on track with the key messages during detailing visits, along with providing supplemental information.
The opioid epidemic has affected many communities in unique ways. How have local clinicians responded to your visits? What do clinicians in Manchester see as major barriers to improving health for their patients struggling with this issue?
Carol: Clinicians can be a little skeptical at first, since they’re often expecting that I’m going to try to “sell them” on something. When I focus on listening to their experiences and their concerns, I’m able to gently address those concerns and give resources or suggestions. Even just having a discussion can help clinicians to feel that you’re interested in how they feel, and that you genuinely want to help them – I would describe some clinicians as “dumbstruck” from our conversations, because they’re preparing to do battle with me, but they instead come to see me as a resource, and are more willing to meeting with me.
As for challenges, we deal with a fair amount of stigmatization of substance use. It’s a major barrier, and we’ve had to spend a lot of time addressing that in my organization. Another barrier for clinicians is a preconceived notion that providing MAT is an onerous process, and too time-consuming to add into their schedules. And these two barriers really complement each other in a bad way – I often get providers saying that MAT is too much work and that their MAT patients will just end up using opioids again and ending up back in the emergency room. Breaking down these misconceptions about MAT and getting to the root of the stigma against MAT is a big challenge.
However, we’re approaching these challenges with education and lots of conversations, since we’ve found that helping our staff to get a better sense of addiction as a disease is really invaluable to making them more open to MAT and treating people with opioid use disorder. The timing of the academic detailing initiative couldn’t have been better for my organization, because having conversations about addiction leads well into having conversations about MAT, and vice versa. Engaging in academic detailing has opened up a whole new avenue of clinician education for me.
Jill: Because of my role at my health system, I talk to providers about many different topics and they’re used to me approaching them, which has definitely helped give me and automatic “in” and bring up sensitive topics. My institutional knowledge helps too, since I can answer questions specific to my organization and our various programs or resources around opioids.
A major challenge I face is that providers don’t think they have the time and resources to implement MAT into primary care, and they don’t feel they have the behavioral health support to do so successfully. However, I’ve found that this is often based around a lack of knowledge, since when I ask more probing questions about MAT, it’s often clear that they don’t really know much about it!
Providers will come to conclusions without getting the right education, and I find that they often “change their tune” when I give them more information. Providers are also hesitant about writing a prescription for a MAT patient if there isn’t someone in their office who can talk to the patient about addiction itself. Right now, we’re working on integrating behavioral health clinicians into primary care, which I’m hopeful will help with this very real concern.
Katie: There has been some hesitation in sharing with detailers, in regards to professional experience, as I believe most clinicians are on edge in trying to do the best that they can to address patient needs, while also supporting alternatives to typical or historical use of prescribed opioids. With an empathetic and interested stance, I’ve found that most clinicians are open with their experience and struggles.
There are a number of themes among clinicians for challenges that I’ve noticed, including a limited behavioral health workforce to support what they view as an ideal MAT protocol, which would include individual and group counseling, regular urine toxicology screens, and wraparound services along the continuum of care. In addition, there is a concern among providers about the potential diversion of Buprenorphine by patients.
Katie: It has been rewarding to meet with each clinician for different reasons – I would view success as learning more about the clinicians that are already on board and excited to pursue getting a waiver, as it gets them talking and feeling a renewed energy to share with others. I view my conversations with clinicians who are not interested in pursuing a waiver as equally rewarding, since it allows for both of us to share and hear the other’s perspective. We can agree that the work is needed and challenging, no matter how we decide to go about addressing the needs of our patients.
Lastly, what advice would you tell new detailers? What do you wish you knew when you started out?
Carol: I would tell new detailers to take a deep breath and know that you’re ready for this – NaRCAD does such a good job of training us as detailers, and you just feel ready.
Jill: I would say to recognize that everyone has a natural process for adapting to new ideas. You’ll get some providers who are ready and energized, some who will want to watch others in action before they jump in, and some who simply may not be interested. It can be frustrating when providers aren’t interested in your topic or resources, but understand that this is natural, and don’t take it personally! Every visit will be different, and that’s okay.
