Trainee Update Series: Where Are They Now?
Bevin K. Shagoury, Communications & Education Director
Tags: Cancer, Detailing Visits, Practice Facilitation, Training
Hi, Emily! We’re happy to reconnect with a NaRCAD trainee, and to feature your current work on this month’s blog. Can you tell us a little about yourself and how you ended up working at the National Colorectal Cancer Roundtable?
I’ve worked in public health for 12 years, and in seven of those years I’ve focused on cancer screening and prevention. I got to know NaRCAD while working at the Washington State Department of Health, where I designed their approach and curriculum to coach primary care clinics and health systems on quality improvement strategies to increase colorectal cancer screening. Then last summer I joined the American Cancer Society as the National Colorectal Cancer Roundtable’s new associate director.
In this role much of my work is still focused on developing educational resources for providers, but I’m also involved in efforts to increase colorectal cancer screening through other channels, such as public education and policy. I learned so much about effective methods for conducting clinical education from the NaRCAD Academic Detailing training that I participated in back in October 2012. I’m grateful to have the opportunity to reconnect with NaRCAD, and thank you for the opportunity to share an update on my work!
Tell us a little bit about background and goals of the Roundtable.
The Roundtable, established by the American Cancer Society (ACS) and the Centers for Disease Control and Prevention (CDC) in 1997, is a national coalition dedicated to reducing the incidence of and mortality from colorectal cancer in the U.S., through coordinated leadership, strategic planning, and advocacy. Today, the Roundtable is a collaborative partnership with more than 100 member organizations across the nation. Through the efforts of several task groups, the Roundtable advances initiatives that focus on provider education, public education, health policy, quality and disparities issues.
Thanks in part to the work of many of our members, colorectal cancer incidence and mortality rates have dropped by over 30% in the U.S. among adults 50 and older in the last fifteen years, with a substantial fraction of these declines due to screening. Yet, despite the good news, colorectal cancer remains the second-leading cause of cancer death in the U.S. when men and women are combined.
The Roundtable is focusing on a great initiative called “80% by 2018.” What’s the story behind this movement?
To accelerate efforts to increase colorectal cancer screening, the Roundtable launched the 80% by 2018 initiative in March of 2014. 80% by 2018 is a movement in which hundreds of organizations have committed to substantially reducing colorectal cancer as a major public health problem and are working toward the shared goal of reaching 80% of adults aged 50 and older screened for colorectal cancer by 2018.
To date over 650 organizations – including medical professional societies, academic centers, survivor groups, government agencies, cancer coalitions, cancer centers, payers and many others – have signed a pledge to make this goal a priority. If we can achieve 80% by 2018, 277,000 cases and 203,000 colorectal cancer deaths would be prevented by 2030. You can learn more about 80% by 2018 and pledge your organization’s support on our 80% by 2018 webpage.
You attended a NaRCAD Academic Detailing Training a few years back to practice skills in clinical outreach education. Can you tell us a little bit about the highlights of your experience?
Academic detailing and practice facilitation are relatively new fields, so when I first accepted a job that included these skills I felt a little in over my head! I was up for the challenge, though, since I saw provider education and training as a way to move further upstream in making substantive and sustainable changes that would positively affect public health. It can take a while for new clinical findings to get implemented in primary care, so I saw that academic detailers and practice facilitators serve a key role in getting these findings into clinical practice.
My two-day Academic Detailing Training with NaRCAD taught me practical skills to work in this role, and gave me the confidence to know I could be effective without a clinical background. The highlight was the role-playing and one-on-one feedback from experienced academic detailers. Their personal feedback was not something I could have found in a book or online training.
What tools from the training do you think are most relevant to active detailers in the field?
Some of the most valuable tools I took from the training were the interpersonal skills needed to be effective as an academic detailer. The tips on how to solicit buy in after sharing a practice change was incredibly useful, such as asking: “does this sound like something you’d be willing to try in your practice?”
It was also really helpful to learn how to approach sharing a clinical update that could potentially make a provider feel as though they had been delivering inappropriate care. The training taught me how to navigate these discussions by saying that while something might be common practice it’s no longer supported by the latest clinical evidence. In my experience, providers were very receptive to learning new clinical updates when it was shared in such a way that they did not feel they were being reprimanded for not knowing already knowing the latest evidence.
Thanks for chatting with us. We’re happy to help get the word out about “80% by 2018” and looking forward to hearing the results of the initiative.
Thank you for the opportunity! I enjoyed reconnecting with you and reflecting on how my training with NaRCAD has enriched my work in clinical education. I’d like to encourage any readers that are interested in 80% by 2018 and efforts to increase colorectal cancer screening to learn about the campaign. And there are lots of great tools and resources in the provider education section of our website that might be of particular interest to academic detailers.
