National Resource Center for Academic Detailing [NaRCAD]
NARCAD
  • About
    • Why We Matter
    • Testimonials
    • Our Team
    • Contact Us
  • Tools & Resources
    • AD Core Toolkits >
      • Inclusivity Toolkit
      • Opioid Safety Toolkit
      • HIV Prevention Toolkit
      • E-Detailing Toolkit
      • Materials Toolkit
    • AD Literature Archives
  • Webinars
    • Webinar Series
    • E-Detailing Webinars
    • E-Detailing Roundtables
  • Blog & E-News
    • Best Practices Blog
    • E-Newsletter
  • Community
    • Discussion Forum
    • Peer Connection Program
    • Detailing Directory
  • EVENTS
    • Training Series
    • CONFERENCE SERIES
    • THE CONFERENCE HUB
  • About
    • Why We Matter
    • Testimonials
    • Our Team
    • Contact Us
  • Tools & Resources
    • AD Core Toolkits >
      • Inclusivity Toolkit
      • Opioid Safety Toolkit
      • HIV Prevention Toolkit
      • E-Detailing Toolkit
      • Materials Toolkit
    • AD Literature Archives
  • Webinars
    • Webinar Series
    • E-Detailing Webinars
    • E-Detailing Roundtables
  • Blog & E-News
    • Best Practices Blog
    • E-Newsletter
  • Community
    • Discussion Forum
    • Peer Connection Program
    • Detailing Directory
  • EVENTS
    • Training Series
    • CONFERENCE SERIES
    • THE CONFERENCE HUB

The DETAILS BLOG

Capturing Stories from the Field: Reflections, Challenges, & Best Practices

Closing Health Inequities Together: The Detailing Approach to Clinician Stigma

5/29/2020

2 Comments

 
An interview with Megan DeNubila, Provider Relations Manager, and Jessica Alward, Academic Detailer, from the Bureau of Infectious Disease Control with the state of New Hampshire. Their mission is to improve public health by promoting evidence-based practices in the areas of infection prevention, screening, testing, and management for HIV, TB, STD/STIs, and Hepatitis. 
​

​by Winnie Ho, Program Coordinator

​Tags: Detailing Visits, HIV/AIDS, Rural AD Programs, Sexual Health, Stigma
Picture
Winnie: Thank you both again for joining us today! In one of our past technical assistance discussions together, we’ve gone into depth about some common clinician stigma and barriers. In particular, you shared with us that because New Hampshire was a lower incidence state for HIV, you would encounter clinicians who felt that that particular issue didn’t really fall within their patient population. It’s a common barrier we hear from many detailing programs, whether they address opioid use disorder (OUD) or infectious diseases. Can you go into more depth about your experiences with this phenomenon, and how you’ve addressed it? 

Megan: Providers are extremely busy, and they’re often expected to be an expert on so many topics. Our program helps bring providers filter through new information so they can start to bring it up with their patients. By walking them through the best practices, the recommendations, and local and state-specific data, we can show them that it’s something that is impacting their patient population.

In addition, one of the things that stuck with me from the NaRCAD training we attended was that because there’s so much new information, providers would be expected to read up to 17 papers a day just to stay current. Something like HIV would be one of many things that providers are concerned with on a daily basis. Our job is to help bring the most relevant and evidence-based information to the surface for them and their patients.

Picture
Jess:  Megan is completely right on this!  I’m in provider offices a lot.  What I hear is that they often feel like they're just treading water and not able to keep up with new information.  What we try to do is bring that info to them in a way that doesn’t feel like just one more thing to squeeze into a day.  When we talk to them about stigma, we don’t want to start there.  We want to start with some easy and really useful information and tools that will make their job easier.  By doing that work first, they feel like the precious time they are giving to us is worth it.  After a couple visits, emails, or phone connections have happened, that's the time to bring up new approaches and topics.

Winnie: I really appreciate that your lens on this barrier embodies a ‘How do we best support you?’ attitude. The goal of academic detailing is to navigate and close knowledge gaps in hopes of changing clinician behavior. Sharing knowledge and having difficult conversations is our best tools to address clinician stigma and discomfort. It’s not a battle against them and certainly the goal isn’t to shame clinicians. This is a collaborative operation to improve health outcomes.