Katie: My advice is to remember that success is not defined as “convincing” someone that the topic of your detailing visit is “the right answer”. In fact, trying to convince another person of anything is essentially walking against waves. Instead, be open to listening to that person and their experiences, and then value the experience that they have had. This is more likely to open the conversation to allow you to share your wealth of information and experiences. It’s all about planting seeds.
Ideas? Comments? Questions? Sound off on this blog in the comments section below!
Guest Blogger: Joseph Leishman
Academic Detailer/Masters in Public Health Candidate
Center for Clinical Management Research, Ann Arbor VA
The University of Michigan School of Public Health
NaRCAD Training Alumnus
Tags: Cancer, Detailing Visits, Materials Development, Training
NaRCAD: How did you get into AD? What were you doing before?
Joe: I’m a graduate student at The University of Michigan School of Public Health studying epidemiology. As a student I started working at the Ann Arbor VA Center for Clinical Management Research on a lung cancer-screening project. Our project involves 8 different VA sites across the country. As we shifted into an implementation phase, academic detailing was selected as an implementation method. I transitioned to an academic detailer role because of my background in epidemiology, my understanding of lung cancer screening (LCS), and my ability to communicate these principles.
I attended the NaRCAD academic detailing techniques training and things took off from there!
NaRCAD: Why is AD for lung cancer screening so important?
Joe: Lung cancer screening can be more complex and complicated compared to other preventative services, and most primary care physicians have very limited time to discuss lung cancer screening with patients. There are a number of potential downsides to screening – false positives, overdiagnosis, invasive procedures, and complications from invasive procedures. The benefits of the screening outweigh the challenges, and we have developed a tool for doctors to quickly evaluate a patient’s lung cancer risk, facilitate shared decision making, and make personalized screening recommendations.
NaRCAD: Tell us about the lung cancer screening detailing aid and related tools that you made with NaRCAD’s support. How was the process of developing the detailing aid?
Joe: Our detailing aid contains background information on lung cancer screening and some of the key evidence behind our tool. It also outlines some of the reasons and benefits behind using this risk-based approach. We tried to keep the detailing aid simple enough that doctors could quickly understand the concepts with little or no additional explanation. This was our group’s first attempt at making something like this. We worked with NaRCAD during the creation of the detailing aid to improve the clinical content, layout, and language. There was a lot of trial and error to create the detailing aid. We ended up going through 10 versions before it was finalized.
NaRCAD: How did you decide what information was most important to put on your detailing aid?
Joe: Initially, we started out with too much information. It was too complicated and wordy to effectively communicate our message. We tested it out with our team to see if our message was clear. It was obvious when sections of detailing aid didn’t work well.
We really had to focus on narrowing down the main evidence and messages we wished to convey. We used the primary lung cancer screening evidence from the US Preventative Task Force and the National Lung Screening Trial. Our tool goes a step beyond screening eligibility to look at individual risk, life expectancy, and patient preferences, which help providers get past some of the difficulties and complexities of lung cancer screening.
NaRCAD: How does your website complement the detailing aid when you are 1:1 detailing?
Joe: A link to the tool is embedded in the Computerized Patient Record System (CPRS), the EMR system that the VA uses. However, it can be also accessed outside the VA with a URL. What I typically do is I have PCPs pull up the website in their workspace after going through the detailing aid. I have providers role play with a sample patient, and I demonstrate how the tool could be used for that specific patient. Using the actual web tool in a detailing meeting really helps to reinforce our message. We feel like it increases the likelihood that it’ll be adopted in an actual clinical practice.
NaRCAD: How have clinicians been responding to your campaign?
Joe: So far there has been a decent response from the doctors we have worked with. Some of the doctors in the VA have met with detailers before which makes the initial contact easy. However, the most majority of the doctors I have met were receptive to my visits.