Emily Butler Bell is the Associate Director of the National Colorectal Cancer Roundtable. In this role she manages a number of projects that support the 80% by 2018 initiative, a movement in which hundreds of organizations are working toward the shared goal of reaching 80% of adults aged 50 and older screened for colorectal cancer by 2018. Prior to joining the Roundtable, Emily served as the Cancer Screening Quality Improvement Consultant for the Washington State Department of Health, where she designed their approach and curriculum to coach primary care clinics and health systems on quality improvement strategies to increase colorectal cancer screening.
Prior to that, Emily worked with the American Cancer Society in Austin, TX as a Cancer Information Specialist and later as a Health Insurance Specialist, where she gained insight into the access and affordability issues surrounding colorectal cancer screening. She holds a Master’s in Public Health from Boston University and a B.A. in Psychology from the University of California, Santa Cruz.
Jerry Avorn, MD, NaRCAD Co-Director
Tags: Detailing Visits, Jerry Avorn, Training
Often, in discussing academic detailing programs with current or potential sponsors, the question comes up: “Wouldn’t it be cheaper just to deliver the message to a whole group of clinicians at once, instead of the much more cumbersome process of talking to prescribers one at a time?” Sure, it would be cheaper.
So would just mailing (or e-mailing) memos to people telling them what to do, or requiring time-consuming groveling on 1-800-DROP-DEAD prior authorization numbers before a costly resource can be ordered. The problem is that cheaper solutions often don’t work, or don’t work well. We have decades of proof that putting health care professionals together in a darkened auditorium and subjecting them to a PowerPoint Tolerance Test does not reliably change behavior.
The main reason that academic detailing relies on one-on-one interactive communication is that it is the best way for the outreach educator to accomplish several key goals:
Well-trained academic detailers understand this, and they use the interactivity to craft a real-time, care-improvement message that best addresses the learning needs (and attitudes and biases!) of the person they’re visiting. Less competent academic detailers force their “targets” to sit still while they administer a canned micro-lecture monologue, which works poorly. They may feel they “got through all the points” they wanted to cover, but if there was no interactivity, no conversation, then the person they were talking at might as well have been falling asleep in a darkened amphitheatre.
We know this is the case from decades of experience and scores of randomized controlled trials. We also know, perhaps most compellingly, that when the drug industry wants to change what we know and about its products, it sends people to our offices to talk with us—it doesn’t rely only on the less expensive modalities of mailings, e-messages, and sponsored lectures.
So the next time someone suggests that it might be more inexpensive to just gather prescribers into a big room and have someone talk at them for an hour, agree with them. Then point out that it’s also less time-intensive to scarf down a Big Mac than eat a real meal, shoot off a series of emoticons rather than a personalized note, or listen to a ring tone of a Beethoven sonata rather than hear it performed by musicians. Cheaper isn’t everything.
Bevin K. Shagoury, Communications & Ed. Director
Tags: Conference, Training
The NaRCAD team is heading into October with an afterglow from our latest 2-day training session with a truly dynamic group of outreach educators. Each new group of trainees inspires our team with their plans to use their new skills for innovative clinical education programming.
This fall’s training class will pursue a range of goals in their programs, including:
With attendees representing diverse geographic regions such as South Carolina, Norway, Washington State, and beyond, we were rewarded by this group’s eagerness to learn and to share fresh, new ideas on how to make our successful program even stronger.
Our program had a few new highlights to share, too—including an engaging presentation on theories of behavior change, led by Arielle Mather, MPH, NaRCAD’s Education & Training Manager. Setting the stage during Day 1 of our program, this foundational presentation reviewed behavior change models and theories that inform the practice of academic detailing, including Motivational Interviewing and the Theory of Planned Behavior. The presentation was met with enthusiasm and appreciation by trainees and facilitators alike, and many trainees requested more time to talk about these theories during breakout sessions.
Another new element of our program provided dedicated time on Day 2 for a lively group discussion on personalized support from NaRCAD. Trainees, staff, and facilitators brainstormed as a group the ways that NaRCAD could continue to bolster an active learning community through virtual resources, e-news, sharing of best practices, partner modeling, and 1:1 consultation. As a final new feature of our program, we created time during the personalized support session for more role-play practice. Participants who wanted additional support prior to their final, recorded detailing session had the option to head to a breakout room and receive additional, personalized practice time with an expert facilitator.
