By: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: Detailing Visits, CME, E-Detailing
​
You asked, we answered! Getting your foot-in-the-door to schedule a detailing visit is a challenge for many detailers. We’ve compiled some of our best tips about gaining access from our past interviewees on the DETAILS blog. 

Relationship Building:
​

• “Being invited to an all-staff meeting is often an excellent way to kick off an introduction to this important intervention and can result in follow-up conversations with individual clinicians. One benefit of meeting in small groups is that if a clinician hears a fellow clinician say that he or she is already prescribing PrEP, there may be more openness to discussing the topic; other providers might feel comforted in having a PrEP "ally", resulting in buy-in from the clinic overall.” – Alyson Decker, NP, MPH, San Francisco Department of Public Health

 

• “…although we try and limit group presentations, this has proven to be an effective strategy when entering into a new relationship. Once they get to know us and recognize the value of the program, they’re engaged in having us come back to conduct 1:1 visits on the follow-up and subsequent campaigns.” – Michelle Dresser, MPH, New York City Department of Health and Mental Hygiene (DOHMH)  

 

• “…I had learned strategies on getting in the door [at the NaRCAD training] 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 comes down to how well you know the physicians.” - David O’Riordan, MPharm, MPH, PhD, University College Cork, Ireland

 

• “I always say that the receptionists in doctors’ offices are the most powerful people in the world. If you can’t get through them, you’re not going to get what you need.”– Lutricia Woods, RN

 

• “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.” – Sarah Ball, PharmD, SCORxE

 

• “Whenever possible, I want to try to connect with people in a way that is the most seamless for them. And that's absolutely true for detailing too! I've had providers who want to meet over coffee and muffins at 6:00 AM because it's the only time they have in their day, or providers who need to pump their breast milk during our visit. I roll with it all and make sure I’m meeting providers where they’re at.” – Jacki Travers, PharmD, Pharmacy Management Consultants (PMC)

Incentives:
​

• “We also met with our medical board and asked them if our service could qualify as a mechanism for healthcare providers to receive their required pain management CME. They supported our request and that ended up being a huge win for our program. In addition to being detailed, clinicians can also get free CMEs.” – Alisha Herrick, MPH, CHES, Center for Health Innovation (CHI)

 

• “Not only is offering CME/MOC credits an educational incentive for providers, but it lends credibility to our messages.” - Meagan Shallcross, MPH, Colorado Assuring Better Child Health and Development (ABCD)

Tools:
​

• “We’re now working on trying some more targeted approaches, like Google Advertisements. For example, if a provider is googling "free pain management CME in New Mexico," our program might pop to the top of the list.” – Alisha Herrick, MPH, CHES, Center for Health Innovation (CHI)

 

• “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.” – Ashley Allison, Oregon AIDS Education and Training Center (ATEC)

 

• “Near the end of 2020, we met with a couple of different video production agencies to learn more about creating a commercial [to use for gaining access to clinicians] and the resources required to make it come to life.” – Alisha Herrick, MPH, CHES, Center for Health Innovation (CHI)

 

• “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.” – Ashley Allison, Oregon AIDS Education and Training Center (ATEC)

• NaRCAD Materials Toolkit:
  • Introducing Your Campaign: Adaptable Community Letter (NaRCAD)
  • Adaptable Calling Script: Scheduling Detailing Visits (CDPHE)
  • Decision Tree: Setting up Access Points (CDPHE)
  • Opioid Academic Detailing Flyer Example (MAHEC)
  • Public Health Detailing Flyer Example (Utah AETC)
  • Academic Detailing Commercial (Center for Health Innovation)
  • Scheduling a Visit: Fax Template (RxFiles) 

• Scheduling/Outreach Tools:
  • Appointlet: Appointment scheduling platform
  • Calendly: Appointment scheduling platform
  • Survey Monkey: Pre- and post- evaluation questions
  • AETC HIV Care Tools App: Featuring free point‐of‐care tools for clinicians caring for people with – or at risk for – HIV infection
  • Pirate Ship Packet Materials: Sample detailing packet

 

• NaRCAD Conference Hub:
  • “Using Virtual Tools to Connect with Rural Providers” | Ashley Allison, Lead Training Coordinator, Oregon AIDS Education and Training Center (AETC)
    • Watch Video Recording (presentation begins at 36 minutes)
    • Download Slide Deck PDF
  • “Virtual Detailing: Creating Supportive Networks in a Digital World” | Kelsey Genovesse, PA-C, MPAS, Director of Utah Public Health Detailing, AIDS Education Training Center (AETC), University of Utah Infectious Disease
    • Watch Video Recording (presentation begins at 1-hour and 17 minutes) 
    • Download Slide Deck PDF​

An interview with Carolyn Wilson, a Senior Health Program Coordinator at Ledge Light Health
District. Ledge Light Health District is located in New London, Connecticut and is the regional health district serving the southern part of New London County.

by Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

Tags: Opioid Safety, Evidence Based Medicine, Substance Use

Anna: Carolyn, we’re thrilled to feature you on our DETAILS blog! I know you wear many hats – can you tell us about your current job role?

Carolyn: I’m a health educator working within primary prevention, an academic detailer, and the host of our health district’s television program called Healthwatch. Healthwatch covers topics like mental health, physical health, disaster preparedness, general public health, COVID-19, environmental health, and disease prevention. I’ve been with Ledge Light Health District for 11 years.

Anna: It seems like improving patient and community health outcomes is a common thread across all your roles. What primary prevention work or related projects complement your AD work?

Carolyn: Depending on what topic I'm detailing on, I lean into my primary prevention work or the harm reduction work that my colleagues are working on.
​
One of the larger initiatives I often share with clinicians during detailing visits is the Naloxone and Overdose Response App (NORA) project. The Department of Public Health developed a web-based application that can be downloaded directly to your phone. It has information about preventing, treating, and reporting opioid overdose. The app can be used by both folks in the community and clinicians. I also speak to clinicians about proper medication storage and disposal while promoting our “Take it To The Box” Initiative. ​

Carolyn: I detail a lot of advanced practice nurses (APRNs) and also work with them on some of my primary prevention projects. The overlap in projects helps me build strong relationships with these clinicians. I sometimes work with school-based health centers as part of my prevention work, and these health centers are typically run by APRNs. These centers act as an access point to care for many students and families. It’s essentially a primary care clinic right in the school.

The Child and Family Agency oversees the school-based health centers in southeastern Connecticut and reached out to me after a horrific event in a Connecticut middle school. A few months ago, a 12-year-old got access to fentanyl and brought it to school. He overdosed and passed away a few days later at the hospital.
 
We haven’t seen many overdoses in schools, but after this happened, a lot of schools started looking at their policies and school-based health centers wanted to have naloxone on hand. The medical director of the Child and Family Agency advocated for a policy that required all school-based health centers to have naloxone and to be trained in administering it.
 
Anna: What a devastating story. Have the school-based health centers been able to put these types of new policies into place?

Carolyn: When one of the clinicians from the Child and Family Agency reached out to me, she said, “Carolyn, I know you do this kind of work. You trained me in naloxone not too long ago during an academic detailing visit. I’d like to have a naloxone training for my nurse practitioners in the school-based health centers. I want naloxone available in all of our clinics.”
​
This type of request would typically be delegated to somebody else in our department, but because of the relationships I had built through academic detailing, I was asked to provide the training, and I did. As a result, the school-based health centers now all have access to naloxone and the clinicians know how to administer it.  ​

Biography. Carolyn Wilson is a health educator and prevention specialist serving as a program coordinator at Ledge Light Health District in New London CT for 11 years. Carolyn studied public health and health education at New York Medical College. Keenly interested in health promotion and behavioral science, Carolyn enjoys bringing her passions and talents to both primary prevention and academic detailing work. Carolyn has been serving as an academic detailer for over 2 years and enjoys speaking with clinicians about strategies to prevent opioid related deaths. Carolyn also manages the Groton Alliance for Substance abuse Prevention @Groton_Prevents. In her spare time, Carolyn enjoys serving on the Board of Directors for the CT Association of Prevention Professionals and Fiddleheads Food Cooperative. To connect with Carolyn, find her on LinkedIn.

An interview with Cheryl Radeloff, Senior Health Educator at the Southern Nevada Health District in the Office of Disease Surveillance.

By Aanchal Gupta, Program Coordinator, NaRCAD

​Tags: Detailing Visits, HIV/AIDS, PrEP

​Aanchal: Hi Cheryl, we’re looking forward to hearing more about your experience in the NaRCAD Peer Connection Program! How did you hear about the program and what encouraged you to sign up?
​
Cheryl: I found out about the 2021 Peer Connection Program from a NaRCAD e-blast and was intrigued with the idea of joining a learning community. I instantly knew that I wanted to sign up since it would be a place where I could feel comfortable asking questions. I gravitated to the fact that I would be communicating with other peers in the field during cohort gatherings and learning about approaches that we could emulate in our program. 

Aanchal: Yes, having that 1:1 time with your peer, as well as the cohort gatherings where other participants in the program come together, are added ways to network with the detailing community. Would you recommend this program to others that are interested in signing up?
​
Cheryl: Absolutely! You should sign up even if you're a seasoned academic detailer or new to detailing. You're going to get tips, insights, and resources to get you started in a welcoming environment. This is a field where you never stop learning so it’s not only an opportunity to share lessons learned, but to learn from others as well. There are people from across the world who have different experiences and expertise that you can take back to your program. 

Aanchal: One of the special aspects of the program is the sharing of resources and ideas. Are there any conversations that you had with your peer that made an impact on your detailing work or changed the way you thought about your program?
​
Cheryl: The time spent with my peer was invaluable. During changing times with COVID-19, it can be daunting, and you tend to wonder if you’re doing things right or where you should even start. She was so generous in talking through challenges such as funding, recruiting providers, and more with me. She even shared a PowerPoint that they developed to educate pharmacy students about academic detailing.
​
During the mid-point peer connection gathering, I was able to learn about a program in Chicago. They were very innovative; if they didn’t have an approach in place for their program, they designed it. Although my clinical topic may not be the same as others, there are still concepts and tools that I can model after these programs. 