We’ve been tracking the use of our tool before and after academic detailing at a site level. We don’t have exact numbers, but there has been an increase between before and after AD. We’d be happy to share more complete data in a future blog post.
NaRCAD: That'd be terrific, we'd love to share that when it's ready! What other reflections do you have from this process that you'd like to share with our community?
Joe: Academic detailing is a new approach for our group. It has been a real learning experience for discovering what does and doesn’t work and how to best address provider needs. For me, going through this process has been a lot of fun. I love talking with doctors about their struggles and being able to offer a tool that can help them better handle lung cancer screening with their patients.
Annual Conference, Off to Vegas for an HIV PrEP Training, & Our Team is Growing (and Hiring!)
Tags: Conference, Training
A letter from the staff at NaRCAD
At NaRCAD, we're getting ready for our busy season, which lately, has become a season that lasts all year long. And we're happy for it--because that means we get to help more programs across the US and Canada figure out the most impactful ways to use academic detailing to promote sustainable change. Whether public health programs are looking to increase prescriptions of HIV PrEP for patients at high-risk, encourage more referrals to nutritionists for patients with diabetes, or improve access to treatment for people struggling with opioid use disorder, we're there to help them, from program conception to implementation and evaluation.
You may know that we offer bi-annual trainings here in Boston for health professionals to learn the techniques of academic detailing with our team of clinical outreach education experts through our 2-day, intensive, hands-on course. But did you know we also travel across the country to train teams on-site in their own communities? Through a partnership with the CDC, NACCHO, and previous funding from AHRQ, we've been on the road for countless successful trainings in early 2018, and we'll be wrapping up the year and heading into 2019 with a bang!
Our next stop is Las Vegas, to work with the Southern Nevada Health District on improving outcomes around HIV prevention this December. (And for once, we hope that "what happens in Vegas" doesn't "stay in Vegas"; our goal is to increase visibility and prescribing of HIV PrEP so that more clinicians everywhere are reaching the patients who need it most.)
Prior to December, we'll be busy here on our home turf for the fall, holding our now-full Fall Training on October 1 + 2, and our fantastic, annual international conference on AD on November 12 & 13. We hope you'll keep your eyes out for dates for our Spring 2019 Training (which will be announced by November!) and that you'll join us for our conference--this year is our 6th annual, and we're excited to announce our full agenda is live on our Conference Series page. Register today--space is limited for this event!
And visit our blog often--we'll be featuring new interviews this fall, showcasing best practices on topics like reducing polypharmacy, reducing opioid prescribing in rural counties, and increasing lung cancer screenings. Want to be featured? Contact us and tell us what you're working on! Our team is ready to custom-tailor our support, so we can offer you the best ideas, resources, and tools to help your program thrive.
We can't wait to see you this fall!
-The NaRCAD Home Team
(PS: Want to join our team as a Program Manager? Send us your resume & cover letter.)
Director’s Letter: Mike Fischer, MD, MS
Tags: Director's Letter, LOOPR, Opioid Safety, Rural AD Programs, Training
The opioid crisis has been recognized as a major national public health problem, but it actually reflects a collection of many thousands of local crises playing out in individual cities and counties. Each region faces a distinctive set of challenges, driven by economic and social factors, local medical practice patterns, political environment and pressures, and many other considerations.
Identifying and implementing effective solutions to address the opioid crisis requires developing an understanding of how these individual challenges interact, and what strategies are most effective in specific situations--one of which is academic detailing.
The NaRCAD team is partnering with the CDC (Centers for Disease Control and Prevention) and NACCHO (the National Association of City and County Health Officials) on an exciting pilot program working with local health officials to develop customized interventions to reduce opioid overdose and death. Four sites experiencing significant public health problems related to opioids were selected: Boone County, Kentucky; Bell County, West Virginia; Manchester, New Hampshire; and Dayton, Ohio.
Public health officials at each site identified a wide range of local stakeholders to participate in developing a community action plan and recruited trainees to complete NaRCAD’s academic detailing training course, which we customized to address the unique challenges that each community faces. We also developed a specialized online toolkit for these sites, including discussion boards, local resources, and printable resources.