As we start planning for our Spring 2016 AD Techniques Training program, we have many new ideas to implement, trainee-to-expert introductions to make, and best practices to feature. As NaRCAD enters our 5th year and prepares for our 3rd annual conference, we hope you’ll join our community of experts leading the way to improving health outcomes with engaging, clinical outreach education.
Behind the Scenes with Dr. Doyle-Tadduni, NaRCAD Training Facilitator
Editor’s note: In this series, DETAILS asks Academic Detailing (AD) Techniques Training facilitators how they lead by example, challenge participants, and ensure that trainees are ready to go out into the field. Dr. Doyle-Tadduni focused on her insights and tips to success in providing excellent clinical education by building strong detailer-to-clinician relationships based on evidence, clarity, and “intrinsic trust.”
Tags: Cardiovascular Health, Detailing Visits, Expert Trainer Insight Series, Training
NaRCAD: Hi, Mary Liz! We’re looking forward to learning more from you about what it’s like to train prospective academic detailers. But first, tell us a little about how you became involved in detailing.
Dr. Doyle-Tadduni: I began working as an academic detailer about 10 years ago in Pennsylvania with the Independent Drug Information Service, which is sponsored by PACE (Pharmaceutical Assistance Contract for the Elderly). My clinical background in nursing and my teaching background within various university settings has served me well in this role as a clinical educator.
NaRCAD: What does a day of academic detailing look like for you? What successes and challenges do you see?
Dr. Doyle-Tadduni: My territory encompasses the westerns suburbs of Philadelphia where I visit physicians, nurse practitioners, and physician assistants. I see these providers in a variety of settings, including private practices, university-affiliated practices, and outpatient health care systems.
Since AD is a new concept to many practitioners, it’s essential to start your visit by educating providers about the importance of academic detailing and how it will benefit them and their patients. In this way, I’ve developed many long-standing relationships with providers who have said that AD has been very beneficial for their individual practices. It’s very gratifying in a follow-up appointment to hear that a provider has taken the evidence you provided and put it into practice, creating a positive outcome for patients.
NaRCAD: How do you build strong relationships with the clinicians you visit?
Dr. Doyle-Tadduni: There needs to be an intrinsic sense of trust between a detailer and the provider. You may not gain the trust in the relationship during your initial visits, but when you provide clinicians with a full understanding of the importance of your visit, along with presenting educational materials that are credible and evidence-based, you promote trust and strengthen the relationship and gain clinician commitment to changing behavior for the better.
NaRCAD: You’ve facilitated quite a few trainings with us at NaRCAD. Tell us more about the course, and why you enjoy doing it.
Dr. Doyle-Tadduni: This course is a great support for both new and seasoned trainees in enhancing their detailing skills, as well as program managers who oversee a clinical education program and need a greater understanding of how best to run an effective program. At the beginning of the training, the trainees absorb AD theoretical content and techniques, and on Day 2, they’re actively practicing the techniques and role playing different educational encounters in small groups.
The program trainees have been wonderful people to meet! I’ve had the opportunity to meet people from all over the United States, and some from Australia, Portugal, and Europe. It’s been very interesting being involved with the trainings and hearing about health care in other regions of the US and abroad. Despite the miles that separate all of us in our different demographics, we all have similar challenges in our respective health care systems.
NaRCAD: As a trainer, you “play” the role of the clinicians during breakout group sessions, presenting different personalities as well as various behavioral and content-based objections to the material or the visit. Tell us more about this part of the course.
Mary Liz practices with a trainee, teaching the importance of showcasing AD as a service that will create better outcomes for clinicians’ practices and patients.
Dr. Doyle-Tadduni: We present the trainees with many different role play scenarios where they can actively practice overcoming obstacles that get in the way of earning clinician commitment. Finding the right delivery of your messaging can be very challenging, depending on the environment, and every detailer will have a unique set of potential obstacles to face at each visit.
The key is to focus on the evidence, so that practitioners can realize how beneficial it will be to their practice. The training’s small group role play practice sessions provides trainees ample opportunity to practice, ask questions, perfect their skills, and be prepared to face inevitable obstacles in their own future visits.
NaRCAD: What do NaRCAD trainees need to have to be ready to succeed as a detailer? How does our 2-day training help to get them ready for success?
Dr. Doyle-Tadduni: The trainees need to have an expert knowledge base of the clinical topic and related materials they’ll be presenting during a visit. They also need to present AD as an on-going resource. With busy practitioners being so tightly scheduled through the day, programs designed to assist them in improving how their practice runs is a plus. By the end of the two days of training, the trainees will have a strong foundation of clinical education techniques, and they’ll be forming ideas about implementing these efforts in their respective programs.
NaRCAD: Any closing thoughts or advice for new trainees, or first time detailers as they prepare to head into the field?