Picture
Megan: Right, in the end, our mission is to close health inequities altogether. If I were a clinician and wasn't comfortable or familiar with best practices for preventing HIV, then I might feel a high level of hesitation trying to broach something like taking a sexual history from my patient. But if it’s something that I get more comfortable with, I’m more likely to bring it up and ask the right questions.
 
Ultimately, we’re trying to build a relationship with the provider so they see us as a resource when a new practice, tool, or clinical guideline comes out. They can then use those tools and information to address stigma that a patient may be experiencing. Providers constantly have new information and guidelines thrown at them, and we would like to help make it easier for them to take that information and apply it in their daily work.

Picture
Jess: Whenever I address something uncomfortable with a provider, stigma or otherwise, I try to create an environment where we can work collaboratively on the issue and the provider feels as though I am a resource for them.  I will say something like, ‘the last we talked, you mentioned this to me and it really got me thinking….” Or “I was talking with a colleague the other day about….” Then I will find a way to circle back around to the original topic.  By approaching the topic in this manner allows them to feel we are a partner and have a shared goal.

​Winnie: I want to circle back to your team’s mission of addressing health inequities. Inequity is the core of why we discuss things like stigma and discomfort. We need to approach clinician stigma with a human approach, but we also need to address the very real impact that it can have on patient health outcomes.

Picture
Megan: In a mostly rural state like New Hampshire, healthcare access is limited to begin with, and clinician stigma could drive patients who need help to either forego care or have to travel very far to seek care that they are comfortable with. We know providers want the best outcomes for their patients, and through detailing, we want to help the providers achieve those outcomes. Looking at potential stigma is one of the keys to making sure we address health inequities.

​Winnie: A lot of these experiences about clinician stigma are anecdotal, but as you just outlined, they have a very real impact on health outcomes. From our previous call, we have discussed and imagined a tracking tool for these encounters with clinician stigma and barriers. What would you find useful about a tracking tool like this, and what would you hope to learn from the data?

Picture
Megan: A tracking tool would help us better understand and represent the stigmatic responses that are out there. It would help us focus our efforts to help a provider address stigma in their practice. Anecdotes are helpful, but it can be hard to grasp. We don’t want to make decisions by theorizing what patients are experiencing. As a small state program with limited resources, this would help us optimize our response and to make sure we’re heading in the right direction by seeing if stigmatic behaviors change.
 
Winnie: It would be extremely exciting to see a tool like this become available and specialized for the hundreds of detailers who do this work. 
​
Megan: Yes, it’s a theoretical tool at the moment, but we were in discussions prior to COVID-19 about how to develop it. It would be amazing to see programs collaborate on something like this. I can only imagine how much further we’ll go with that as a resource.

Picture
Biography. 
Megan DeNubila is the Provider Relations Manager for the Bureau of Infectious Disease Control, New Hampshire Division of Public Health Services. She has been leading the Public Health Education and Detailing team since August of 2018. Megan has over 8 years of public health experience in capacity building, coalition development, and community health. She earned her Master of Public Health degree from the Boston University School of Public Health with a concentration in Maternal and Child Health in 2016/2017 and her Bachelor of Arts degree in Health: Science, Society and Policy from Brandeis University in 2012.
​

Picture
Biography. 
Jessica Alward has been with the State of New Hampshire Division of Public Health Services for almost two years and recently earned her MS in Homeland Security and Emergency Management.  With a background in education and training, she works full time as an academic detailer all over the state.  In her spare time she enjoys directing community theatre productions, running and hiking. She is married to Scott and mom to two grown sons. 