We traveled to each site in March and April of this year, facilitating hands-on trainings in the techniques of academic detailing in alignment with the CDC prescribing guidelines. Trainees came from diverse backgrounds, including pharmacists, nurses, public health officials, and students in the health professions, including pharmacy students, dental students, and medical school students.
Plans for implementing AD varied by site depending on the local health care environment; some sites focused more heavily on appropriate prescribing of opioids by clinicians, while others prioritized increasing referral rates for patients with opioid use disorder (OUD), including access to medication-assisted treatment (MAT).
As the AD trainees at each pilot site continue their work in the field, we’ll learn more about how these diverse strategies succeed, and how we can support adaptations to make academic detailing more impactful. This important collaboration has allowed us to form invaluable partnerships with CDC and NACCHO, leveraging national resources to improve local responses to this epidemic through plans that respond more precisely to local needs and priorities.
We’re excited for this pilot program to serve as a model for future opioid safety AD interventions, and we’ll be providing updates here on the blog. In the meantime, tell us: what's happening in your local community around the opioid crisis? Sound off in the comments section below, and let us know if you think clinician-facing education could be a strategy that would improve outcomes for your community. And join us for our next training and our terrific annual conference to learn more about this and other exciting AD projects.
Michael Fischer, MD, MS | Director of NaRCAD
Dr. Fischer is a general internist, pharmacoepidemiologist, and health services researcher. He is an Associate Professor of Medicine at Harvard and a clinically active primary care physician and educator at Brigham & Women’s Hospital. With extensive experience in designing and evaluating interventions to improve medication use, he has published numerous studies demonstrating potential gains from improved prescribing. Read more.
Guest Blogger: Monica Mais, MSN, FNP
Family Nurse Practioner/Academic Detailer
California Opioid Safety Network, Fairchild Medical Clinic
NaRCAD Training Alumnus
Tags: Detailing Visits, Opioid Safety, Rural AD Programs, Training
In 2011, I went from 15 years as an Emergency Room nurse to a new role as a Family Nurse Practitioner in a rural healthcare setting. I couldn’t believe the amounts of prescribed opioids that were coming out of our little clinic—the average chronic pain patient was receiving 240 Morphine Equivalents/day (MEDs), and many of these patients had been receiving these medications for years without oversight. In 2013 I introduced an evidence-based protocol and policy for safe prescribing of Opiates for Chronic Non-Cancer Pain (CNCP).
However, patients who could not obtain opiates from our clinic quickly moved on to the clinic across town. This influx of opiate seeking patients was reason for concern from those receiving clinics. My colleagues and I opened our doors to neighboring clinics and providers and began sharing our policies and successes. Many other area clinics started adapting our policies to their own practice, reducing their opiate prescribing as well.
We formed a coalition called Siskiyou Against Rx Abuse (SARA), and based on our previous successes, we were all shocked to see data showing our county was among the highest opioid prescriptions per capita in California, and had a high overdose rate per capita, despite our efforts. Clearly, more needed to be done! Our coalition facilitator, Maggie Shepard, RN, along with our medical director, Dr. Sam Rabinowitz, and myself were all invited to attend training to become Academic Detailers in San Francisco with the San Francisco Department of Public Health, a partner with NaRCAD, the National Resource Center for Academic Detailing.
We did scripting and role-playing throughout the training, learning the important social marketing and communication skills needed to conduct a personalized visit with a provider where the goal would be to change behaviors to continue to promote safe opioid prescribing, Naloxone, and Buprenorphine out to providers in our area.
During the training, I was videotaped during a practice role-play, which was very helpful, as it reminded me to speak more slowly, and to organize my key messages and talking points. After the training, getting our detailing program into the field involved a step-by-step process.