As long as you’re well-versed on the material you’re delivering, and you’re presenting yourself as an “ambassador of the evidence”, you’ll have the tools you need to ensure that an academic detailing visit is truly successful.
An Interview with Frank Leone on Treating Tobacco Dependence with AD
Dr. Leone directs Penn’s Comprehensive Smoking Treatment Program and was a former trainee with NaRCAD.
Tags: Detailing Visits, Smoking Cessation, Substance Use, Training
NaRCAD: Tell us a bit about yourself. How did you get into academic detailing?
Frank Leone: I’m a pulmonologist, and have been focused on the treatment of tobacco dependence for over 20 years. In my early years, I had always been amazed at how infrequently my colleagues would approach the literature for solutions when facing this common problem in the clinic. It seemed to me that they relied heavily on “common sense” approaches and techniques derived from misunderstandings, rather than consulting published guidelines and available standards.
I became interested in the behavioral economics of tobacco treatment decision-making in the clinic, and realized that traditional approaches to changing physician behavior might be inadequate for dealing with a cultural problem this well-entrenched. We initially turned to NaRCAD for advice on Academic Detailing in 2011, and found the approach to have just the right potential to both meet the needs of the target audience, and allow us to deliver our message in a cost-effective and scalable way.
We were also given an opportunity to work with the Philadelphia Department of Public Health as they started up their efforts to influence the local provider culture around tobacco, and we’ve been “off to the races” working within our community, creating positive changes, ever since.
NaRCAD: What does your program focus on? (What health issue does it address, and what clinician behavior are you seeking to change?)
Dr. Leone: Our Academic Detailing (AD) program focuses exclusively on tobacco dependence treatment. As you can imagine, that problem cuts across a number of different audiences. Our detailers work with physicians, psychologists, nurses, counselors and others to impact the rate at which tobacco treatment services are delivered in our area. We use AD to address the limits in knowledge base around pharmacotherapy, as well as to shape the core assumptions about effectiveness of treatment in key patient populations (e.g. those with established lung disease or serious mental illness).
NaRCAD: Tell us about some of the growth you’ve seen and been a part of as it relates your program.
Dr. Leone: Our AD program has grown every year since its inception. We started out focused on primary care physicians in underserved parts of Philadelphia. From there, we expanded our target audience to include specialist physicians, nurses, and nurse practitioners. Most recently, our audience has expanded to include behavioral health practitioners in both inpatient and outpatient settings. Because of our success using AD to work with care providers from a variety of disciplines, we are currently exploring ways to extend AD principles to “system-wide” approaches to creating behavior change.
NaRCAD: What would you say are the greatest challenges you see in implementing this intervention?
Dr. Leone: Finding the right people to go into the field is imperative. Over the years, I’ve been impressed that success during the AD interaction is less about what degree a person has, and more about the ability to be gently directive, while willing to truly listen. Detailers need to be spontaneous and responsive to their audience, while at the same time keeping their inner eye on the target. This is a skill that takes a little time and training to develop. It sounds like it ought to be an easy thing to do, but we’ve found that an organized, logical, mentored approach to learning these skills is important to success.
NaRCAD: How about what works well? How do you know when you’ve been successful?
Dr. Leone: We always try to incorporate some sort of measurement tool into our AD projects. It might be about knowledge, attitudes, or behaviors, but having a metric to gauge our impact is important feedback ensuring we stay on mark. Our funders appreciate a concrete measure of change as well.
If I could figure out how to capture this, my favorite measure would measure the “A-ha!” moments that happen so often within the audience. I love the look of epiphany in the clinician’s eye when a detailer has found a way to make the information relevant and transformative. That’s when I know we’re really making change for the long run.
NaRCAD: You attended our Academic Detailing Techniques Training a few years back. What are the most useful resources or information that you’re still using today?
Dr. Leone: Truthfully, the greatest resource has been the continuing relationship with the NaRCAD team. On multiple occasions during the conception and start-up phases of our project, we were able to touch base with professionals who had a large collective experience in diverse disciplines to get some great tips and suggestions.
On one specific occasion, I remember sharing a written detailing piece with the NaRCAD team. We had developed it in hopes of getting some feedback. Not only did we get great advice, but it was professional advice – complete with references, examples, resources, and connections to the theoretical basis for the suggestions. To me, this is the kind of interaction that helps my team grow and learn over time.
NaRCAD: What does future success look like for you?
Dr. Leone: In twenty years, when you go visit your doctor for your annual check-up, and you hear him or her say, “Of course tobacco dependence is a chronic illness of the brain for which there are a number of effective treatments. It’s hard to believe we used to simply tell people to stop!” –then you’ll know we’ve done our job well.