Aanchal: It’s great to hear about these fruitful conversations you had and how there’s always something to learn from others in the detailing community. How would you describe your experience overall with the peer connection program?
​
Cheryl: Every time I attended a peer gathering, I always learned something and never had to question what I was gaining from these meetings. I think it’s essential to hear about what’s going on in the field. It’s difficult as we’re all busy people, yet it’s important not only for learning and development, but a necessary element to have peers to consult.
​
I found the structure of this program to be helpful as we were given the reins to set up 1:1 meetings with our peer match over several months. In addition to that, there were gatherings where the entire cohort could come together and connect which I appreciated. 

Aanchal: Those are some great takeaways, and we are glad to hear about the impact the program has had on your work! To wrap up, we’d love to learn more about what you’ve been up to at the Southern Nevada Health District.

Cheryl: I’ve been with the Southern Nevada Health District for 13 years. Along with being a detailer, I’m also the public health co-chair for our HIV prevention planning group. We meet a few times a year to talk about HIV prevention initiatives, as required by the CDC. I also work with many of our community-based organizations to talk about the fundamentals of HIV.

Academic detailing has been an important strategy for the work that we do. Our main AD initiatives we've been working on are uptake of PrEP and PEP. We have two PrEP navigators who've been educating the community about these initiatives. Lastly, congenital syphilis has been a big topic for us as we’re currently fourth in the country for the highest rates of syphilis.
​
Aanchal: Thank you so much for sharing your experience, Cheryl. We’re so glad that the Peer Connection Program has had a positive impact on your detailing work and can’t wait to hear more about your program’s AD initiatives in the future. We look forward to continuing these connections with our 2022 cohort!

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

​Biography: Cheryl Radeloff is currently a Senior Health Educator with the Southern Nevada Health District Office of Epidemiology and Disease Surveillance. Formerly she was Disease Investigation and Intervention Specialist II. She is also an adjunct professor of Sociology at UNLV as well as Women’s Studies at the College of Southern Nevada. She received her Ph.D. in Sociology from the University of Nevada, Las Vegas in 2004. Her dissertation “Vectors, Polluters, and Murderers: HIV Testing Policies toward Prostitutes in Nevada” explored the development of mandatory testing laws for legal and non-legal sex workers in the state of Nevada. Her work duties include serving as the public health co-chair for the Southern Nevada HIV/AIDS Prevention Planning Group as well as training community providers on Rapid HIV Testing. She is the co-author of multiple editions of Transforming Scholarship: Why Women’s and Gender Studies Students are Changing Themselves and the World with Michele T. Berger for Routledge Press.

​ 
By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

Tags: Detailing Visits, Evidence Based Medicine, Pediatrics, Primary Care

​As we’ve jumped right into 2022 programming, our team at NaRCAD continues to support detailing efforts that improve outcomes for vulnerable populations, recognizing that patient needs are complex and often informed by social determinants of health. One critical topic for which we’ve developed resources focuses on detailing to improve patient health as informed by both adverse and positive childhood experiences. We’re seeing an increased need from our community members to support detailing efforts related to this critical topic. We partnered with the National Association of County and City Health Officials (NACCHO), Centers for Disease Control and Prevention (CDC), and consultants from Brigham and Women’s Hospital and Tufts Medical Center over the past two years to develop academic detailing materials for clinicians working with both adults and children. 

​The CDC defines adverse childhood experiences (ACEs) as traumatic events that occur in childhood, including abuse, neglect, and family dysfunction. These events are linked to poor health outcomes in adulthood like chronic health problems, mental health conditions, and substance use. When considering the impact of environment on health, the CDC notes that children are likely to flourish when they have safe, nurturing relationships. These supportive settings create the opportunity for positive childhood experiences (PCEs). PCEs can mitigate the effects of ACEs and toxic stress, promote healing from traumatic events, and foster healthy development and learning in children.

Encouraging clinicians to consider both ACEs and PCEs is a natural fit for clinical outreach educators. There are many reasons that clinicians may not be prepared to have conversations with patients about childhood experiences. Perhaps the clinician doesn’t have a behavioral health provider to consult within their practice, so they don’t know who to turn to if a patient discloses a traumatic experience. A detailer can encourage a clinician to explore this concern, as well as provide a list of local behavioral health providers in the community. 

​Another barrier may be that clinicians could feel hesitant to approach discussions related to trauma, or may not have the skills to do so with sensitivity. In this case, detailers can offer tools that illustrate supportive language that creates a safe environment for patients to share their experiences. Supporting clinicians in using evidence-based tools to build trust with their patients signals that it’s not only okay to talk to patients about this sensitive topic; it’s vital for clinicians to lead these conversations in order to ascertain their patients’ needs and promote patient-centered decision making.   

A detailer can encourage clinicians to adopt new behaviors through specific key messages, including asking clinicians to take the following steps to support adult patients:

• Ask patients general questions about trauma such as, “have you had any life experiences that you feel have impacted your health and well-being?”
• Use supportive language with patients who disclose trauma or ACEs to help build resilience such as, “thank you for sharing that with me. Have you talked about this before?”
• Document patient responses and communicate patient-identified strengths to the care team. Avoid documenting the details of the trauma itself and focus on the impact the trauma has had on the patient’s health and well-being.
• Create a plan in collaboration with the patient that encourages self-advocacy.

When clinicians are supporting pediatric patients, detailers can deliver this set of evidence-based key messages, encouraging clinicians to:

• Identify positive experiences and strengths of the patient by asking questions such as, “which adult(s) besides your parents is/are important part(s) of your life?” or “who could you call to help if there was an emergency?”
• Ask about social determinants of health. Understanding how family and community environments impact growth potential helps to improve health outcomes. Questions can address:
  • housing security
  • food security
  • transportation needs
  • utility needs
  • interpersonal safety
  • employment
  • family and community support
  • education
  • mental health
• Use a screening tool to evaluate potential ACEs if indicated. Formal questionnaires provide a structured way to identify adverse and positive childhood experiences, but routine screening for all patients is not currently recommended.
• Evaluate ACE screens based on the child’s current health. If abuse, neglect, or family disruption is going on, there may be an immediate need to intervene. If the child is safe, provide resources to the family and patient.
• Explore collaborative interventions with patients and families. Effective problem-solving of ACE challenges can foster and encourage post-traumatic growth.

With evidence-based tools, successful AD interventions related to ACEs can result in multi-faceted support for patients, such as stronger connections with community resources, mental health supports, and more trusting relationships between clinicians and their patients.
​
We hope to continue to explore this important and complex topic together as a community. If your program is currently working on an ACEs or PCEs AD campaign, or is interested in starting one, please reach out to us so we can support the development of your programming. We always love collaborating and learning more about the important work that you’re doing, and we hope to continue to build our resources and create toolkits in support of complex topics such as these that intersect with other behavioral health and prevention-focused AD campaigns.

By: Aanchal Gupta, Program Coordinator, NaRCAD

As we kick off 2022, it’s been incredible seeing the detailing community build on new and previous strategies over the past year.
​
We’re continuously learning and sharing insights together. Let’s take a look at some of the advice shared on our DETAILS Best Practices Blog this past year. 

Planning and Team Building: Communication, Trust, Building Morale
​

• “We spend a large amount of time talking in detail about stigma as related to cocaine use. It’s critical that our detailers are comfortable and knowledgeable when speaking about stigma, because it sets the tone for the providers, who then set the tone for their patients.” – Carla Foster, New York Department of Health and Mental Hygiene (NYC DOHMH)

 

• “Programs need to plan for time for back-and-forth communication and to engage as many viewpoints as possible [for their materials development process]. Our modules are accredited for continuing medical education and we have reviewers assess the detail aid to ensure accuracy. We also make sure that detailers, who will be using the material in the field, have an opportunity to try out the materials.” – Ellen Dancel, Alosa Health

 

• “You don’t need to know everything to be a leader, but you need to surround yourself with people who can collectively make decisions based on good information. Surround yourself with people who know more than you do, and listen to them.” – Liesa Jenkins, ONE Tennessee

 

• “Trust is essential for effectively exploring differences of opinion, and how to turn challenges into opportunities. Without it, you don’t get to understand where someone is coming from, or to truly grow and learn.” – Loren Regier, RxFiles Academic Detailing

 

• “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.” – Julia Bareham, RxFiles Academic Detailing

 

• “We previously defined success for detailers as the number of visits they had completed in a given period of time. Now, we define success as making a connection or having any type of interaction with office staff, whether that be with front desk staff, an office manager, or a clinician. Focusing on these small wins has been a morale booster for our detailers.” – Anna Gribble, Maryland Department of Health

 

• “I recommend starting recruitment efforts early [for the NaRCAD training] to allow plenty of time to find the right recruits in order to build a successful training cohort!”– Karen Curd, Midwest AIDS Training and Education Center in Indiana

Gaining Access to Clinicians
​

• “We worked with the pharmacy technicians on communicating the benefits our programs offered, with attention to utilizing accessible language and avoiding unnecessarily complicated healthcare terms.”– Natalie Miccile, Connecticut Early Detection and Prevention Program (CEDPP)

 

• “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.” – Ashley Allison, Oregon AIDS Education and Training Center (ATEC)

 

• “The 1:1 approach is something that separates AD from other tactics, and makes it easier for both clinicians and funding organizations to see you as unique. This work is worth it.” – Harald Langaas, KUPP – The Norwegian Academic Detailing Program

Conducting Field Visits: Resilience, Empowerment, and Leverage
​

• “It takes time to educate providers. It also takes time to alleviate some of those misconceptions that this is “just too good to be true”. So be patient, talk to people, and listen twice as much as you talk to build those relationships.” – Alisha Herrick, Center for Health Innovation (CHI)

 