Here are important things to consider that have worked well for my detailing process:
I plan to continue AD throughout 2018. I believe we have experiences that we can share to encourage our colleagues to make positive changes in in their prescribing habits. Academic Detailing works due to mutual respect of one another’s experiences, professionalism, and willingness to receive new information—it’s an excellent way to foster change within a system!
Monica Mais, MSN, FNP
Family Nurse Practioner/Academic Detailer, Fairchild Medical Clinic
Monica Mais is a Board Certified Family Nurse Practitioner working at an FQHC in Siskiyou County, located in far Northern California on the Oregon border. She is a founding member of Siskiyou Against Rx Abuse, member of the California Opioid Safety Network and an X-Waived prescriber, working with chronic pain and opioid dependent patients. As a former Emergency Room Nurse for 15 years, many of Monica’s shifts involved witnessing overdoses, drug-seeking behavior, violence, desperation, and healthcare worker burnout. It had been escalating every year to its current crisis level, and Monica wanted to be part of the solution to this heartbreaking epidemic. Questions on this piece for Monica Mais? Contact her at email@example.com, or leave your thoughts in the discussion forum below.
As the Public Health Education Specialist for the WIC (Women, Infants & Children) program and the Opioid Task Force in Butte County, California, Stacy Piper, CLEC, acts as a regional liaison with the medical community as well as coalition's and various community partners. Learn more about Stacy in the bio at the end of this piece.
Tags: Detailing Visits, Opioid Safety, Substance Use, Training
NaRCAD: Hi, Stacy! Thanks for joining us. Tell us a little bit about your work—we understand you, like many folks in public health, wear multiple hats.
As the Butte County Public Health Education Specialist for the WIC (Women, Infants & Children) program and the Opioid Task Force in Butte County, I act as a liaison with the medical community. I collaborate with hospitals, health care providers, public health programs, and community organizations to improve public health and continuity of care.
NaRCAD: Talk to us about detailing for the opioid crisis—you do this 1/4th of your time. How did you get started?
After providing educational detailing for the WIC Program funded at 30 hours a week, I was asked to be an Opioid Academic Detailer for Butte County. In preparation, I attended the Academic Detailer Training in San Francisco. The training provided by the CA Health Department, San Francisco Public Health Department's Substance Use Research Unit, and NaRCAD was one of the finest training experiences - even after the countless hours of extremely comprehensive training I received in the Pharmaceutical Industry.
Regarding impact on a local level, it is indescribable how every interaction with a healthcare provider is beneficial. Academic Detailing (AD) is an equal exchange of information. I consider it a huge responsibility, and a privilege, to be an educator for doctors and medical professionals.
I prefer the word “educator” instead of “detailer” because I have concerns that a “detailer” may be initially viewed as a salesperson. I love and respect that AD is not driven by attempting to influence medical professionals for personal gain. It’s all about helping providers improve health outcomes in patients with the entire focus of the conversation about the real people in their practice that need help.
NaRCAD: Tell us a little about your background in pharma, and how this translates to your detailing work now.
I was a Senior Executive Pharmaceutical Sales Representative for 15 years in Northern California, advocating for immunizations and promoting various prescription drugs. This provided first-hand experience of the astonishing evolution in the Medical, Pharmacy, and Insurance industries. Understanding the basic dynamics of medical offices has helped me navigate and gain access at a quicker pace for AD. Also, understanding the business acumen component of running a medical practice has proven to be valuable in my recent interactions.
NaRCAD: You mentioned that you’re committed to providing value for clinicians and patients alike. Talk to us about how you share key messages with the clinicians you visit.
In my experience, to truly influence the behavior of a highly-educated and experienced individual, you must come to the table with the goal of learning. With attentive listening, you ‘hear’ the medical professional, and process what you have learned. Your intuition will guide you to ask the appropriate, insightful questions needed to evaluate his/her priorities and challenges. This is a beautiful thing, because trust starts to blossom and the partnership has begun.
You can then confidently tailor key messages, valuable resources and solutions that are closely tied to those needs and challenges you uncovered. You should begin to see the individual’s genuine desire to truly change behavior and habits.