Dr. Leone received his medical degree from the University of Pittsburgh, School of Medicine, and completed his postgraduate training in both general internal medicine and pulmonary / critical care medicine at Thomas Jefferson University Hospital. He also received his masters degree in clinical epidemiology and biostatistics from the University of Pennsylvania School of Medicine. Dr. Leone directs Penn’s Comprehensive Smoking Treatment Program, a clinical program of the Penn Lung Center, located at both Penn Presbyterian Medical Center, and the Perelman Center for Advanced Medicine. The new program provides state-of-the-art and individualized treatment to smokers, including those with co-morbidities.
Dr. Leone’s scholarship focuses on investigating advanced treatment strategies for tobacco use disorder, and on testing educational strategies for improving the care of the tobacco dependant patient. Dr. Leone is a member of several professional and scientific societies, including the Society for Research on Nicotine and Tobacco, the American College of Chest Physicians, and the American Thoracic Society. He has served the Commonwealth of Pennsylvania as a legislative appointee to the Governor’s Tobacco Use Prevention and Cessation Advisory Committee since 2001. Dr. Leone has been invited to speak at numerous lectures on topics of smoking treatment and pulmonary medicine, and has been published in a variety of clinical and research journals. He is board certified in pulmonary and critical care medicine. Learn more and review related publications on the University of Pennsylvania’s site.
Read more: Behavioral Economic Insights into Physician Tobacco Treatment Decision-Making : Leone, Frank
Mike Fischer, MD, MS
Tags: Cardiovascular Health, Detailing Visits, Smoking Cessation, Training
At NaRCAD, we work together with our many partners, collaborating on important interventions to improve patient health through clinical outreach education. This summer, we’re especially looking forward to a unique collaboration to improve cardiovascular health, as we travel to Oklahoma to support the Healthy Hearts for Oklahoma project, part of AHRQ’s EvidenceNow initiative.
EvidenceNow is a group of 7 large studies across the United States working to improve cardiovascular care in small primary care practices. Along with materials development and program support, the NaRCAD team will travel to Oklahoma City in July to train over 20 health professionals, teaching them how to provide the service of academic detailing to participating practices. Focusing on the ‘ABCS’ (aspirin use, blood pressure control, cholesterol management, and smoking cessation), the professionals we train will carry out academic detailing visits in order to present best evidence to participating practices.
By using the skills and techniques of AD to assess the needs of clinicians and practices throughout Oklahoma, the detailers we train will gain commitment from clinicians to commit to practice change. The Healthy Hearts for Oklahoma project will visit hundreds of practices, tracking these practices’ behaviors over time. Ultimately, the evidence generated by Healthy Hearts and the other EvidenceNow studies will yield key insights about how best to bring evidence to diverse practice settings and improve the cardiovascular health of all Americans.
Supporting organizations that are carrying out important work such as this is at the core of who we are and what we do. The positive impact of academic detailing can be amplified with each new intervention, program, or even a single visit to a clinician. As we enter into our 5th year as the only nationally available resource center for for academic detailing, the strength of the relationships we build makes it possible for clinical outreach education to serve more practices and have a greater impact on patient health.
We’ll share highlights from the Healthy Hearts for Oklahoma project and other exciting collaborations with our subscribers this fall. In the meantime, we’d love to see you at a future Boston-based training, or at our 3rd annual International Conference on Academic Detailing this fall—join us as we work together to advance the field of clinical outreach education.
An Interview with Paula Walker, Clinical Pharmacist
Baylor, Scott & White Health | Dallas, Texas
Tags: Cardiovascular Health, Chronic Illness, Detailing Visits, Elderly Care, Training
Tell us a bit about yourself. How did you get into care redesign and transitional care? I grew up in the area of Inman Square Pharmacy in Cambridge, Massachusetts. After graduating from Northeastern University in 1990, I began my career in community pharmacy. Soon after I entered the pharmaceutical industry, I spent many years representing the biological division of Rhone-Poulenc. I continued to keep connected with public health by practicing in the community part time; I’ve also been serving in a family practice clinic for over 8 years now. Three years ago, upon recommendation from our clinic director, I joined The Institute of Chronic Disease and Care Redesign at Baylor Scott and White Health in Dallas.
Tell us about the institute. What does your team focus on with regards to providing transitional care? What approach do you take?
Our multidisciplinary team focuses on improving outcomes among chronically ill older adults. Our innovative approach includes using advanced technology to identify patients at most risk for readmission. With a focus on heart failure, COPD, and pneumonia, patients are identified and supported as they transition from one level of care to the next. Our transitional care team encourages each specialty to work at the very top of their license to assist patients whose recovery is complicated by cognitive impairment, frailty, and social issues. Our team shares offices together so each discipline is available to all team members at all times. A strong team and constant communication is the key to our success.