• “When I’m detailing on one topic, I’m always thinking about future topics by gathering data from providers so that I can better understand their challenges. I ask providers their biggest concerns and I’ve been really surprised at how ready they are to share gaps in resources and information.” – Jacki Travers, Pharmacy Management Consultants (PMC)

 

• “There was [a recent visit I had where there was] no commitment to action or change and we didn’t build a connection. In order to bounce back from something like that, I think you need to acknowledge that it will happen sometimes and debrief with colleagues who have been in your shoes. Then just pick yourself up and try again.” – Jacqueline Meyers, RxFiles Academic Detailing

 

• Addressing the substance use crisis requires an “all-hands-on-deck” approach. Any setting where patients seek care are environments where detailing can improve patient access to support.” – Clement Chen, Rutgers New Jersey Medical School

Data Collection and Evaluation
​

• “We found that practices were most successful when they chose an intervention, stuck with it, and set attainable goals. Some practices were at a 50% HPV vaccination rate and wanted to be at 80%. In those situations, we sat down with them and asked them to think about something more attainable, like a 5% increase in 6 months. Practices that committed to smaller increases not only met their goal, but slightly outperformed it.” - Lisa Gruss, Quality Insights

 

• “For anyone looking to intertwine AD with their state legislative process, you need to understand what your state’s priorities are. You can start by looking at state plans and guidelines for major health issues, just like the opioid crisis. You may need to do more research to understand where your program fits in and more importantly, who the movers and shakers in your governance are.” – Mary Moody, University of Illinois Chicago (UIC) College of Pharmacy

 

• “Be flexible in your approach – group detailing sessions or detailing sessions with non-clinicians can be extremely effective, and can lead to 1:1 clinician visits. Also, stay organized! Keep track of who you're reaching out to and who you're following up with. Having all that information tracked over time will help with your evaluation down the road.” - Kelsey Genovesse, Utah AIDS Education Center (ATEC)

We’re featuring a snapshot from an academic detailing visit with Corinne Puchalla, PharmD, BCPS, a clinical pharmacist and academic detailer at Illinois ADVANCE.
 
By Anna Morgan, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
Tags: Substance Use, Detailing Visit

Hi Corinne! Can you tell us about a recent academic detailing visit that you’re proud of?
 
Academic detailing does not come naturally to me—each visit starts with excitement, nervous energy, and the tingling anticipation of the unknown:
 
Will the prescriber be in a good mood and be receptive to the key messages?
Will I be able to express myself adequately?
Will I negotiate the right “ask”?
 
NaRCAD’s training elevated my confidence in making “the ask.” I’ve learned how to set small, quantifiable goals and give the prescriber a short timeframe for follow-up.
 
My first academic detailing visit after the NaRCAD training had the potential to be a doozy. The topic for discussion was the CDC guidelines for chronic pain management, and I was scheduled to meet with someone who only dealt with acute pain management in cardiothoracic surgery. 

​Adding to my sense of foreboding was the knowledge that the prescriber had been singled out by her employer for this AD visit based on the number of opioid prescriptions she’d written. Using the communication strategies I learned at NaRCAD, I researched and prepared more for this visit than I had for any other. I practiced with multiple colleagues. On the day of my visit, I felt ready—but uncertain.
 
My practice paid off. What began as a terse, somewhat tense conversation with the prescriber turned into an educational, productive, and collegial visit. I used my AD communication skills to dovetail from one question into another, ultimately discovering how my key messages resonated with the prescriber.

​I’m proud of the strides I made during that AD visit. I remained calm despite my anxiety, used my research on acute pain management to ask open-ended questions, translated what I know about chronic pain to support her in the acute pain setting, and laid the foundation for a strong, collaborative relationship. Best of all, I made a solid “ask.” I’m motivated to do it all over again with my next prescriber and take each learning opportunity as it comes.

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography. Corinne is a clinical pharmacist at the University of Illinois at Chicago (UIC) College of Pharmacy. She uses her passion for drug information and advancing patient care in her role as a clinical instructor and academic detailer. Her areas of interest include hepatitis C, migraine, and diabetes pharmacotherapy, and new drug approvals. Corinne is a proud graduate of the UIC College of Pharmacy, Class of 2016. Her enthusiasm for science, health, and helping others prompted her to pursue a career in pharmacy. Before beginning her career in pharmacy, Corinne was a symphonic bassoonist and also worked as personnel manager for The Florida Orchestra. She graduated from the University of Iowa with a Bachelor of Music in 2001 and from Indiana University with a Masters in Music in 2006.

An interview with Clement Chen, PharmD, BCPS, Clinical Pharmacist Specialist, Rutgers New Jersey Medical School.
 
by Anna Morgan, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
Tags: Substance Use, Detailing Visits, Evidence Based Medicine

Anna: Hi Clement! We can’t wait to hear about all the impactful work you’ve been doing in New Jersey. Tell us a little about your academic detailing program.
 
Clement: The Northern New Jersey Medication-Assisted Treatment Center of Excellence was established in 2019 and is funded by the New Jersey Department of Human Services. Our goal is to not only increase access to medications for opioid use disorder (MOUD) in office-based addiction treatment practices, but also to ensure that providers treat this chronic disease with evidence-based practices. Our vision is to end the stigma of addiction and ensure that all people with substance use disorders have access to high quality care so they may live full and satisfied lives. I was hired as the academic detailer to provide education and identify the needs of providers in these practices.

Anna: Tell me more about the types of providers you visit.

Clement: I’ve been working with providers from all areas of care. In addition to office-based providers, they also include those from hospital settings, psychiatric hospitals, community health centers, substance use licensed facilities, and prison settings.

Addressing the substance use crisis requires an “all-hands-on-deck” approach. Any setting where patients seek care are environments where detailing can improve patient access to support.

Anna: It’s so important to approach academic detailing with a wider lens and consider where it can fit in with other community initiatives. Can you walk us through some of the work you’ve done so far, or are planning to do, in each of these settings?

Clement: I’d be happy to!

Hospital Setting: One of the inner-city hospitals that we are working with is looking to establish an addiction medicine service within their hospital system. The goal is to provide trainings and consultations on best practices for addiction medicine, in addition to technical assistance in setting up a program. I’ll be working with their attending physicians and residents to provide evidence-based practice trainings. 

Another one of our partners, an addiction medicine provider, has been pushing for greater initiation of MOUD in her own hospital system. The main issue is to ensure that providers use MOUD in an evidence-based manner and adhere to the latest findings. For example, the provider has been receiving pushback from other providers due to the lack of referral sources. These providers have shared that they believe MOUD should not be initiated without a “warm handoff.”

Furthermore, buprenorphine has been discontinued during the pre and peri-operative settings and only resumed post-operatively despite growing evidence for continuing buprenorphine in these settings. I plan to detail these providers in-person to provide literature supporting the use of MOUD, even when warm handoffs are unavailable. I’ve provided supporting literature and a summary to the addiction medicine provider to assist with her case to expand this initiative, which helped her to develop an information sheet to justify the expansion of MOUD in her hospital.

Psychiatric Hospital Setting: We’ve also partnered with physician champions at some of the psychiatric hospitals in New Jersey. Stigma and the inaccurate idea that patients do not experience acute withdrawal for opioid use has made many providers hesitant to start therapy with buprenorphine. Psychiatric hospitals have been fervently looking to provide treatment for opioid use disorders.

The goal is to implement a clinic designed for initiating and maintaining those on buprenorphine and naltrexone extended release. We’ll be assisting with the implementation of the clinic and provide individual in-person detailing visits for the providers at the hospital. To prepare for this, we’ve developed several informational sheets on MOUD and other related information to give to the providers.  

Community Health Center Setting: One of the community health centers that we’ve partnered with wants to begin providing MOUD for those already on the therapy. There are several advanced nurse practitioners and physicians at the health centers looking for more guidance and support on the appropriate prescribing of buprenorphine. I’ll be working with their team to provide them with evidence-based practices and help them with buprenorphine induction strategies. 

Substance Use Licensed Facility Setting: One of the substance use licensed facilities I’ve consulted with mentioned that fentanyl has made initiation of buprenorphine very difficult due to the increase in the number of cases with precipitated withdrawal. As a detailer, I’ve worked closely with their lead providers, providing them with available literature on alternative buprenorphine induction strategies. They're in the process of updating their protocols for the induction of buprenorphine. Another facility is working with us to start prescribing MOUD within their residential settings.
​
Prison Setting: I regularly consult with the Department of Corrections providers since access to MOUD have traditionally been low in the prison system. Their patients also have unique needs compared to those in the community setting. I meet with them on a monthly basis via a case conference and discuss clinical solutions in order to help them provide the best care to their patients. ​

Anna: Your work is incredibly comprehensive and thoughtful. It’s truly amazing to see how your team has incorporated academic detailing into so many initiatives and clinical settings within your community.

Clement: We believe that to overcome this crisis, all patients with opioid use disorder need equitable and timely access to care. With the record number of overdose deaths reaching over 100,000 in one year, this is our greatest focus. We’re confident that our academic detailing work will help us achieve this goal.

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography.  Dr. Clement Chen graduated from the Ernest Mario School of Pharmacy at Rutgers University in 2013 with his Pharm.D. He then completed a one-year residency at the Hudson Valley Veterans Affairs Ambulatory Care Clinic. Thereafter, he has worked as a staff pharmacist at St. Michael’s Medical Center in Newark and as a cardiology heart failure clinical pharmacist specialist at University Hospital in Newark. In addition to working as a clinical pharmacist specialist, he was a Transitions of Care pharmacist at Hunterdon Medical Center from 2016-2020. This has helped him to balance his inpatient and outpatient roles as a pharmacist. To further demonstrate proficiency in clinical pharmacy care, he received his Board Certification in Pharmacotherapy in July of 2016.  His current role is as the academic detailer in the Northern NJ Center of Excellence, with the goal of providing education and support to increase statewide capacity to provide medications for addictions treatment (MAT) for patients with substance use disorders with a focus on opioid use disorder.