NaRCAD: Talking about opioids is a sensitive topic. What’s some of the typical pushback you get from clinicians you detail about opioid safety?
The response to academic detailing really depends on the situation and the type of clinician and/or establishment I am working with. Sharing local opioid statistics compared to our state statistics is an eye opener! I try to paint real life pictures by telling true stories.
For example, I’m honest about my own family members who were innocently caught up in this crisis, including the true story about the day my sister’s husband accidentally took his prescribed opioid medication twice. My sister lost her husband that day.
NaRCAD: Along with telling true stories, how do you handle pushback and stay positive, encouraging clinicians to pivot?
Time, or lack of time, is the biggest culprit in keeping physicians from attempting to personally assist in ending the addiction cycle for patients. I passionately believe clinicians need more time with people on opioids.
It takes several visits with an office to start moving in the right direction. Working with the medical assistants, nurses, and/ office managers is a key component. They can often have influence, give advice or insight, and even advocate when you are not there.
Also, I review our county’s Safe Prescribing Guidelines. If clinicians cannot institute all items in the guidelines, I ask providers to choose what they can commit to doing and to think about some specific patients they can work with. I also ask them to consider prescribing Naloxone for patients on high doses of opioids (above 50 morphine milligram equivalents).
NaRCAD: What would you share with new detailers who are about to go into the field and use AD to tackle the opioid crisis?
I have a few reminders and tips for detailers:
Stacy M. Piper, CLEC, Public Health Educational Specialist
Butte County California Public Health Department
As a Public Health Education Specialist, Stacy was chosen to work with two CA State grant funded programs educating Medical Professionals, Hospitals and Community Organizations for the WIC Program and the Opioid Drug Abuse Prevention Program. She maintains an active involvement with the Butte County Opioid Task Force, as well as the Butte County Drug Addiction Prevention Coalition, ACE’s Coalition (Trauma Informed), Breastfeeding Roundtable Coalition, Butte County Breastfeeding Coalition, Mother Strong Coalition, and Perinatal Coalition. Stacy has had extensive training with the California Department of Public Health's Opioid Stewardship & Chronic Pain Detailing Program, ID Training, UCSD CLE (Certified Lactation Educator), Coalition & Equity Training, Advocacy Training and holds 14 years of ongoing training & certification in the Pharmaceutical Industry. She is a member of the team coordinating and orchestrating the 2018 Northern California Opioid Summit.
Tags: Detailing Visits, HIV/AIDS, LOOPR, Opioid Safety, Training
We've been staying busy here at NaRCAD this spring! With public health challenges like the opioid crisis, and the continued need for HIV prevention, the team here at NaRCAD has been on the road for 5 trainings in 6 weeks, and we're not stopping yet!
On February 14th - 16th, 2018, NaRCAD joined the amazing teams at San Francisco Department of Public Health and the New York City Department of Health and Mental Hygiene for an exciting initiative: A Public Health Detailing Institute on HIV PrEP and RAPID.
Hosted in San Francisco's South Market neighborhood, 31 trainees attended, representing diverse public health departments from Texas, Connecticut, Alaska, Louisiana, Florida, Tennessee, Los Angeles, San Francisco, Mississippi, Michigan, Oregon, Nevada, Virginia, and beyond. These trainees joined the institute for a customized, 3-day event focusing on learning the techniques of academic detailing, along with showcasing best practices and success stories via special presentations and expert panels.
This past month, from March 7th through April 4th, 2018, NaRCAD hit the road four more times, as part of an exciting 4-site pilot project in partnership with our terrific colleagues at the CDC (Center for Disease Control) and NACCHO (The National Association of County and City Health Officials).
Upon identifying counties and cities with the highest burden of fatal and non-fatal opioid overdose and high prescribing rates, the CDC selected Bell County, Kentucky; Boone County, West Virginia; Manchester, New Hampshire; and Dayton, Ohio as 4 pilot sites in which to convene with key community stakeholders and roll out community action plans, along with targeted academic detailing interventions.
