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

Tags: Opioid Safety, ​Harm Reduction

The NaRCAD team is back on the road! We had the privilege of attending the 2023 Rx and Illicit Drug Summit in Atlanta, Georgia, where we joined a diverse learning community of over 3,000 participants. We heard about best practices in prevention, treatment, and recovery for those affected by the opioid epidemic and engaged with experts from various fields who have developed innovative strategies to combat the crisis.
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We attended presentations, poster sessions, and booths from a wide range of professionals, including clinicians, law enforcement personnel, public health officials, lawmakers, attorneys, families, and individuals in recovery. It’s clear that we need to continue to work together across disciplines to reduce opioid use disorder and opioid overdoses within our communities. 

While we were in Atlanta, we saw folks from our AD community who are working on opioid-specific academic detailing projects, including our colleagues at Alosa Health! If we didn’t catch you while we were there, please reach out to us at [email protected] and tell us about your experience in Atlanta!

NaRCAD also had the opportunity to present with our colleagues from Comagine Health to share about our own collaborations and findings from a recent project, a 15-month clinic-based intervention called Improving Pain and Opioid Management in Primary Care (PINPOINT).

​The PINPOINT intervention was implemented in 36 clinics in Oregon and combined the Six Building Blocks, academic detailing, and practice facilitation approaches to improve pain management, opioid prescribing practices, and treatment of opioid use disorder in primary care settings.

​A baseline survey of clinical staff and prescribers was conducted to assess knowledge, attitudes, and behaviors regarding opioids. The survey results suggested differences between clinical staff and prescribers in behaviors and attitudes about opioid therapy for treatment of chronic pain, familiarity with opioid prescribing best practices, and opioid-related policies and procedures. The participants who attended the conference session were eager to learn about how they could implement academic detailing programs in their own communities. 

We’re excited to share about the importance of academic detailing at future conferences and continue to learn and grow alongside all of you. 
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Interested in submitting a proposal with the NaRCAD team at a future conference? Email us at [email protected]! 

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

Curated By: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: ADvice, Program Management, Training
 
Academic detailing program managers oversee and coordinate all aspects of an AD program to ensure its success, impact, and strengthen the detailing team. They have a crucial role in achieving team goals. In this edition of AD-vice, we’ll look into how program management in AD contributes to team and program success.

Team Building and Support:

• “Having a team that is well-prepared, confident and excited to bring this information to the practices is the cornerstone to a successful detailing program.” – Michelle Dresser, MPH, NYC Department of Health and Mental Hygiene

 

• “It can be lonely when you’re in the field detailing by yourself, so managers need to have touchpoints with their detailers. Building trust and having your detailers know you’re all working together helps them stay self-motivated; it makes them want to go out into the field and do a good job because they know someone is backing them up.” – Tony de Melo, RPh, Alosa Health

 

• “… a strong detailing team supports one another. That support can be helping each other out in the detailing session itself (e.g., co-detailing), or through communicating with each other about the providers we serve and in between detailing sessions. We want the team to be successful in moving towards our goals together.” – Marlys LeBras, PharmD, RxFiles Academic Detailing Service

 

• “It’s also important to know that with your team, you’re never alone. 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, MA, ONE Tennessee

Recruitment and Training:

• “When recruiting detailers, it is more important to make sure to recruit people who have the bandwidth to do the detailing, rather than making sure they have the perfect clinical background. It may be a good idea to create a formalized agreement to ensure they complete their required detailing visits.” – Amber Elliot, BSN, RN, St. Francois County Health Department

 

• “The detailer upskilling process for other visits includes weekly webinars to review key messages and the surrounding evidence, and a two day in-person workshop where detailers get to practice their visit discussions with each other and family physicians prior to launching visits.” – Lindsay Bevan, MScHQ, Centre for Effective Practice

 

• “If you have the capacity, take it one step further by adding practice role play sessions among peers and allow new detailers to observe other detailers in the field. ​​​When training, help the detailers step out of their comfort zone within a group of people that they know before they step out of their comfort zone with a stranger.” – Nicole Green, BSP, RPh, ACPR, DPLA, ThedaCare