Aanchal Gupta,  NaRCAD Program Coordinator

Tags: Conference, Detailing Visits, Stigma, ​E Detailing, ​Opioid Safety
​
​Take a peek at the NaRCAD2021 conference materials on our Conference Hub.

Bevin Shagoury
NaRCAD Deputy Director

Tags: Conference, COVID 19, ​Detailing Visits

Unless you’re delightfully old school, I’m going to guess that you’re not holding the page you’re reading in your hands. That’s been a tough adjustment for those of us who prefer a paperback to a Kindle, or for those of us who miss unfolding an inky newspaper in the morning.

In either case, this trend toward the intangible has been in motion for a long time, even pre-pandemic (if you can still imagine a world without COVID). We’ve been forced to step up the transition from tangible to virtual, seemingly at warp speed. And yet, as always, we’ve found ways to adapt.

In a field like ours, where our work relies so heavily on the intricacies of human interaction, the inability to see nonverbal cues (at least, none below a clinician’s shoulders) during an e-detailing session could have easily thrown us off. If AD was the focus of a Netflix series, we could have entire episodes that depict the harsh reality of being “ghosted” after setting up a virtual visit, or trying to engage with a clinician who’s typing in chart notes while eating a sandwich.

​An interview with Karen Curd, Program Manager, Midwest AIDS Training and Education Center in Indiana (MATEC-IN).

by Anna Morgan, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

Tags: HIV/AIDS, PrEP, ​Training​

Anna: You recently partnered with us for a customized academic detailing virtual training and successfully recruited 18 trainees. Can you tell us a little about what that process was like and what tools you used to recruit those trainees?
​
Karen: We planned our training as a regional MATEC opportunity and opened recruitment to our entire 10-state region to any organization funded by EHE. We first hosted an introduction to academic detailing session for our other MATEC sites which gave them an opportunity to learn about what academic detailing was and begin thinking about who they might want to recruit from their state for the 3-day NaRCAD training.

Because the training is extremely interactive and is limited as far as size, we wanted to make sure that we were recruiting the right individuals. Our director, Malinda Boehler, developed a recruiting tool  that we shared with the different site directors in our region. We then asked each site to recruit two to three individuals from their state and have the individuals complete a short questionnaire that we developed prior to registering for the training.

Anna: You did a thorough job recruiting detailers and it shows; we had an amazing training with you all because you selected such engaged and passionate trainees. Do you have any tips you would share with other folks who are looking to recruit a large number of trainees for a customized training?

​Karen: Set expectations. I would stress the importance of clearly defining training expectations as far as what attendees should and should not expect to learn over the 3 days. We wanted to make sure that it was clear to trainees that the NaRCAD training would not cover the day-to-day of how an academic detailing program would be rolled out at their specific institution, but rather the communication techniques used during an academic detailing visit. We had a lot of conversations with trainees before they came to the training and I think that helped to set those expectations.

​Anna: That’s a great tip! You were in a unique position where you were able to observe the training. What were some of your key takeaways?

Biography. Karen Curd is the Program Manager at the Midwest AIDS Training and Education Center (MATEC) in Indiana.  She has worked in public health for nearly two decades, starting her career as a Disease Intervention Specialist for the Marion County Public Health Department (MCPHD) in Indianapolis, Indiana.  She also served as Screening and Surveillance Coordinator for MCPHD before transitioning to the role of HIV/MAI Training Coordinator at MATEC Indiana in 2011. In her current role of Program Manager, Karen oversees several MATEC initiatives focused on providing training and technical assistance to healthcare providers throughout Indiana. Karen received her BS in Kinesiology from Indiana University in Bloomington, Indiana.

An interview with Carla Mena, Capacity Building Manager at Hands United of the Latino Commission on AIDS.  

by Aanchal Gupta, NaRCAD Program Coordinator 

​Tags: HIV/AIDS, Training, Program Management

Aanchal: Hi Carla, thank you so much for joining us today! We’re excited to delve into Capacity Building Assistance (CBA), as well as feature Hands United of the Latino Commission on AIDS on our blog. How did you get started in this line of work, and could you describe your current role as a capacity building manager?

Carla: I worked at a Duke University hospital in North Carolina for 7 years as a bilingual research coordinator in both local and global studies. I have research experience in hepatitis C, HIV, immigration, LGBTQ+, childhood obesity prevention, neonatal vaccinations, reproductive health, and the intersection of these areas. I also did some leadership development work, as well as community organizing. I had the opportunity to connect with teams and individuals on how to work with underserved populations, and taught them about social determinants of health, cultural humility, and health equity.

At Hands United, I began as a capacity building specialist, and have now transitioned to a capacity building manager. I make sure that we’re thinking within our funding guidelines while also highlighting the intersections of folks living with HIV or who may be at risk of acquiring or transmitting HIV. As a manager, there's the administrative side of supervision, following up on tasks, and so on.

The other aspect of it is to continue to provide technical assistance (TA) to our jurisdictions. For example, if someone is interested in implementing an HIV self-testing program in a non-clinical setting, I can assist with that. I enjoy the fact that, although I'm not a specialist anymore, I still provide TA with the team. Both of our directors also provide TA, which I think is unique. 

Aanchal: Wow, you have such an extensive background in public health and sounds like it has informed your current work! Tell us more about the Hands United program as well as the importance of capacity building assistance.

Carla: The Hands United of the Latino Commission on AIDS is a capacity building technical assistance program (CBA). The CHANGE (customized, holistic, analytical, network-building, grassroots, evaluatory) model is an approach developed by the Latino Commission on AIDS. Hands United is one of the two programs available. It combines community-based organizations, health departments, or any other social service organizations to optimally plan, integrate, implement, and sustain prevention programming and services. CBA improves the performance of the HIV prevention workforce by building individual-level competencies and technical expertise while also strengthening organizational capacities.

We serve 19 jurisdictions in the southern region of the United States including, Arkansas, Alabama, Delaware, D.C., Florida, Georgia, Kentucky, Maryland, Louisiana, Mississippi, North Carolina, South Carolina, Oklahoma, Tennessee, Texas, Virginia, and West Virginia.

An organization will contact us about various topics related to HIV prevention such as recruitment for HIV testing, referrals for HIV medical care, referrals for PrEP, nPrEP, STIs, hepatitis C, or TB screening. Our role is to help them figure out what resources they need. Then we can support them with webinars or resources such as literature reviews, marketing samples, and successful stories. 

Aanchal: Thanks for providing some context on the program and intervention. It’s always great to know that there are resources like this out there for organizations to utilize. Could you describe how CBA relates to academic detailing?

Carla: Detailing is very fundamental for the work that we're doing because it teaches effective social and personable skills that organizations can take out in the field. Sometimes health departments reach out to us and say that they are not sure how to recruit for providers to refer or prescribe PrEP in primary care settings. These are times when we discuss academic detailing and how it can be useful for them. Although we’re not detailing, we’re able to provide information in a way that makes sense to those who need it.

​We ask them questions to better understand their program and help programs figure out exactly what they need. We ask questions like, “What is part of your package?” “What are the questions you're asking clinicians?” “What is your elevator pitch?” “Is there capacity and effort from the staff?” We might even say, “You need detailing, but you don’t have enough staff to be able to detail all the primary care providers in your county.” When this happens, we provide assistance on developing a recruitment plan that’s feasible for the requestor.  

Aanchal: Those are all important questions for programs to consider as they brainstorm what it is that they need. Is there something that your program was able to accomplish during this past year that you’re proud of?

Carla: We were able to work with your team at NaRCAD and host a training this past July. This was a highlight for us because we were able to have a good representation and engagement from the jurisdictions. A community was created through the participation of the trainees. We gained a lot of knowledge that we needed in order to provide TA or CBA services to our programs.

Aanchal: That’s so nice to hear! Speaking of the training, I’d love to hear about your experience, particularly as you’re someone who was not planning to be a detailer.

Carla: For me, it was a great training because all the training facilitators were so welcoming of feedback and even role played to include our specific experiences. They took time to understand our roles and built a sense of community. Additionally, it was very hands-on, and I enjoyed having the opportunity to role play a detailing visit.
 
Walking in the detailer’s shoes helped me understand exactly what could be happening to them during a visit or where they may be challenged. Fusing my own lens with the lens of the detailer was very helpful.

Aanchal: I agree -- the trainings provide a practical space for trainees to share their unique experiences while practicing the communications techniques necessary to carry out a 1:1 detailing visit.

Is there any advice you would give to someone who may be hesitant about attending an academic detailing training if they ‘re planning to be a program manager rather than a detailer?

Carla: I would say, go for it! Although we may not be detailers, being able to walk through what a detailer does has made me a better CBA specialist and manager because I understand the processes through the eyes of the detailer. Watching webinars or reading resources on academic detailing was helpful and effective, but attending a training gave the opportunity to put it all into practice.
​
Aanchal: That is great advice! Thank you so much, Carla, for speaking with us and it was a pleasure having you at our training. We look forward to working together in the future. 

​Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography: Carla is the Capacity Building Assistance Manager for Hands United at the Latino Commission on AIDS. Prior to joining the Hands United at the Latino Commission on AIDS team, Carla worked at Duke University Hospital, as a bilingual research coordinator working with studies that were both local and global. 
 
Carla has extensive research experience in several fields including hepatitis C, HIV, immigration, LGBTQ+, childhood obesity prevention, neonatal vaccinations, and sexual and reproductive health. In addition, she has experience training people and partnerships on how to work with under-represented and under-served populations in the US. Some of those trainings include exploring social determinants of health, cultural humility, and health equity. 
 
She graduated from Meredith College with a BS in biology. Carla is a certified Culture Facilitator, Diversity to Belonging Facilitator and Culture Assessor.  

Jerry Avorn, M.D.
Professor of Medicine, Harvard Medical School
NaRCAD Co-Founder & Special Adviser

Tags: Evidence Based Medicine, COVID 19, Jerry Avorn
​
​We’ve lived through the vast human tragedy this virus has inflicted, and witnessed the heroic work of our colleagues in the medical and public health sectors. We now see clearly the disproportionate damage it did to the most vulnerable in our country and around the world.
​
And the coronavirus has also had lessons to offer our little academic detailing community. While more modest in scale, they’re worth considering, even as the worst days of the pandemic continue (we hope) to fade.

