An interview with Julia Bareham, BSP, MSc, Information Support Pharmacist, Academic Detailer, RxFiles Academic Detailing, College of Pharmacy and Nutrition, University of Saskatchewan.
by Anna Morgan, MPH, RN, PMP, NaRCAD Program Manager
Tags: Substance Use, Stigma, Detailing Visits
Anna: Hi Julia! We’re so excited to feature your work on DETAILS. You’ve had over a decade of experience with academic detailing. Can you tell us about your academic detailing journey?
Julia: I was hired by RxFiles in 2009. Shortly after starting with RxFiles, the program began working on a long-term care project and that became my focus until I left in 2015 to work in the prescription monitoring program in my province in Canada. I returned to RxFiles in 2019 and have since been working on helping to increase Suboxone prescribers in Saskatchewan.
Anna: It’s nice to have you back in our detailing community! What are some of the unique challenges that you’ve faced since returning to the field and detailing on this particular topic?
Julia: I think the most obvious answer is the global pandemic, which is a challenge that everyone has faced. For me, building relationships with clinicians through videoconferencing has not been easy. Reading your audience via videoconferencing is challenging, and that’s if you're fortunate enough that they'll have their cameras on!
In terms of the topic itself, many prescribers are unfamiliar with prescribing Suboxone and there is still some stigma related to opioid use disorder. Presenting the appropriate information to prescribers to properly assess, treat, and troubleshoot is key. Prescribers also must be authorized by their regulatory body to prescribe Suboxone in our province, which includes an educational program and mentorship.
To help make prescribing Suboxone less overwhelming, we created a Suboxone 101 resource for our detailing visits where we introduce clinicians to the treatment option and some of the main considerations around it. We also created a longer resource that walks through a detailed approach of assessing patients and prescribing Suboxone if clinicians indicate that they want to learn more. We’ve received positive feedback on our 101 resource and have had a lot of interest in our longer resource, which we plan to detail interested clinicians on in the near future.
Anna: Thanks for catching us up on some of the ways your program has approached detailing on this topic. Let’s talk a bit about being a detailer – what are some of your tips for being a successful detailer?
Julia: That’s a great question.
Anna: These tips can be applied to work beyond detailing as well! How has your team supported you in using those skills and qualities to become such a successful detailer?
Julia: I have an amazing team; we all have unique personalities and different approaches to detailing. They give me insights into how I might want to approach a certain topic when I’m in the field. I always gain new perspectives through trainings with my team, observing detailing visits, and debriefing after visits.
It’s especially nice to be able to debrief with colleagues when things don’t go as planned during a detailing visit. Sometimes the debriefs are long discussions and sometimes they are a quick text message to share what happened. Our team is honest and vulnerable with one another, which helps elevate the work that we do because we can support each other during challenging times.
We share wins with one another during debrief sessions as well. There's nothing better than a visit when you feel like you did an awesome job and really helped the clinician you detailed. It’s important to put that wind back in your sails!
Anna: Speaking of wins, can you share a story from the field when you felt that you made an impact as a detailer?
Julia: Absolutely. When I first started detailing, I detailed clinicians at a neighboring clinic to the pharmacy I worked at. One of the first topics I detailed on was gout and we had a key message around selecting the best non-steroidal anti-inflammatory drugs (NSAIDs) to use for treatment. I found that most of the prescribers I detailed were prescribing a less than optimal NSAID when it came to an acute gout flare. When I was later chatting with one of the clinicians at my pharmacy about a prescription that he had written, he said at the end of the conversation, “Oh, by the way, I just want you to know, I have changed how I prescribe for gout after meeting with you.” In that moment, it was clear to me that he wanted me to know that he listened to the evidence that I had shared with him and had changed his practice as a result.
I knew that prescribing different NSAIDs for gout was probably not going to save lives but knowing that the clinicians were listening and valued what I had to share with them let me see that I could have an impact on them.
Anna: That sounds like it was a nice boost of confidence for you as a new detailer. We’ll wrap up with our final question. Is there a piece of advice that you would offer to new detailers?
Julia: For your work to be fulfilling and for you to have that sense of satisfaction, it needs to be meaningful. We want to know that the work that we do matters and that we're making a difference. I find that it can be hard to see that right away with academic detailing. Sometimes I might just be confirming that a clinician’s current practice is still the optimal approach and other times I might be causing a clinician to reassess how they might make future drug therapy decisions. Don't underestimate the impact you might be having on a clinician, and consequently patient care, in doing the work that you do.
Anna: Thanks for sharing your perspectives, Julia! We look forward to hearing more about your impact in the future.
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Biography. Julia joined the RxFiles team in 2009 and until 2015 she provided academic detailing services across the province of Saskatchewan, primarily focusing on medication optimization in the long-term care population. During that time, Julia also returned to the University of Saskatchewan to pursue her Master of Science degree in the division of Pharmacy focusing on comprehensive medication management, graduating in 2014. In late 2015, Julia joined the College of Physicians and Surgeons of Saskatchewan where she held the position of Pharmacist Manager for the Prescription Review Program. In early 2019, Julia returned to RxFiles and is currently focused on opioid use disorder, in addition to medication therapy in both geriatrics and psychiatry.
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