Interprofessional Collaboration:

• “Create an interprofessional team. It was very helpful to get insights from multiple health disciplines since there are many opportunities [within the health system] to encourage patients to be vaccinated.” – Kimberly C. McKeirnan, PharmD, BCACP, Washington State University

 

• “Programs considering hiring student detailers can often rely on the flexibility of students’ schedules, as well as an enthusiasm and energy for learning that may exist in smaller quantities later in one’s career, when full-time roles in healthcare take priority.” - NaRCAD

Effective program management plays a crucial role in the success and support of academic detailing programs. We hope the insights shared in this edition of AD-vice will help in navigating and implementing strategies of team building, recruitment, training, and more. As always, our NaRCAD team is here to support you and your detailing programs!
 
Best,
The NaRCAD Team

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Rocko Cook, Public Health Detailer and Public Health Detailing Program Manager, Detailing Improved Sexual Health (DISH), Arizona State University.
 
Tags: Detailing Visits, Evidence-Based Medicine, HIV/AIDS

Anna: Hi, Rocko – thanks for joining DETAILS today! HIV prevention work is critical and often deeply meaningful to those working in the field. Can you tell me why this work speaks to you?

Rocko: I found out I was positive for HIV and syphilis in 2002. I encountered firsthand the stigma and shame associated with these diagnoses. It was devastating, but it’s made me feel even more connected to the work I’m currently involved in.

I’ve worked in various roles in the field of HIV prevention and care since 1994, just two years before medication was widely available. In the 90s, there was little support for people who tested positive for HIV from a care perspective, financial perspective, and housing perspective. We now have the medications and tools to prevent, treat, and support people with HIV.
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Despite this, there’s an urgent need to continue educating clinicians, staff, case managers, community health workers, and other people who are on the frontlines about these tools and resources. Academic detailing helps to close that gap and gives me the opportunity to live my passion of educating others about HIV.

Anna: Thank you for your openness in sharing your personal and professional experiences. Your passion for HIV prevention and care is evident. What’s the number one thing you want clinicians and staff in your community to do differently when it comes to HIV?

Rocko: I’d love for them to change the culture of the entire clinic space and create a more welcoming environment for patients. There needs to be a focus on consistent communication coming from every professional a patient meets with when receiving care. All clinicians and staff need to be able to communicate with patients in a sex-positive way and in a way that connects with patients’ specific experiences, identities, and needs. They need to be comfortable communicating about sexual behavior, testing, and PrEP.

It’s difficult to have these conversations. I've been doing this for a long time and I’m not perfect at it either, but once we practice and start getting comfortable with ourselves, then it gets a lot easier to be comfortable with patients.

Anna: Modeling this type of communication during a detailing visit is key. It can help clinicians and staff feel more comfortable having the same conversations with patients. Can you share a story from the field about a positive response or reaction from someone you detailed?

Rocko: There was an agency we worked with that hired a new physician, testers, and medical assistants for their mobile medical and HIV testing unit. They had never worked with this patient population, so our team did several trainings and 1:1 detailing sessions where we role played conversations with patients. We needed to bring them up to speed on how to have gender inclusive conversations and communicate with sex positivity. We had a lot of fun together.
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The team ended up going to Phoenix Pride to do a big testing event. We were delighted with their success in providing testing to the community and creating a welcoming and safe environment for people interested in being tested. 

Anna: That’s a large event for the mobile unit team to tackle, while also succeeding in creating a safe space for all! Let’s talk a little bit more about the impact on patients. Can you share any data on the impact of your detailing work?

Rocko: We have anecdotal evidence that folks are benefiting from our services. My colleague and I are closely involved in the gay community and people often tell us about their care experiences. We’re in an enviable position because we know a lot of people and hear things in passing. It helps us do a better job targeting our services; we can work directly with clinics that we’ve heard would benefit from detailing.