​Lesson One was a re-demonstration of the validity of Avorn’s 6th Law: “Good information doesn’t disseminate itself.” In the most striking possible way, the pandemic rubbed our noses in the fact that just because a medical intervention is very effective and safe, it doesn’t mean that everyone will understand that and use it appropriately – or that a useless and/or dangerous treatment won’t become appallingly popular. The therapeutic misstatements of the former President undermined trust in science badly, and many have become blind to first-rate evidence and disbelieve it.

Even today, the flawed communication efforts of the CDC, FDA, and current administration all remind us that even when the scientific Truth Is Out There, it can still be conveyed poorly: more proof that the completion of rigorous, compelling randomized clinical trials is just the beginning, not the end of the journey. Getting the message out, and acted on, is key.

But COVID-19 also provided us with yet another opportunity to discover how crucial public – taxpayer – funding is for the development of innovative new medical products, and to ask once again how drugmakers can continue to charge sky-high prices for these products after they’ve patented them.


The scientific triumphs of the COVID-19 era have been remarkable. But as we move into what we hope will be the Waning Pandemic Era, it’s a good time to also reflect on the less-heralded but vital role played by evidence-based communication, outreach to health care professionals and their patients, and the importance of fairness in making the victories of medical science available more equitably to all who need them.

​Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

We’re featuring a snapshot from an academic detailing visit with Reem El-ankar, MPH, an academic detailer and health educator at the Florida Department of Health in Broward County.
​
by Anna Morgan, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

​Tags: Substance Use, Stigma, ​Detailing Visits

Hi Reem! Can you tell us about a time that you felt like you made an impact during an academic detailing visit?
 
I’ve experienced countless rewarding moments as an academic detailer working to educate healthcare providers.
 
One particular visit instilled a strong sense of satisfaction and pride in me. I was detailing a primary care clinician who manages several chronically ill patients. He was aware of the CDC guidelines and statistics on the opioid crisis. Because the clinician was well-versed in this area, it was challenging to serve as an educator. I walked through the key messages with him, and we made progress.
 
We hit a roadblock when we started discussing the topic of co-prescribing naloxone with opioids. He expressed a concern that co-prescribing naloxone could encourage patient overuse of prescription opioids; he believed that naloxone should only be used as a safety net for individuals diagnosed with substance use disorder.

​I reviewed the evidence with him, showing him that co-prescribing naloxone can save lives for all patients using opioids. After I provided the CDC data and studies that describe the benefits of co-prescribing naloxone, the clinician was more receptive to the information I was presenting.
 
At the conclusion of the detailing visit, I reminded him that saving one life with naloxone was worth the effort, and that his primary mission is to save lives. After that he smiled and said, “Okay, you got me.” I asked him if he could commit to co-prescribing naloxone to just one patient, and his response was, “Due to your clear passion for this national crisis, I will prescribe much more than just one.” This experience taught me that my passion coupled with data and statistics has the potential to impact lives.


Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography. Reem El-ankar is an academic detailer, health and community educator, and public health professional. She holds a bachelor’s degree in pharmaceutical science from the Hashemite Kingdom of Jordan, and a master’s degree in the public health from Purdue University Global - Indiana, US.

Before joining the department of health, she worked in the private and the non -profit sectors as a pharmaceutical representative (Kuwait), and a community outreach and a HRSA grant coordinator, respectively.
 
During her internships with the American Red Cross and the local department of emergency managements, she worked in community preparedness and emergency response field on the national and international levels.

An Interview with Anna Gribble, MPH, Provider Engagement and Policy Manager at the Maryland Department of Health in the Office of Provider Engagement and Regulation.

By Aanchal Gupta, Program Coordinator

​Tags: ​Evaluation, Program Management, Training, ​Detailing Visits

Aanchal: Hi Anna, thank you for speaking with us today! Can you start by telling us about your program and your role at the Maryland Department of Health?
​
Anna: I’m the Provider Engagement and Policy Manager in the Office of Provider Engagement and Regulation which houses our Prescription Drug Monitoring Program (PDMP). I’m responsible for a number of different health educational outreach initiatives, particularly for safe opioid prescribing and overdose prevention.

Our biggest project is our academic detailing project, which we started in May 2019. It’s a joint project between the state and local health departments. At the state level, we run the project management aspects of the program, and our detailers are located in local health departments across the state. We work with 15 counties in Maryland and have representation from both urban and rural areas.  

A lot of our detailers have a strong understanding of the public health impact of opioid use disorder (OUD) based on their diverse work in the field. Their knowledge has been very valuable for our program, and we’ve encouraged them to leverage their resources and experiences when communicating with different clinicians. 

Aanchal: It’s great that your project has detailers covering a variety of areas across Maryland. What kind of data do you collect from your detailers to assess how they’re feeling about their work, and how you can provide support to them?

Anna: We host monthly technical assistance (TA) calls with all of our detailers. Additionally, we make sure they attend a basic training to learn the communication techniques needed to implement field visits well.

We also have the detailers fill out quarterly reports to see how we can improve our TA. We ask our detailers questions such as, “What are you proud of this quarter?” “What challenges did you face this quarter?” and “What resources do you wish you had to make your sessions easier?” We use a lot of the data we collect from the detailers  to tailor our trainings and TA calls.

This data has helped inform the content of our trainings, especially this year. We’ve used the summer of 2021 to focus on trainings and refresher courses for our detailers. Some of the trainings we’ve been excited to host this summer include motivational interviewing, detailing pharmacists, and a clinical content refresh. 

Aanchal: It’s exciting to know that the data you’re collecting is being used to inform the support that you’re providing to your detailers. What are the most important data points for detailing programs to consider when they’re evaluating the needs of their detailers?  

Anna: We’ve worked closely with your team at NaRCAD to reframe the questions that we ask detailers in our quarterly reports. For example, instead of asking “What went wrong during your visit?”, We ask, “What are areas where you need support?”

It was also important for our program to reassess how we defined success. We previously defined success for detailers as the number of visits they had completed in a given period of time. Now we define success as making a connection or having any type of interaction with office staff, whether that be with front desk staff, an office manager, or a clinician. Focusing on these small wins has been a morale booster for our detailers.  

Aanchal: Celebrating small wins is something we always appreciate here at NaRCAD. What advice do you have for other programs about supporting the unique needs of your detailers?

Anna: When working with detailers who don’t have a clinical background, making sure that they feel confident in their skills and knowledge during their detailing visits is important. Many of our detailers want to debrief after their detailing sessions and have a space to process what happened during a visit. We’re able to provide that reassurance and support for them during our TA calls and build their confidence. By assessing their needs during TA calls, we can figure out what kind of support to offer our detailers.

It’s also important to be responsive to your detailers’ needs because detailing can be isolating. It can sometimes be difficult for our detailers to make connections with other detailers since they are spread out across the state. They have the opportunity to learn and connect with one another during these TA calls and meetings. These calls give them a space to brainstorm, and problem solve together. We need to continue to empower detailers and remind them that they’re doing important work in bringing a tremendous amount of value to clinicians. 

Aanchal: I agree, providing opportunities for detailers to learn from their peers is incredibly beneficial. Let’s talk a little more about evaluating your program. What does your program evaluation process look like?

Anna: We’re working with John Hopkins School of Public Health to create a more robust evaluation. Ideally, we’ll be able to match the provider who was detailed to their prescription monitoring data to see if their prescribing trends have changed before and after receiving a detailing session. Our biggest barrier to getting that done is having enough visits completed so that we have enough data to evaluate.

We’re currently working on collecting data from the detailers on who they detailed and are matching that with the PDMP data. We’ll then ask the school of public health to measure the impact. We’re hoping that utilizing PDMP data will help assess our program’s impact on a bigger scale. 

Aanchal: It will be very exciting to see the findings from this evaluation. Do you have any advice for programs looking to take a similar approach to evaluating their program?

Anna: If you’re looking to match PDMP data with providers, then you need to make sure you’re collecting enough data to facilitate that match, like asking for a National Provider Identifier (NPI) number in a follow up survey. Early in the planning process, it will be important to prepare to collect enough data to complete data matching—thinking ahead will help later in the evaluation process.

Aanchal: Planning ahead is critical. It’s always exciting to hear what established programs such as yours are accomplishing. We’re so grateful your team is a part of our community. We look forward to hearing about program results in the future and continuing to work with you and your team. 


​Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography: Ms. Gribble is the Provider Engagement and Policy Manager with Maryland's Department of Health in the newly created Office of Provider Engagement and Regulation. Her focus within this role is prescriber education and outreach as it relates to PDMP implementation and opioid overdose prevention. Ms. Gribble manages several state initiatives including oversight of federal funds to conduct qualitative and quantitative research on healthcare provider resources and needs, development and evaluation of provider educational resources, and outreach to healthcare providers on the state’s PDMP and Use Mandate. Ms. Gribble is responsible for PDMP programmatic activities and policies that aim to improve clinical services, public health programs, and research in the fields of substance use prevention and pain management.
​
Before working with Maryland Department of Health, Ms. Gribble worked with the federal Department of Health and Human Services, Office of the Assistant Secretary of Health as a Health Policy Fellow. Ms. Gribble obtained her Masters in Social and Masters in Public Health from Boston University.

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.