What does a typical day or week look like for you in this field? How do you incorporate academic detailing techniques into your work?
My role is to perform the medication reconciliation on all of my patients and communicate any concerns with the appropriate providers. I attend weekly rounding with my team and need to be able to make and support any medication recommendations. In terms of using academic detailing techniques, our team practices evidence-based medicine in the care and treatment of our population with chronic disease. It’s also key for a pharmacist in this role to be able to communicate to providers quickly and effectively regarding drug selection, dosage, and titration. Learning and practicing the skills required to communicate effectively in this environment is essential. In a typical day I will consult with a geriatric specialist, cardiology, nephrology, APRN, social worker, and corporate administration. That is a lot of communicating!
You attended our Academic Detailing Techniques Training a few years back. What parts of the program worked well for you, and what are the most useful resources or information that you’re still using today? I found the skills learned during the NaRCAD training to be useful and confidence building. There is an art to being able to research information then applying it to support a recommendation in a short amount of time. NaRCAD brings together professionals from different disciplines that are focused on improving the communication of science-based information in their practice or facility. It is useful to connect with others that require these skills in their work. The small class size made it very easy to meet all the participants and learn from their experiences. I believe you can never be too experienced, and I constantly learn from the experience of others.
What are some future successes you’re looking forward to in your work and in the field in general? As we prepare to expand the Transitional Care Model at Baylor Scott and White Health under the population health infrastructure, I look forward to the pharmacist’s role to expand as well. Our goal of disease management, well above the national standard, will require evidence based medicine and the sharing of clinical information to all members of the care team. I look forward to continuing my relationship with NaRCAD—together we can help each other transform care, resulting in an improvement in the quality of life for our patients. And I’m looking forward to NaRCAD’s 3rd International Conference on Academic Detailing this November in Boston!
Biography: Paula Walker, Clinical Pharmacist, joined the Baylor Scott & White Health Transitional Care Team in 2012. Paula is the team pharmacist and oversees all medication reconciliation for their older adult population with heart failure, COPD, and pneumonia. Prior to joining BSW, Paula has worked in community pharmacy, clinic pharmacy (still active), and the pharmaceutical industry. Paula holds BS in Pharmacy from Northeastern University.
Bevin K. Shagoury, Communications & Education Director
Tags: Detailing Visits, Training
Our most recent 2-day Academic Detailing Techniques Training was held here in Boston on May 4th and 5th, 2015, and it was a successful and exciting convening of 18 trainees from all over the country. Clinical pharmacists, nurses, and program specialists gathered in Boston’s downtown to learn and practice social marketing techniques to use when educating front line clinicians about new evidence and important interventions.
Our trainees will take these valuable skills back to a wide range of programs, with goals including improving health for veterans with PTSD, increasing referrals to smoking cessation programs, and strengthening chronic disease lifestyle management programs.
Many of us have attended trainings and conferences heavy on Powerpoint presentations and light on practicing tangible skills. At NaRCAD, we use a dynamic curriculum wherein we integrate role-play, interactive large and small-group discussion, live demonstrations of a successful academic detailing visit, reflection through videography, ongoing networking, and the chance to learn from experts, clinicians, and colleagues through practice and skills sharing.
After their training sessions are done, trainees move forward to establish new academic detailing programs, strengthen and develop existing ones, or use our techniques in other clinical education settings. And as their work continues, so does ours—we maintain contact with our trainees, providing critical resources and featuring their work on our website and DETAILS blog. This fall, we’ll be featuring partner profiles of many of our trainees’ academic detailing programs, so that our community can learn about the critical role these programs play in improving health outcomes.
Join us at our next training this September—a program one recent trainee describes as “an excellent program, with fabulous faculty, and a well-run, valuable service to the healthcare community.” We keep improving our curriculum to ensure that each of our trainees gets personalized support to make their work easier. Their appreciation and feedback helps us to refine our training, encouraging us to think about ways we can continue to provide the best resources available. As the field continues to grow, so do we—and our trainees tell us that we’re making an impact by leveraging their work, sharing best practices, and running “the best training I’ve ever been to—seriously!”
Spring 2015 Director’s Letter
Mike Fischer, MD, MS, Director of NaRCAD
Tags: Detailing Visits, Director's Letter, Training
Despite the difficult winter weather in Boston, NaRCAD has been off to a great start so far this year. We’ve been very excited to begin several new initiatives with terrific partners. As we move forward through 2015 and beyond, we invite those of you reading our newsletter and following us through our blog or on social media to reach out about working together on similar efforts.