I also recently connected with someone of trans experience who was tested at Phoenix Pride. They’ve had poor encounters in the past where clinicians and staff assumed the body parts they have. They shared that they had a positive experience with the mobile unit and felt comfortable throughout the visit. Being able to see our impact firsthand has been really motivating for me; it makes my heart sing.
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Anna: It’s rare to be so closely connected to the community that’s being impacted by your detailing work. It’s clearly been beneficial for your detailing efforts and getting your program up and running. Let’s wrap up with a final question - what has made you most proud of this project so far? 

Rocko: I’m so proud of the way our team has come together and engaged with partners across the state. We’ve been able to leverage partnerships and community relationships to enhance program development, implementation, and dissemination.

I’m also proud of our creativity in choosing our program’s name, DISH AZ (Detailing Improved Sexual Health). We send out a Weekly Special with a buffet of options on new evidence and information related to HIV prevention and care. We’re creating an active and robust network of professionals, while using food as our motivator!
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Anna: That’s an innovative way to keep your network engaged! We’re looking forward to hearing about your program as your team continues to expand its network and positively impact more people in the community. Thanks for chatting with us today and sharing your experiences, Rocko! Your passion for this work is palpable. 

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

Biography. Rocko Cook serves as the Program Manager for DISH-AZ (Detailing for Improved Sexual Health in Arizona), a program of the Office of Evaluation and Partner Contracts for the Southwest Interdisciplinary Research Center (SIRC) at Arizona State University in partnership with Arizona Department of Health and Human Services. Rocko began working in the field of HIV in 1994 and is a community leader with over 15 years of experience implementing prevention and care programs in Arizona, Ohio, and Kentucky. In addition to his duties as a program manager, Rocko has served as a public speaker, presenter at local and national conferences, and as a consultant and leader for HIV community planning groups. Rocko has been living with HIV since 2002 and is passionate about improving sexual health for all communities.

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

An interview with Lindsey C. Beardsley, Individual in Recovery. This month, we’re looking through the lens of the patient experience, something that all detailers and clinicians work so hard to improve. We’re pivoting to an interview with a person with use disorder, her experience with use and recovery, and the ways in which the patient experience can encourage detailers and clinicians to continue working together to improve outcomes for those who struggle with substance use.  
 
Tags: Harm Reduction, Opioid Safety

Anna: We hear many stories from patients about substance use starting after pain medications are prescribed during adolescence. Despite the power that you felt when you used, were you ever worried about the health effects of your drug use?

Lindsey: I dated someone in my teenage years, and we often used together. Cape Cod is a small community and within a few weeks of dating him, my mom heard that he had Hepatitis C. My entire family was devastated, but I didn’t care at all – I couldn’t see how it would affect me.
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I think back to all the times I shared needles and drug supplies. Even if I tried to use new needles, everything looked the same and would get mixed up in the rush of using with other people.

I would always have a little fear inside of me that I would overdose on my first time using again after being in treatment, but that fear never stopped me.

Anna: We know that substance use disorder is a medical condition and patients need professional support. When you felt ready to address that fear and seek treatment, were there healthcare resources or community supports that helped guide you towards recovery?
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Lindsey: I’m lucky to be in a state like Massachusetts where we have a lot of resources that the rest of the country doesn’t have. I was a frequent flyer at our detox facilities. When I was admitted, I was always paired with a peer that was in recovery. I often knew the peer; it gave me hope to hear the stories of recovery from people I knew and previously used drugs with.

I was assigned a counselor, and we would discuss my treatment goals and next steps. The counselor would walk through every community resource within several miles of me, like partial hospitalization programs, sober homes, Narcotics Anonymous (NA) meetings, 12-step programs, and syringe exchange programs.

We also have a mobile harm reduction center in my community. Before it existed, a woman in recovery started a needle exchange program out of her home. She sparked a need and desire for our community to learn more about harm reduction. ​

Anna: Many people don’t have access to substance use resources in their community, especially harm reduction services. Here at NaRCAD, we’re trying to encourage primary care clinicians to be able to provide those linkages to care and harm reduction services. What does harm reduction mean to you?