1. Be prepared and know your topic well. The clinicians that we detail trust that the information we provide is accurate, evidence-based, and current. I always want to make sure that I come prepared with the best information, that I’m knowledgeable, and that I can answer any question to the best of my ability during a detailing session.
2. Be comfortable saying, “I don’t know.” There’s a danger in academic detailing if a detailer is unsure of something and is uncomfortable saying that. My biggest fear as a detailer is that if I’m not confident in my answer to a clinician or if it’s incorrect, then it could result in suboptimal patient care. It’s not always easy to say that you don’t know the answer to something, especially when you value being so prepared.
3. Be flexible. Take the conversation in the direction that the clinician would like to go. I always remember that I’m there to support the needs of the clinician and let them drive the conversation, even if I have a script prepared. Being able to do that is extremely valuable to the clinician you’re detailing and makes your visit personalized and relevant.
4. Leverage your personal superpower. It’s important to be true to who you are during your detailing visits. Our personalities are all unique and bring so much value to each visit. My personal superpower is humor and that’s how I connect with clinicians and build that relationship right off the cuff. It’s not always the best tool for everyone but knowing what you’re good at and leveraging it is crucial.

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.

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

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.   

Overview: Lisa Webb, a recent NaRCAD Basic AD Techniques Trainee, joins us to discuss her experiences preparing to conduct 1:1 visits with clinicians to support treatment of substance use disorders.

By: Winnie Ho, Program Coordinator and Aanchal Gupta, Program Coordinator

Tags: Detailing Visits, Substance Use, Training

Winnie: Thank you so much for joining us today to talk about your experiences training to be an academic detailer. Can you start by telling us a little bit more about yourself and your program?

Lisa: I’m a licensed chemical dependency counselor and have been treating substance use disorders (SUD) for about 12 years in the Houston, Texas area. Prior to that, I had some sales experience as well. In November 2020, I was hired as an academic detailer on a Baylor College of Medicine research project entitled “Bringing alcohol and other drug research to primary care.”

​Our work has a strong educational focus on evidence-based practices for the treatment of SUD related to alcohol, tobacco, and opioid safety, and how to implement various modalities into primary care treatment settings. I’m one of two detailers on this project. Together, we focus on the greater Houston area and the Rio Grande Valley area in South Texas. 

W: The majority of your program’s work started in the middle of the pandemic. Your previous work was patient-facing, and now you’re focused on engaging clinicians to impact patient health outcomes. How has this transition been for you?

L: I have always been an advocate for patients who live with SUD, so becoming an academic detailer was a great way to utilize my background. Between my counseling and sales background, clinical outreach education was a natural fit. I also loved that this was an opportunity to keep learning.

​W: At NaRCAD, we appreciate the fact that life-long learning is central to academic detailing, and that it’s a unique part of working in this field. Most recently, you joined our AD Techniques Training. Do you have any reflections on that experience?

L: Our program had already been using NaRCAD resources in our work, so when the opportunity opened up to be trained, we were excited. Detailing is similar to the process of counseling in that you’re screening, assessing, and confronting barriers as they arise. Providing a plan and resources were exactly the kinds of things I’d done in the past with patients, so I felt a moment of “Oh! I know what I’m doing!”

W: I’m not surprised, since you excelled at our training course.

​L: The training helped me focus on the process of a visit and on a relationship between two people. It’s an exchange of information; I’m not just educating, I’m also gaining valuable information from the provider. 

W: During our trainings, we’re teaching an interactive communication technique and empowering people to feel confident to conduct 1:1 visits. You had the special circumstance of having one of your first field visits shortly after the training. How did it feel to be in the field for the first time?

L: It felt natural and familiar to me, especially after having a lot of practice with my team. The provider I met was very interested and engaged, so it was easy to build rapport. We were able to have a good conversation, and the detailing aid that our team used is comprehensive and user-friendly, which was extremely helpful.

​I have several more visits coming up, and I’m taking this time to get more familiar with the detailing aid. I’m trying to find the balance between knowing my information well without memorizing a script because detailing visits are meant to be open conversations. I want to practice listening and asking more open-ended questions to encourage the provider to lead us through parts of the conversation, but also avoiding becoming sidetracked from our goals. 

W: We’ve seen more and more people entering the AD field. As someone who has just recently started their AD journey, what advice would you have for newcomers?

​L: I’m a believer in the phrase, “don’t re-invent the wheel.” NaRCAD provides so many tools and resources that can be adapted to fit individual programs. It’s also a great way to connect and engage your community of support. Practice has been important, so newcomers should try and practice often, either with colleagues, family, friends, pets – anyone who will listen. My cat hasn’t been a great listener, but my dog has been a little better practice partner. 

W: You can always pretend a cat is an exceptionally distracted provider. Practicing is definitely the key to becoming comfortable and ready to face whatever arises from a 1:1 visit.

​L: Absolutely. The last piece of advice I’d offer is that it’s important to welcome feedback, as well as to learn how to take it. When providers and peers are brave enough to give you honest feedback on your work, it really is an honor that they care enough to listen and invest in your growth.  ​
​
​
​Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography: Lisa A. Webb obtained her BA in Psychology from the University of North Florida and has decades of professional experience ranging from Human Resources, office administration, to proposal planning for a group of Architects.  Lisa has worked in the substance use disorder field for the last 12 years as a Licensed Chemical Dependency Counselor (LCDC) in the Greater Houston area.  She is passionate about helping people find recovery and advocates for those who struggle to find their voice. 

After being laid off in 2020 due to the pandemic, Lisa found her way to the Baylor College of Medicine where she is working on a grant project as an Academic Detailer. This project is focused on bringing alcohol and drug treatment to primary care settings by providing the latest evidence-based treatment modalities.

​Lisa has been married to her husband, Alan for 27 years and they have a 16-year-old daughter, Jade.  Her hobbies are walking, riding her bike, horseback riding and fellowship with friends and family.

An interview with Kelsey Genovesse, PA-C, MPAS, Public Health Detailer and Clinician, AIDS Education Training Center (AETC), University of Utah Infectious Disease. The public health detailing program at the AETC is currently focused on expanding pre-exposure prophylaxis (PrEP) throughout the state of Utah and educating clinicians on STI prevention and guidelines for correct treatment.

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

Tags: Detailing Visits, ​E Detailing, ​PrEP

​Anna: Hi Kelsey! Thanks for joining us on DETAILS today! Can you tell us a bit about your background, your current role, and your program? 
 
Kelsey: I’m a physician associate (PA) by training and previously worked in family practice with underserved communities, including migrant farmworker populations and patients in federally qualified health centers.
 
Our program in Utah is tiny; our AETC only has three or four employees. I do the outreach, schedule the detailing sessions, detail the clinicians, collect the data, and evaluate the program. We’re fortunate that our first year was so successful and we’re looking forward to continuing to expand our program over time. This year, we were even nominated for a Utah Telehealth Education Award!
 
Anna: That’s incredible – what a great accomplishment! Your program is unique in that it started with e-Detailing right from the beginning. Can you tell us a little bit about that?

Kelsey: We attended an in-person Public Health Detailing Institute run by the San Francisco Department of Public Health in partnership with NaRCAD in March of 2020. We had planned to focus on in-person detailing only in Northern Utah because we didn’t have the capacity to drive all over the state. Shortly after we left the training, the pandemic shut everything down and we had to move our program to a virtual platform. We couldn't put the program off because our funding timeline wasn’t changeable, so we gave e-Detailing our best shot.
 
Anna: Your attempt at e-Detailing turned out to be quite successful. Can you tell us more about the nitty gritty of pivoting to e-Detailing?
 
Kelsey: Absolutely. When it became clear that we were moving to e-Detailing, we had to recreate our entire plan. We began with strategizing about outreach to clinicians.
 
Nobody in Utah knows what public health detailing is - this is not a model that has been used here before. We had to get creative about spreading the word about our program. We connected with experts on our topics and clinicians who were already doing a lot of training on PrEP and asked them if they wanted to do a detailing visit with us. This was extremely successful, and we received referrals and warm handoffs to other clinicians from those initial visits.
 
We also used a lot of listservs so that we could contact multiple clinicians at once. We worked with the Utah Department of Health and gave them a flyer we created about our program that was sent to all the clinicians on their listserv. We even connected with local medical groups, like the Utah Medical Association, a PA Association, and a Nurse Practitioner Association. These approaches brought in a lot of clinicians for detailing visits and helped us spread the word.

​Anna: Rather than emailing each clinician and sending out hundreds of individual emails, you targeted hundreds of clinicians at once – I love that approach! It sounds like you also had some great AD champions in your network.
 
Kelsey: Yes. I found that I was also doing a lot of e-Detailing sessions with folks who were not clinicians but were involved in the healthcare system in another capacity. I discovered that when I was connecting with these folks, whether it be someone at the health department or a representative from a health-based community program, they were wonderful champions who knew a lot of clinicians. Visits with these non-clinicians also helped spread the word about our program and open access even more. 
 
Anna: Many programs have faced challenges when gaining access virtually, but you were able to overcome many of these challenges with your innovative approaches. Has your program faced any other challenges with e-Detailing? 
 
Kelsey: We frequently detail clinicians who are short on time. I’ve tried to create a schedule where I have a little bit of availability, almost seven days a week, so that there are more options for clinicians whose schedules are busy. I also try to keep the detailing visits focused on the topics that clinicians are most concerned about. I always send them a comprehensive follow-up email with the resources they've asked for after the visit. 

Anna: Clinicians’ limited time is a common challenge for detailers—these strategies are helpful to employ when this challenge arises. Do you see specific opportunities with e-Detailing that you wouldn't see with in-person visits?
 
Kelsey: Yes! Within our first year, we connected with providers in rural areas that may have taken us a longer time to gain access to using an in-person approach.

Anna: That’s a great point, especially for a state as large as Utah. Do you envision incorporating any in-person detailing in the future? 
 
Kelsey: We’ve had a few clinics that have asked for us to come in person, but as we just discussed, it can be time-consuming. However, there is something to be said about showing up and seeing what a town or clinic looks like in order to understand a community structure better. We’re going to try adding it in in the future.
 
Anna: Being physically present in a clinic can certainly help with assessing the needs of a clinician. You mentioned earlier that within your role you’re not only doing outreach and detailing visits, but you’re also working on your program’s evaluation. Can you share a bit about that?
 