Training academic detailers is a core part of our mission, and we continue to have full registrations for our Boston-based training sessions, telling us that there’s an interest and a demand for our training course. This year we were thrilled to take our training on the road for the first time, working with the San Francisco Department of Public Health on several new initiatives, focusing on diverse topics including overdose prevention, increasing use of vaccinations in pregnancy, and HIV screening and treatment. This July, we’ll again deliver training outside of Boston, this time in Oklahoma to help support a new AHRQ-funded project aimed at improving care for cardiovascular risk factors in primary care.
We also created and launched a new workshop for the experienced group of academic detailers at Atrius Health here in Boston. Similarly to our 2-day techniques training, we used role play and interactive group discussion to help clinical pharmacists work on overcoming barriers and obstacles. Interacting with Atrius’s dedicated group of outreach educators has all of us thinking about how academic detailers can best maintain and develop their skills over time, and we’re interested in hearing about how existing programs approach this challenge. If you have similar experiences to share, let us know—we’re always eager to share best practices with our network community of detailers, programs, and supporters.
We want to hear from you. Your ideas matter–tell us how you’d like to collaborate, create new opportunities for academic detailing, and improve quality of care and patient outcomes.
by Joy Leotsakos, PharmD
Tags: Cardiovascular Health, Detailing Visits, Evaluation, Program Management, Training
Who We Are. The Academic Detailing Service (ADS) of the Atrius Health Clinical Pharmacy Program provides clinically appropriate, evidence-based, cost-effective medication management in a multidisciplinary team setting. Our Clinical Pharmacy Program includes 15 clinical pharmacists (CPs) serving nineteen Internal Medicine and Family Medicine (IM/FM) ambulatory care practice locations. In the past four years, our program has evolved and transformed through evaluating our impact, absorbing and implementing internal feedback, and collaborating with others in the field, including NaRCAD.
Our Start. As the program manager of our ADS, I’ve seen our service grow and change. When we began our program in 2011, it was as an administrative mandate to meet with all IM/FM prescribers once per fiscal quarter to deliver messages about cost-effective prescribing and clinical quality. We started by formulating a menu of topics to cover in our ADS work each quarter, including individual clinician prescribing reports reflecting performance on prescribing initiatives from the Pharmacy & Therapeutics Committee, specific questions to survey clinicians on a clinical topic, targeted education for low performers on prescribing initiatives, and various other ‘hot topic’ clinical issues. CPs detailed individual clinicians via formal 1:1 scheduled appointments, and also did so less formally (such as by catching them in the hallways) or in larger groups during department meetings.
Is it Working? We documented our ADS activities by checking off the individual clinicians we detailed each quarter. At that time, there was no formal training for our CPs on how to conduct a detailing meeting. Unfortunately, this method of creating content for visits soon resulted in a large menu of topics so varied that each quarter’s detailing became unwieldy and too broadly focused. And our documentation, while it gave us a general sense of the number of clinicians detailed, did not tell us anything about the quality of this detailing.
Room for Improvement. Our group is fortunate in that our ADS activities have always been accepted and even expected by our IM/FM clinicians. We experienced almost no clinician resistance to our educational meetings. But in 2013, when attending one of NaRCAD’s 2-day Academic Detailing Training sessions, I learned that we could make changes to improve our services, as well as my own skills as a detailer. As a result, we altered the format of our ADS program, choosing to detail clinicians in a 1-1 or small group format of less than 4. We also selected a goal of 90% of clinicians receiving detailing at least once every quarter.
Evaluating Impact. We began evaluating the impact of the changes we’d made to our ADS, specifically choosing to look at its impact on a discretely measurable topic: reducing the unnecessary ordering of an ALT test (alanine transaminase) in patients on the ’statin’ cholesterol-lowering medications. We were able to demonstrate that our detailing of all IM/FM clinicians led to significant reductions in ALT ordering and meaningful cost avoidance for our organization.
Asking for Feedback. With NaRCAD’s support, we further refined our program in 2014 based upon feedback from an internal focus group. By soliciting honest feedback from the CPs about their detailing experiences, I discovered considerable variation in how they approached the menu of topics provided each quarter and came to understand that the continuous process of visiting with each clinician at their sites often felt stale and repetitive.