Our work has involved launching on-location trainings at each of these pilot sites, focusing on providing front line clinicians with tools and support to improve outcomes for patients.
Messaging and support for these campaigns include lowering prescribing rates, referring patients to treatment for opioid use disorder (OUD) including Medication Assisted Training (MAT), and using their state's PDMP (Prescription Drug Monitoring Program) to identify troubling patterns of use, which may, in turn, help to identify those patients who need more support and care.
Trainees at each site of these pilot sites work with us across two days to learn the structure of an academic detailing visit, practice role playing 1:1 visits with clinicians, and become experts at using educational materials (including a suite of materials constructed by the CDC based on their 2016 Opioid Prescribing Guidelines).
Our pilot site trainees walk away from our trainings ready to actively engage with clinicians to assess individual needs and provide customized support, and encourage behavior change for the opioid crisis in their respective communities.
NaRCAD's team will continue to focus on launching new academic detailing interventions across the U.S. well into 2018, with upcoming opioid-specific trainings being carried out in late May in Albuquerque, New Mexico, with the University of New Mexico's Health Sciences Center, and in late June in Lansing, Michigan, with the Michigan Public Health Institute.
Our next all-topic, AD techniques training in Boston will kick off at the end of this month, where we'll train 24 health professionals from across the U.S.--we'll report back after that training and share lessons learned, highlights, slide decks, and clinical topics from represented programs, and we look forward to sharing those with our community.
Join our subscription list to receive alerts for upcoming training opportunities. Want to customize a clinical topic-specific training for 15 trainees or more, on site in your community? Reach out to us to schedule a training consultation call at firstname.lastname@example.org.
We can't wait to work with you!
-The NaRCAD Team
University of Charleston School of Pharmacy Students, Faculty Partner with CDC to Pilot Academic Detailing Program in Boone County, West Virginia
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/.
Tags: Conference, Training
We’re noticing a pattern over here at NaRCAD. As we enter into our 8th(!) year as the only resource center dedicated to clinical outreach education, we’re proud of the recent work we’ve done together with our community, as we are every year. But the pattern we’re seeing is about much more than just pride.
With each January that rolls around, we’re invigorated by the energy of our community members, and by the important programming that's taking place across North America. So it’s no surprise to us that we’re consistently excited to greet each year with the creative solutions, expertise, and events you need to make your program thrive.
This year, some of those creative solutions are ready for you to take for a test drive. We’ve just launched our CoRE (Clinical Outreach Education) Podcast Series, featuring 20 minute episodes of insight, and innovation. (Listen to our pilot episode here, and suggest topics you’d like to hear in the comment section below.)
We’re also proud to release our brand new Detailing Directory, highlighting shareable resources from successful field programs across the US and Canada. Explore the Detailing Directory by clinical topic, and explore our AD Fact Sheets, featuring toolkit examples, publications, and video sessions on specific topics in academic detailing. The goal of our Detailing Directory is to give you direct access to resources and building blocks to strengthen your program so you don’t have to reinvent the wheel. (Want to be featured and share your resources? Contact us today and we’ll be happy to add you to our directory.)
And while we’re proud of our ever-growing portfolio of virtual resources, what we love most is to connect with you person to person, program to program. That’s why we’re delighted to announce the dates (and open registration!) for our upcoming Spring Training on AD Techniques in Boston on April 30 & May 1st, 2018.
We’ve also just released our Save the Date for our 6th annual International Conference on Academic Detailing on November 12th & 13th, 2018—and we’re taking submissions for presentations starting March 1st--we hope you'll consider applying!
With so much happening for NaRCAD, and for our dedicated community members, who work tirelessly to improve patient care through clinician education, it's easy to see why we’re looking forward to the opportunities ahead. Thanks for continuing to share your insights with us--we’re here to support you, highlight your work, and ensure that your programming has the greatest possible impact.
We hope to connect with you soon.