Kelsey: Kristefer Stojanovski, MPH, PhD, the Evaluation Specialist from San Francisco Department of Public Health, has helped us tremendously with our evaluation work. We have pre- and post- surveys for clinicians to fill out with each detailing visit to collect data related to their knowledge around the clinical topic. It has an open format at the end to allow clinicians to request certain information prior to their first visit and leave feedback and comments. I'm hoping that as our sample size increases, that the data starts to look a little bit more robust.
 
At the end of last year, we also sent an email asking clinicians to give us feedback on how they felt their experience was and if they felt like this was a program that was worth continuing. At least a third of our detailed clinicians sent back responses, and all of them were very positive. Most of the feedback reflected on how useful the information was when it was tailored and directed to their personal practice. A couple of clinicians noted they felt they were practicing to the standard on the topics, but detailing helped them gain knowledge they were unaware they were missing. It was nice to see that folks felt that it was useful.

​Anna: We’re excited to hear more about your evaluation as you gather more data. We'll wrap up with our final question: what’s one piece of advice you'd give to other programs that are just starting out, specifically with e-Detailing?
 
Kelsey: Be flexible in your approach – group detailing sessions or detailing sessions with non-clinicians can be extremely effective, and can lead to 1:1 clinician visits. Also, stay organized! Keep track of who you're reaching out to and who you're following up with. Having all that information tracked over time will help with your evaluation down the road.
 
Anna: That's fabulous advice, Kelsey. We’re looking forward to continuing to watch your program grow and succeed!

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography. Kelsey Genovesse is a Physician Associate with the AIDS Education Training Center and University of Utah Infectious Disease Department. After eight years in underserved family medicine Kelsey started the Utah Public Health Detailing Program to expand support and education to providers throughout the state of Utah on evidence based practices surrounding STIs and PrEP. She also provides care in the Free HIV PrEP Clinic with the University of Utah offering in person and virtual services to help expand access to HIV Prevention throughout the state of Utah, specifically to those without insurance. In June 2021 she was Nominated for a Deborah LaMarche Telehealth Excellence Award for her work with the Utah Public Health Detailing Program.

​Anna: Hi, Alisha! Thanks so much for joining us on DETAILS today. We’re excited to chat with you about UPDATE New Mexico and the tips you have for building relationships. Can you tell us a bit about your program?
 
Alisha: Absolutely! We provide evidence-based information and recommendations around chronic non-cancer pain management. We’re expanding the service to include information on medications for opioid use disorder so healthcare professionals can better serve their patients in our rural state of New Mexico. We offer rural healthcare providers, who may feel somewhat isolated, an opportunity for continuing education that typically might only be available in bigger cities.
 
Anna: It’s wonderful that your team offers these resources – we know that there are often limited resources in rural areas. Detailing in rural areas also brings up additional challenges for the detailing team, but you do such a great job keeping your team engaged and feeling connected. Can you tell us a little about your team and the recruitment process?

​Alisha: Geographically, New Mexico is the fifth-largest state in the country, but we only have 2 million people living here. All we do is network, network, and network. Whenever we're looking for detailers, we use our existing networks to talk to people and spread the word. Many people have heard the term six degrees of separation, but here in New Mexico, there’s only about two or three degrees of separation. Word travels fast when we share job opportunities with our partners.
 
In terms of resources we’ve used for recruitment, we’ve adapted the generic job description on the NaRCAD website and circulated that throughout our network. The detailers we’ve hired all hail from different backgrounds, disciplines, and parts of the state. However, we make sure that they have a few common attributes – excellent communication skills, the time and resources needed to devote to the program, and the ability to share their perspective with others on the team.
 
Anna: Along with recruitment, you’ve also put a lot of work into building your team. Can you share one of your approaches for building a strong and effective team?
 
Alisha: One of the ways we keep our team engaged is through monthly meetings. Because of the diverse backgrounds of our detailers, there’s always a rich exchange of ideas and perspectives when we convene. We also invite our clinical support team so that the detailers have a chance to discuss the clinical content with experts. We connect, troubleshoot, and share insights - our entire team looks forward to these meetings.

​Anna: Creating a space to share and exchange with peers is key, especially for such a unique job like detailing. Your team also recently worked together to create a commercial to help get the word out about academic detailing and continue to build relationships with the larger community. What was that process like?
 
Alisha: Once the COVID-19 pandemic began, we knew we had to have another venue to capture our audience's attention in the virtual world and continue to spread the word about our academic detailing service. Near the end of 2020, we met with a couple of different video production agencies to learn more about creating a commercial and the resources required to make it come to life. We reallocated some marketing funds and picked a production team. We shared our vision of what we wanted to accomplish, outlined a few ideas, and they helped us refine a script.
 
The fun part was putting together a cast. The detailer is played by one of our own detailers, the doctor is played by one of our clinical support team members, the patient is played by my fiancé, and the clinical staff member is played by our program coordinator. We didn't have to pay for our cast, which helped us cut down on cost; however, we did have to hire a dog for the commercial since I couldn’t bring my own due to the distance to the filming location! Overall, I’m very pleased with how it turned out.

​Anna: You should be – it’s so well done. What other approaches have you taken to gain access to clinicians or get the word out about academic detailing?
 
Alisha: Relationships are key in New Mexico, as they are in every other place. We have partner organizations working in the community on overdose prevention who have been tasked to prioritize marketing our detailing service to clinicians. We also met with our medical board and asked them if our service could qualify as a mechanism for healthcare providers to receive their required pain management CME. They supported our request and that ended up being a huge win for our program. In addition to being detailed, clinicians can also get free CMEs.
 
On the marketing side of things, we've tried just about everything over the last year since we expanded statewide - postcards and flyers, newsletters, webinars, and social media. We’re now working on trying some more targeted approaches, like Google Advertisements. For example, if a provider is googling "free pain management CME in New Mexico," our program might pop to the top of the list. 

Anna: It’s clear that you’ve used approaches that align with your goal of building strong relationships throughout your state – I can’t wait to hear how your new approaches have worked next time we chat. Let’s pivot to our final question to wrap up today. What is one piece of advice you'd give other programs that are looking to replicate your program's success?
 
Alisha: I would say don't get discouraged if you don’t see as much demand as you would hope for when you’re first starting out. Like everything else, it takes time. It takes time to educate providers on what and how this service is being offered. It also takes time to alleviate some of those misconceptions that this is “just too good to be true”. So be patient, talk to people, and listen twice as much as you talk to build those relationships.
 
Anna: Thank you so much for sharing that, Alisha. It’s an honor to work and learn from you and your team. We appreciate all the tips you shared today an we hope to catch up with you soon!

​Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography. Alisha believes that communities should be engaged in developing solutions and driving decisions that affect them. Having lived in New Mexico for eight years, she deeply values the strengths, resiliency, and beauty of New Mexico’s communities. Alisha has facilitated CHI’s leadership team since its inception and together, they continue to challenge the status quo by creating an environment in which social and health conditions allow individuals, families and communities to thrive.
 
As a program manager at CHI, she supports opportunities for critical linkages across partners; promotes shared decision making, researches and implements innovative frameworks, and works to address social and racial inequities. Alisha manages UPDATE NM (Understanding Provider Demands and Advancing Timely Evidence), CHI’s academic detailing program; serves as PI for the HRSA RCORP (Rural Community Opioid Response Program) Implementation project and directs the organization’s Project ECHOs for systems change. Some of her past professional endeavors include health education, training and teaching medical interpretation, ESL and motivational interviewing.

Overview: Loren Regier, a NaRCAD Expert Training Facilitator, joins us to reflect on nearly 25 years of his AD career, his experiences in learning AD for the first time, and his role in being a mentor to a new generation of academic detailers. Loren is a hospital pharmacist by training and has served with the RxFiles Academic Detailing Program and the Centre for Effective Practice, both longstanding Canadian AD programs.

by Winnie Ho, Program Coordinator

​Tags: Detailing Visits, International, Program Management, Sustainability, Training

Winnie: We’re delighted to hear more about your AD journey, especially about the ways in which you continue to be a leader and supporter of the AD journeys of many others. Can you tell us a little bit about how you got started in this field?

Loren: I was a hospital pharmacist doing a lot of work related to clinical decision-making, public speaking, and education.  The Director for our Saskatoon Health Region (SK, Canada) had come across academic detailing from a colleague in Vancouver, and was interested in piloting something similar to what is now the British Columbia Provincial AD (BC PAD) Service.  

​Our region needed someone who would take on this project and build something from scratch. Only partly knowing what I was in for, I said “yes”. To train and learn more, I had the chance to shadow Terryn Naumann in June of 1997. Terryn was the pioneering solo detailer in North/West Vancouver. What was initially a 1-year project for us, became a 2-year, and then a 3-year project, eventually morphing into an ongoing AD service that expanded to cover our  province of Saskatchewan.

W: That’s incredibly fortuitous that you had Terryn to turn to for help! We’ve gotten to interview her before at DETAILS and know that she was a trailblazer for AD across Canada.
​ 
Before I ask you about your experiences now as a mentor to others, I would love your reflections on your experiences as a mentee back in the days when you were learning AD as a new trainee with Terryn as your guide.
​ 
L: There are both good days and difficult days to think back to – it involved a lot of hard work, but I was fortunate to have an awesome mandate and the opportunity to see another successful service in operation.

​Most importantly, I was able to see what a successful visit looked like. I joined Terryn for 7 visits over 2 days. After each visit, we reflected on how the visit went, what we liked, and if there was anything one might handle differently. The opportunity to shadow Terryn instilled in me the vision that academic detailing was about both relationship and service, and that clinicians could find both aspects valuable and enjoyable.

W: We do encourage a lot of new people starting AD for the first time to try and find someone to tag along with. You were especially lucky with Terryn because she had had a few years to build up her network and relationships in her community.

L: Relationships are key in AD – and witnessing those relationships and the resulting AD conversations – was educational and inspiring.
​
W: Is there a particularly strong piece of advice or a mentorship experience that sticks with you to this day? 