New Approach, New Results. We revised our ADS workflow to tie each round of clinician appointments directly to a specific and single P&T prescribing initiative. Furthermore, we developed a method to tag low performing clinicians for an ‘intense’ ADS visit and higher performers for a ‘touch’ ADS visit. We began this new workflow with an initiative to improve the use of evidence-based beta-blockers in patients with heart failure, a quality measure for the Medicare Pioneer Accountable Care Organization (ACO) project. Using this new approach, clinical pharmacists were able to deliver a fresh and meaningful message to the right prescribers, resulting in a change from 73.6% to 97.8%prescribing of evidence-based beta-blockers in this patient population.
Partnering with NaRCAD for Ongoing Learning. In March 2015, we coordinated with NaRCAD again, and they provided our group of clinical pharmacists with a 2.5 hour workshop to enhance our AD skills. I’d encourage anyone who does this type of educational outreach to make use of this invaluable resource. Of course, our Atrius Health Academic Detailing Service will continue to grow and change as we find additional ways to improve our workflows and messages. I look forward to continued collaboration with NaRCAD and with others in the field, so that we can all keep learning from each other and improve health outcomes through effective academic detailing.
Bio: Joy Leotsakos is a senior clinical pharmacist and the program manager for the Academic Detailing Service (ADS) of the Atrius Health Clinical Pharmacy Program. Joy joined Atrius Health in 2007 and became the program manager for the ADS program in 2012. Prior to joining Atrius Health, Joy worked as an assistant professor at Massachusetts College of Pharmacy and Health Sciences University in Boston, MA and provided ambulatory care pharmacy services to the South End Community Health Center also in Boston. Joy graduated with a Doctor of Pharmacy degree from Virginia Commonwealth University School of Pharmacy and then completed her residency in Ambulatory Care and Community Pharmacy at the University of Florida College of Pharmacy. Joy is the mother of one son, and enjoys salsa dancing, cycling and running in the summer and skiing in the winter. You can reach Joy by email at email@example.com.
by Michael Fischer, MD, MS, & Bevin K. Shagoury
Tags: Detailing Visits, Evidence-Based Medicine, Training
Changes in healthcare are accelerating faster than ever, amplified by the immediacy of virtual communication. New research studies or guidelines appear simultaneously in traditional media, online news sites, and social media. Front-line clinicians may not have the time to review the actual data before incorporating new information into their practices. We’ve seen this recently with topics such as managing cholesterol and hypertension, the safety and possible overuse of pain medications, and new treatments for hepatitis C.
These topics present a challenge not only for clinicians and their patients, but for those who work on medical education and quality improvement efforts. Educational messages cannot be static; rather, organizations working to promote change and improvement need to identify new evidence, incorporate it into interventions and bring it to frontline clinicians. Amidst the steady stream of research and new discoveries, along with ongoing debates about those findings, how do organizations work to effectively assess needs, share best evidence, and improve healthcare outcomes?
NaRCAD is uniquely positioned to help address this question, serving as a powerful and integral link between the best evidence and frontline clinicians by supporting academic detailing programs and related outreach interventions. We’re leaders in the field, providing training and support to health care organizations to establish effective academic detailing programs, working with partners to develop academic detailing program templates which can be adopted by others, and sustaining a network of programs sharing best practices in academic detailing to improve patient health outcomes.
Evidence aside, observation and insight tells us that healthcare, like the populations it serves, is organic; constantly changing, growing, and redefining the best next steps to improve the quality of care and patient outcomes. As new medical evidence emerges and new delivery system innovations are introduced, we at NaRCAD look to help those changes enter practice in a way that most benefits patients and public health. Learn more about us, or tell us how we can help you.
by Bevin K. Shagoury, Communications & Education Director
Tags: Detailing Visits, Training
NaRCAD spent January 12th and 13th, 2015 with the enthusiastic and talented public health professionals of the San Francisco Department of Public Health (SFDPH), teaching them the principles and practice of AD. As with our prior trainings, the main goal was to ensure that trainees can understand and effectively practice AD techniques. This collaboration with SFDPH served as our first “on the road” training, providing an opportunity for our staff and facilitators to look closely at how to customize AD training to meet the needs of public health workers.
The SFDPH participants are developing and implementing programs to address needs in several important areas, including immunization programs, viral hepatitis outreach, HIV screening, reducing the risk of opioid overdose, and perinatal care. Like many of our prior trainees, this group was eager to learn about how to adapt the innovative, service-delivery model of AD to improve health outcomes by communicating effectively with front-line clinicians.
Throughout the training, SFDPH trainees and NaRCAD staff joined in brainstorming ways to implement novel strategies and techniques in their respective clinical areas to strengthen program successes, expand impact, and achieve long-term practice changes in San Francisco.
With academic detailing in their arsenal of intervention tools to change clinician behavior for the better, we look forward to seeing the ways in which our partners at SFDPH will improve health outcomes for the people of San Francisco.
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.