Innovations in e-Detailing: Using Digital Platforms to Increase PrEP Prescribers in Oregon

An interview with Ashley Allison, Lead Training Coordinator, Oregon AIDS Education and Training Center (AETC). Ashley works with health departments and clinic systems to coordinate HIV-related training across the state ranging from prevention to care and treatment. She also oversees the detailing program where their main goal is to expand PrEP access in Oregon.

by Anna Morgan, MPH, RN, PMP, NaRCAD Program Manager

Tags: COVID 19, Detailing Visits, E Detailing, ​HIV/AIDS, ​PrEP

​​Anna: It was so nice to catch up on your team’s progress at our recent virtual training with the San Francisco Department of Public Health! Your program launched about two years ago and really took off when you pivoted to e-Detailing. Can you tell us more about that?
 
Ashley: Our program started with in-person visits and we would send our detailers out with a little briefcase of materials and an iPad full of slide decks—it was pretty “old school”. When the pandemic began, we had to take a hard look at our entire program to successfully pivot to e-Detailing.
 
As we began e-Detailing, we developed an outreach process and approach that has been working well for us. Here are a few of the steps and considerations that you can share with other new programs:

• We start by mailing out packets to clinicians with our state’s endorsement letter, a very simple explanation of our program, and detailing materials.

• Our materials are bright and colorful, and we made sure they align with the state's HIV campaign branding colors.
• We also include a card with a QR code that clinicians can scan to schedule an appointment directly with a detailer. (If a clinician doesn’t respond, we send a follow-up email with information about our program and links to schedule an appointment.)
• If a clinician schedules an e-Detailing visit, we then send digital copies of our materials in advance of the visit. However, we continue to believe in the value of having hard copies that they can keep in their lab coat and pull out as needed. It’s also much easier for our detailers to reference the hard copies that we mail with our packets during their virtual detailing visits.
• Throughout our outreach process, we track how we’re targeting each clinician that engages with us (e.g., through a referral, through a training, or through the National Clinical Consultation Center’s (NCCC) line on PrEP). By tracking this information, we’re able to evaluate where we’re finding success in connecting with clinicians, and where we need to try a different approach.

 
We’re trying to find new ways to engage clinicians who’ve received the materials but haven’t yet scheduled a detailing visit. We want to provide multiple entry points and make our detailing visits more accessible. 

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Anna: Thanks for outlining this process and giving us a better understanding of how your program gains access to clinicians! What do you do to connect with clinicians who have yet to set up an appointment?
 
Ashley: One of our solutions has been what we call “virtual office hours”. In the calendar slots where a detailer has no detailing visits scheduled, they can hold open office hours, and we send out a promotional email about them to clinicians. Multiple clinicians can be there at once and chat about anything under the umbrella of the HIV care continuum. The detailer slowly shifts the clinicians who attend office hours into a detailing relationship by creating opportunities to meet again 1:1 to further discuss certain topics.
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Anna: That’s such an innovative approach in gaining access. Can you discuss some of your team's other recent successes as it relates to virtual detailing?

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Ashley: Virtual detailing has allowed us to increase our number of detailing visits due to the decreased number of resources and time required to complete an e-Detailing visit, including scheduling. We spent a lot of time looking into different platforms for automated appointment scheduling and ended up finding the Appointlet scheduling app. It allows us to manage all of our detailers’ schedules in a centralized place. It’s extremely intuitive and easy to use.
 
We’ve also switched our evaluation from a handwritten survey to a digital version on Survey Monkey. We made our survey significantly longer when we moved it to Survey Monkey and pulled a lot of our questions from example surveys from other programs and the national HIV curriculum website.
 
Our questions are specific to knowledge, attitudes, and practice and allow us to distinguish if a clinician isn’t doing something because they don’t have the knowledge, they don’t feel comfortable, or they don’t see it as within the scope of their role. Despite the lengthier survey, our response rate has been much higher now that we can send follow-up emails with the survey link right in it.
 
Survey Monkey has also allowed us to quickly review the pre-evaluation data prior to detailing visits. If there are any red flags, we can highlight it for the detailers so they can customize which key messages will likely resonate with the clinician during their visit.
 
Anna: ​That's great. There are certainly advantages to using a virtual platform to conduct the different steps of the program process. What are some of your goals for the remainder of 2021?

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Ashley: We want to start implementing a successful hybrid model of in-person detailing and e-Detailing while also training our new detailers in a robust and consistent way.
 
We want to continue with our main goal of increasing the number of PrEP prescribers in Oregon and making it more accessible across the state. We also want to start detailing pharmacists, depending on how the current legislation lands around providing supports for pharmacists to prescribe PrEP. We feel confident in our key messages for primary care providers. We’re excited to start crafting our key messages in ways that appeal to pharmacists and address the different barriers to implementation for them as well.
 
Anna: Those are excellent goals! What’s one tip that you would offer other academic detailing programs who’d like to replicate your success?
 
Ashley: Utilize e-Detailing; it’s a wonderful tool! Many developers are coming out with apps to serve this new digital landscape that can assist in implementing e-Detailing successfully. It’s just a matter of finding the right tools by taking a little bit of extra time and patience to experiment.
 
I would also say that it’s important to build a relationship with your state’s health department leadership and obtain an official endorsement letter from the state supporting your activities. Establishing a relationship not only positively impacts your program’s visibility and ability to gain access to clinicians, but it also helps to make sure you're aware of other outreach initiatives, which allows you to align efforts and not duplicate processes.  
 
Anna: ​Terrific advice, thanks, Ashley! You’ve given us such a unique perspective on e-Detailing. We look forward to continuing to hear about all of your team’s successes and groundbreaking ideas.
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Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

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Biography. 
Ashley has been with the Oregon AETC since 2018 where she works to bridge the gap between local public health priorities and education and training opportunities available to providers.  Before joining the Oregon AETC, Ashley spent over two years working for local and international HIV focused CBOs in Johannesburg, South Africa. A majority of her work in Johannesburg focused on grant writing and managing the implementation of community-based HIV medication adherence models in partnership with provincial and municipal public health.  Prior to moving to Johannesburg, Ashley spent five years working at Planned Parenthood in Portland, OR occupying a variety of roles, including clinic assistant, phlebotomist, patient advocate, and call center representative.  Ashley credits her passion for supporting patient access to quality HIV prevention and care to the experiences she had with patients while providing HIV testing and counselling services at Planned Parenthood.   

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