L: One of the things I recall is that she said, “One day, when you have a tough visit, I want you to call me, because I’m one of the only people who will understand what you’re going through.” Well, the day came when I had to call Terryn and we were able to debrief on a challenge I had faced. That was a critical moment that served to propel me forward with greater insight and confidence.

W: You bring up something important – our work is focused on creating safe learning spaces for providers in order to enact change. What we’ve been able to expand on are the connections between individual members of the detailing community. Luckily, the field has grown and new detailers have many more role models and teachers to learn from.
​
Let’s also talk about this vulnerable moment, because it requires a lot of trust to go to someone when something goes wrong.

L: The mentorship process ideally involves deep, authentic discussions about being a detailer.  Being a detailer involves constantly putting your best self forward. Trust allowed both of us to open up to each other with lots of safe space to discuss our different approaches and experiences.

Trust is essential for effectively exploring differences of opinion, and how to turn challenges into opportunities. Without it, you don’t get to understand where someone is coming from or to truly grow and learn.
​
In addition, I need to mention Frank May who also became valued mentor over the years. Frank  helped pioneer academic detailing in Australia. His thoughtful conversations and leadership were instrumental in my growth in AD, as well as my eventual role in helping train and mentor  new detailers.

W: I have definitely seen the large and small ways that mentorship has propagated through the AD community. In the process of learning and educating others in this field, we never truly stop being mentors or mentees – it’s not a binary. It’s a great lifelong process.

Let’s flash forward to now: given your experiences, how have you continued to integrate mentorship into your current work?
​ 
L: A big part of my role these days has been training, mentoring, and supporting others - both academic detailers and those who are moving into program leadership. It’s important to recognize that the world needs more people to do this kind of work and that we need to pass the baton. That involves coming alongside their journey, having good discussions, and being able to dig deep into those critical ingredients for success.

It has meant being transparent about my decisions and leadership so that my team can not only see how I’m thinking and processing things, but also provide their own input and ideas. Being a mentor to me means modeling the approach of learning together and working enthusiastically and collaboratively when pursuing opportunities.
​ 
W: You’re in a capacity now where you’re training future leaders in AD. You provide an important link and opportunity to reflect on where AD has been, but also the space to give new AD folks a chance to figure out where AD may go next. The people you mentor now will likely go on to mentor others, just as Terryn and Frank did for you. What advice would you give to those who are seeking to be strong mentors?

L: People can sense if they are respected and valued.  If they know you care and are interested in their growth, they will open up, share the important stuff, and work together to address the challenges of academic detailing.  If you add some fun and enjoyment along the way, the process serves as a model of what will eventually happen between the detailer and those they detail.
​ 
W: That’s wonderful advice, because one of the best things you can do for someone who is learning is to fully believe in their potential and strengths. They’re already a part of your team – they’re there for a reason.

L: Somebody once asked the coach for Bobby Orr, one of the greatest Canadian Hockey players of all time, “How do you coach Bobby Orr?” and the reply was, “You don’t coach Bobby Orr, you give him room to play the game.”
​
There’s some truth in applying that to leadership and in AD.  You need to appreciate where your team members excel and empower them. It means coming alongside, supporting their input, and also giving them the freedom to make their own mistakes and learn from them. Give people the support they need to do best. They’ll show you what they’re capable of.

​Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

LoLoren Regier is a Pharmacist and Consultant Editor with RxFiles Academic Detailing Service in Saskatoon, SK, Canada.  Loren has guided the development of this provincial academic detailing service since the first “ground breaking” pilot project began in 1997.  Loren is active as a member of the Canadian Academic Detailing Collaboration and provides training and consultation to various programs and initiatives.  Loren’s interests cover the practical application of evidence to practice and the ongoing development of multifaceted interventions that support academic detailing.  Additionally, Loren serves as a faculty facilitator for NaRCAD’s Academic Detailing Techniques trainings.

Loren is co-editor of the RxFiles Drug Comparison Charts – 10th Edition and a contributor/reviewer for Geri-RxFiles and the RxFiles – Bringing Evidence to Practicesection of Canadian Family Physician journal.  Loren obtained his degree from the University of Saskatchewan, College of Pharmacy in 1988 which he followed with a hospital pharmacy residency.  He serves as a lecturer, instructor and preceptor in the areas of evidence informed drug therapy decision making, educational outreach and chronic pain management in a wide variety of professional settings

Overview: Harald Langaas speaks with NaRCAD about his experiences in co-founding Norway’s first national AD program, KUPP. KUPP, which loosely stands for “Knowledge-Based Updating Visits” in Norwegian, has been actively serving Norwegian General Practitioners (GPs) for several years.

by: Winnie Ho, Program Coordinator

​Tags: Chronic Illness, Detailing Visits, Evaluation, International, Program Management

Winnie: Hi Harald, thank you for joining us all the way from Norway to talk about KUPP, the Norwegian Academic Detailing program! Can you tell us a little bit more about yourself and the work that KUPP does?
 
Harald: I’m a pharmacist by training, with experience in working at hospital pharmacies and as a pharmacy manager in the private sector. My interest has always been in how to better provide independent information about the use of medicines to healthcare professionals to improve the quality of healthcare. I work for one of the four Regional Medicines Informational Centers in Norway, one for each of the four health regions.
 
The Norwegian AD Program is strongly connected with those Centers, so my position is split between the regional center and as Director of KUPP, which operates at the national level. KUPP is a small organization – it’s myself and a consultant in clinical pharmacology handling the administration of AD.

W: I can absolutely see why AD fits a lot of your interests! Let’s talk about how KUPP got its start. You were part of the founding of a brand new AD program. What was that like, and what did you learn?
 
H: My colleague Roar Dyrkorn had visited Australia, met the NaRCAD team in Boston, and was very inspired by AD. He saw it as an opportunity to improve the quality of prescribing in primary care and began lobbying to acquire funding for an AD program.
 
Our first campaign in 2015 was put together within a month or two, focusing on NSAIDs (Non-steroidal anti-inflammatory drugs) for GPs. We were extremely fortunate to have Debra Rowett from Australia, who has been pioneering AD in Adelaide for many years, fly out to train our first detailers because we were still novices to this work. This campaign went quickly – maybe too quickly -- but we were able to implement it well, and we had success with the campaign. We’ve been continuing to detail ever since.

W: You also mentioned that Norway is divided into four health regions. Can you tell us a little bit more about these regions and the communities that you serve in each?
 
H: The four jurisdictions, all funded and overseen by the government, are responsible for hospital services in that region. However, primary care services are overseen at the national level. In each region, KUPP has between 5-10 people that are trained as detailers and conduct visits in addition to working at the Regional Medicines Information Centers or at a Clinical Pharmacology department at a hospital.
 
W: On average, how many clinicians does KUPP work with per year?
 
H: There are about 5,000 total GPs in Norway, and we visit between 1,000-1,200 GPs a year, which is about 20%. We have limited resources while trying to reach as many providers as we can nationally. For the funding we have, we’re happy with our work, but of course, we are ambitious! We want to be able to visit everybody.

W: That’s a pretty sizable population that you reach, especially on limited resources! Can you provide some context about Norway’s healthcare system that help us better understand the context in which KUPP operates?
 
H: In Norway, we have universal healthcare, which is fully funded by the government. It means that our healthcare system is quite homogenous across the country. The GPs that we focus on are mostly self-employed, but fully funded by the government. This does mean that when we make arrangements to schedule detailing visits, we have to contact GPs one at a time.
 
They have no financial incentive to see us, and since we take up their time instead of them seeing a patient, they actually lose money by seeing us. This means that we have to ensure that a visit from us is useful and that it’s a valuable investment towards improving the treatment of their patients. We keep all visits to 30 minutes or less.
 
Another important thing to mention is that patients are designated to their GPs. You can’t shop around for providers, so you have to see the same one each time or apply to change to another one. This means that a GP follows their patients for a long period of time, and have a lot of history with their patients.

W: That’s useful background information to know about. Since patients often stay with the same and only GP, how does that impact a GP’s insight into their patient population?
 
H: Because of the long shared history, it means that when we are talking with clinicians, they know their patient pool very well. Even when a GP has taken over a practice, they will be very knowledgeable about who they are serving.
 
W: I imagine that when detailing on chronic conditions, this is an advantage because a GP and a detailer can follow a patient population over time and offer continuous support! Now, we’ve been able to follow KUPP’s work for a while, especially with a lot of your recent presentations and research. How are things going with research and evaluation lately?
 
H: It’s always been useful for us to evaluate and publish our results, especially when we approach the government for more funding. While we can’t do every campaign as a research project, I’ve been working on evaluating a campaign we did on diabetes and also a study on the impact of group visits vs. 1:1 detailing.

We’re also working on a small qualitative evaluation of our virtual visits at the moment. It’s been exciting to be contacted by other research groups who want to work with us. It’s really inspiring for us to know there are groups who want to learn more about AD because of us, and that we’re being noticed and seen as a good research partner.

​W: It’s always exciting to see where AD travels and how many borders it can cross. We always learn more because the AD community is constantly growing and innovating. As someone who has been at the forefront of establishing AD abroad, what are your hopes for the international AD community at large?
 
H: I would sure hope to see more AD programs emerging in Europe. It would be very helpful to fully connect the AD initiatives that are ongoing around us, to build the same kind of network that North America has had between the United States and Canada.
 
W: We hope to see more programs emerge too! Last question – any final words of advice for detailers and programs?
 
H: The main advice would be to not give up. There will be resistance, and you will run into some troubles, but keep on working. If you believe in the method, and you believe in the work you do, it will pay off. The 1:1 approach is something that separates AD from other tactics, and makes it easier for both clinicians and funding organizations to see you as unique. This work is worth it.

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

​Harald Langaas has been the director of a hospital-based medicines information centre (RELIS) in Trondheim, Norway since 2013. Together with colleagues at St. Olavs Hospital he started the first academic detailing program in Norway in 2015, and has been involved in AD work both as administrator and active detailer since then. Since 2018 he has been the director for KUPP – The Norwegian Academic Detailing Program. He is currently working on a PhD based on evaluation of academic detailing.