2 Comments
Patterson
1/13/2023 05:05:39 am

Goodnews to everyone out there with different health challenges as I know there are still a lot of people suffering from different health issues and are therefore looking for solutions. I bring you Good news. There is a man called Dr Osato, a herbal practitioner who cures me from HSV2, i have suffered from this virus for the past 5 years. I got my healing by taking the herbal medicine Dr Osato sent to me to drink for two weeks and after the completion of the dosage, I went for a medical checkup and I tested Negative and my doctor confirmed with me that I was completely free from HSV2. All thanks to God for leading me to Dr Osato who was able to cure me completely from this horrible virus, I’m sharing this so that other people can know of this great healer called Dr Osato because I got to know him through Martha Jecorick post who he cured from HSV1&2 . I was made to understand that he can cure several other deadly diseases and viruses. Don’t die in ignorance or silence thinking that there is no cure for HSV1&2 or HIV and don’t let that illness take your life. Contact Dr Osato and get the cure from him. Dr Osato email is osatoherbalcure@gmail.com or WhatsApp him on +2347051705853 and His website is https://osatoherbalcure.wordpress.com . He cure all forms of diseases/virus {1}HIV/AIDS {2}DIABETES {3}EPILEPSY {4} CANCER or all kind {5} HPV {6} BRAIN TUMOR {7} HEPATITIS {8}COPD{9} SICKLE AND ANAEMIA {9} HSV1&2. Be kind enough to share as you read for others to know and get cured.

Reply
Maria Stehman
1/15/2023 07:26:10 am

Hi everyone, I’m here to give my own verdict about the herbal cure Dr Osato is sending out to people to cure them of Herpes-1&2 and HIV. Dr Osato herbal medicine is the best remedy for Herpes-1&2 and HIV/AIDS, I was a carrier of Herpes and I saw a testimony on Youtube on how Dr Osato cure Herpes with herbs, I decided to have a contact with him and asked him for solutions and he started the remedy for my health and prepare the herbal cure for me and send it to me through UPS and he gave me instructions on how to use it which i rightly followed and after 14days of taking the herbal medicine i went for a blood test and my result was Negative. I waited for 3months to confirm my result before sharing this beautiful testimony of mine and also to observe myself if i would have an outbreak and nothing came out from my body, i went for another blood test after 3 months of testing Negative and the result still shows Herpes Negative and my doctor was pretty sure i was totally cured from herpes and he confirm with me that I’m free from herpes. All the symptoms of Herpes were completely gone from my body. Thank God, now everything is fine, I’m cured by Dr Osato herbal medicine, I’m very thankful to Dr Osato and i will not stop publishing his name on the internet because of the good work he did for me, You can contact Dr Osato on email: osatoherbalcure@gmail.com Or you can call and WhatsApp him on +2347051705853. His website is https://osatoherbalcure.wordpress.com

DOCTOR OSATO CAN AS WELL CURE THE FOLLOWING DISEASE:-

1. HIV/AIDS
2. HERPES
3. CANCER OF ALL KINDS
4. HPV
5. Hepatitis A,B,C
6. Diabetes
7. CHRONIC DISEASE

Natural remedies for curing HIV/AIDS and Herpes call and whatsapp Dr Osato on +2347051705853 to get your cure and get rid of the virus from your body

Reply



Leave a Reply.

    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.

    Search Archives
    by Topic:

    All
    Autism
    Cancer
    Cardiovascular Health
    Chronic Illness
    CME
    Conference
    COVID 19
    Data
    Deprescribing
    Detailing Visits
    Diabetes
    Director's Letter
    E Detailing
    Elderly Care
    Evaluation
    Evidence Based Medicine
    Expert Trainer Insight Series
    Harm Reduction
    Health Disparities
    Health Policy
    Hepatitis C
    HIV/AIDS
    International
    Jerry Avorn
    LOOPR
    Materials Development
    Medications
    Mental Health
    Obesity
    Opioid Safety
    Pediatrics
    Practice Facilitation
    PrEP
    Primary Care
    Program Management
    Rural AD Programs
    Sexual Health
    Smoking Cessation
    Stigma
    Substance Use
    Sustainability
    Training
    Vaccinations

    RSS Feed


​NaRCAD is a program of the Boston Medical Center, founded at the Division of Pharmacoepidemiology & Pharmacoeconomics [DoPE], at Brigham & Women's Hospital.

​Privacy Notice
Proudly powered by Weebly