Lindsey: I was against harm reduction for a long time because I was very involved in a 12-step fellowship where the primary purpose was complete abstinence from drugs. Harm reduction was a shift in mindset for me, but it’s pretty cut and dried. We’re reducing harm, saving lives, and preserving a sense of family and community.

When we reduce harm, we allow a mom to be a part of her family again, we allow her to get a job, we allow her to get off the street and out of harm’s way. Harm reduction can allow people to return home.

Anna: It’s valuable to know that a 12-step program and harm reduction can co-exist. What message about harm reduction would you want to share with members of your community?

Lindsey: Harm reduction doesn’t enable drug use – use is going to continue until the person is ready to seek treatment. A simple approach to harm reduction, like syringe exchange, prevents the spread of infectious diseases and reduces needles in public and community spaces. It prevents someone from contracting Hepatitis C when they use drugs.
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Anna: We know that harm reduction plays a huge role in preventing drug-related deaths and offering access to services. There are many approaches to harm reduction and even using just one approach reduces so much harm. Let’s transition to talking about patient care. How would you want your care to look, or not look, when seeking help for substance use from a clinician? 

Biography. ​Lindsey C. Beardsley, an individual in long-term recovery, was born and raised in Cape Cod, Massachusetts. She was involved in many different sports growing up – gymnastics, soccer, and dance – but riding and working with horses quickly won over her time and heart from a young age. After many years of struggling with addiction, Lindsey walked into a treatment facility in August of 2018 and made the decision to stop using drugs one day at a time. Lindsey has been in recovery since September 21, 2018.

Curated By: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: Stigma​, Primary Care, Data

Time and time again we’ve heard about the challenges detailers face when tackling clinician stigma. Detailers have shared comments from clinicians such as, “We don’t take those types of patients” or “I don’t want to be known as the gay doctor.”
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Addressing stigma and fostering understanding with clinicians can often feel overwhelming for detailers. In this edition of “AD-vice” we shine a light on these issues and share experiences from our community on how they managed stigma during detailing visits. 

Understanding Stigma
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• “Whenever I address something uncomfortable with a provider, stigma or otherwise, I try to create an environment where we can work collaboratively on the issue and the provider feels as though I am a resource for them. – Jessica Alward, MA, New Hampshire Bureau of Infectious Disease Control

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• “One of the biggest myths about stigma is that some people carry it, and some people don’t. However, stigma is not binary, and we all possess the ability to stigmatize another group that we perceive to be an ‘outsider’ group. Historically, stigma has appeared mainly in the form of social inclusion, with those identified as ‘others’ being treated as societal outcasts.” - NaRCAD

 

• “Imagine that the clinicians or people you detail hold stigma not because they want to stigmatize others, but for some more relatable reasons: they’re impressionable, they’re naïve, they’re vulnerable. In the same way that a clinician wouldn’t expect someone with a substance use disorder to suddenly recover if harshly confronted, we can’t expect the person who stigmatizes to respond to similar tactics.” – Zack Dumont, BSP, ACPR, MSPharm, RxFiles Academic Detailing Service

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• “Stigma isn’t something that folks are actively choosing, it’s more of what they’ve been taught. Changing that culture of practice is much more difficult compared to asking prescribers to prescribe cholesterol-lowering therapy. There’s very little societal baggage when it comes to improving cholesterol than there is when it comes to destigmatizing addictions or chronic pain.” – Andrew Suchocki, MD, MPH, Clackamas Health Centers

Addressing Stigma through Education and Conversations
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• “We’re approaching [stigma] with education and lots of conversations, since we’ve found that helping our staff to get a better sense of addiction as a disease is really invaluable to making them more open to [medications for opioid use disorder (MOUD)] and treating people with opioid use disorder (OUD).” – Carol Furlong, LCMHC, MAC, MBA, Elliot Hospital