-The NaRCAD Team
Guest Blogger: Deborah Monaghan, MD
Public Health/Academic Detailer
Colorado Department of Public Health and Environment
NaRCAD Training Alumnus
As the first and only detailer hired by the Colorado Department of Public Health and Environment, which serves 5.6 million people (about 3 million of which cluster around one metro area), the idea of building a detailing program from the ground up was incredibly exciting…and daunting. From the outset, it was important to determine the place of detailing within the community and establish its fit in the department’s mission.
Shortly after joining the team, I presented the intended scope of my work at a department meeting--and it generated tremendous interest in the use of academic detailing for public health initiatives far beyond the current planned intervention. This served to solidify the potential value of clinical education outreach to leadership throughout the department. Lessons learned are continually surfacing as we move into year two, and a few key concepts are worth sharing.
Particularly in the early stages of program establishment, it was essential to stretch resources and leverage partnerships. NaRCAD connections with other detailing programs facilitated the exchange of print resources, protocols and lessons learned, saving valuable development time.
Through CDC-funded capacity building visits, I shadowed detailing teams at two other health departments' AD programs (San Francisco Department of Public Health and the New York City Department of Health & Mental Hygiene), which provided a framework for our own program’s function.
At every opportunity, I presented our detailing goals to community partners and stakeholders, resulting in many connections to medical providers, which, in turn, generated most of our initial provider visits. Submitting articles for local clinical practice newsletters and magazines also established recognition and trust in the state’s new detailing initiatives.
Once provider-facing detailing visits began, two things became quite clear:
Providers crave connection to their public health department.
Providers want regional data.
In a state with both urban and rural/frontier areas, urban clinicians wanted to be seen as “boots on the ground” to impact large populations by treating their own patients, while rural providers wanted to be acknowledged as part of the team and directed to resources they could access remotely. All clinicians, both urban and rural, wanted the latest disease and health data for their county, zip code, and even census tract level to compare to the rest of the state.
It has taken multiple attempts to get in the door in many practices. However, after a detailing visit, most providers are outspoken that they found the session worthwhile, and we've used this opportunity to ask for referrals to other providers who might be open to visits. The time investment has also enabled two-way communication allowing us to get a “finger on the pulse” of regional health and disease, particularly in the more rural areas.
The initial time invested to establish relationships with providers was high, but the rate of return has justified the investment. With a new detailing program, the responsibility falls to the detailer to establish credibility, both in resources provided as well as in value for time spent.
If I were starting a detailing program again, or could support new programs who were just getting started, I would love to be armed with these lessons learned:
Establish as many protocols, procedures and resources as possible.
Just start! Even if every detail isn’t in place, start visiting with providers. (The steep learning curve of on-the-ground visits is incredibly valuable and will continue to shape and improve your methods.)
Document everything! As methods change and processes improve, document what is changing and why. Document with the goal of sharing not simply a starting point and a finished product but an entire story.
Be willing to adjust in real time. Providers will have varying needs from one to another and from one day to the next, and our flexibility will ultimately strengthen the relationships we are trying to build, allowing academic detailing to have the greatest possible impact.
Deborah Monaghan, MD
Public Health/Academic Detailer, Colorado Department of Public Health and Environment
Deborah joined CDPHE in 2016 as the Department’s first detailer and currently provides clinical outreach on HIV prevention and sexual health. A graduate of the University of Mississippi School of Medicine, internship took Deborah to Drexel University in Philadelphia, Pennsylvania followed by residency at St Mary’s Hospital in Grand Junction, Colorado. She will complete her MSPH through the University of London School of Hygiene and Tropical Medicine in 2018. Initial response from the provider community receiving detailing has been overwhelmingly positive, and Deborah hopes to facilitate expansion of detailing efforts into other branches of public health to impact more Coloradans.
Highlighting Best Practices
We highlight what's working in clinical education through interviews, features, event recaps, and guest blogs, offering clinical educators the chance to share successes and lessons learned from around the country & beyond.