 

• “When we detail in groups, we focus on small group discussions. One method I use involves flashcards with myths or biases about OUD, and asking two or three of the attendees to discuss that amongst themselves. We have also used a language sheet that guides providers in what to say.” – Elisabeth Fowlie Mock, MD, MPH, Maine Independent Clinical Information Service

 

• “A lot of the older language around OUD identifies with “bad choices” and “bad people”. For example, relapse is associated with a fault of the person. When we are talking about a person with OUD, we are talking about someone with a disease and relapse is a natural course of the disease. When a patient’s blood sugar goes up, we don’t call it a relapse. Just like people with diabetes, we will never cure a person with OUD, but we help them manage [it].” – Don Teater, MD, MPH, Teater Health Solutions

Addressing Stigma through Data and Resources

• “Our team provides statistics that relate to the provider’s specific neighborhoods and specialty, giving them real-time pictures of what’s happening with the patients they see. We know that [cocaine use] is still a difficult topic to bring up, so we help address this with our action kit resources on stigmatic language and counter-top brochures that signal to patients that the provider’s office is a safe place to discuss these issues.” – Carla Foster, MPH, New York City Department of Health and Mental Hygiene

 

• “Know your patient population: Understand who the patients are, the trauma they’ve faced, and the stigma they may endure. Look at the experiences of your team, the clinicians, and the patients you’re working with and try to understand how these different perspectives all influence one another as you develop your resources.” – Trish Rawn, BScPhm, PharmD, Centre for Effective Practice

Our team at NaRCAD is here to learn and support you as we combat stigma and continue to promote inclusivity. Check out our new Healthcare Inclusivity Toolkit for detailers for additional resources. 

Best,

​The NaRCAD Team

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Meghan Breckling, PharmD, BCACP, Ambulatory Care Pharmacist and Academic Detailer, University of Arkansas for Medical Sciences and Arkansas Department of Health.
 
Tags: Detailing Visits, Opioid Safety, Harm Reduction, Evidence-Based Medicine

Anna: I can imagine having something tangible to give to patients makes clinicians feel more equipped to have these conversations. What other resources were you able to share with clinicians?

Meghan: We encouraged clinicians to utilize a new, free mental health resource called AR ConnectNow. This program provides immediate virtual care to all Arkansans dealing with mental health and substance use disorders. Clinicians were grateful for AR ConnectNow because mental health services are scarce in rural Arkansas; they’ve been sharing it with their patients frequently.

Anna: You must have been proud to be part of a project that had such an impact on both patients and clinicians. How did the harm reduction lens inform your detailing visits for this project compared to your prior pain management-focused visits?

Meghan: Many visits centered on communication with patients. Communication and empathy are two huge pieces to consider with this topic. We spent a lot of time asking clinicians about the conversations they have with patients and the types of questions they ask about substance use. We really wanted to understand what was going well and where there were gaps that we could help fill with resources and support.
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We also focused on naloxone prescribing and administration. We gave out free naloxone kits to all clinicians that they could either keep in the clinic or give to a patient who was having trouble accessing it. Clinicians were open to the idea of prescribing naloxone to patients who were at risk of overdose and open to keeping kits in their clinic in the event of an overdose. Our team had a lot of clinicians say during follow up visits that they felt more comfortable prescribing naloxone and were prescribing it more to patients and family members. 

Anna: It’s impressive how you were able to clearly shift your focus from opioid prescribing to harm reduction and prioritize the relationship between the clinician and patient. Did you receive any pushback from clinicians on harm reduction?

Meghan: Clinicians understood the need for harm reduction services but were more inclined to refer patients out rather than providing services within their clinics. For example, we found that a lot of clinicians were resistant to prescribing Medications for Opioid Use Disorder (MOUD), either because they were uncomfortable with the steps to do so, or they were told by leadership that they should not prescribe MOUD at their practice.
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It can sometimes take an hour or more for patients in rural areas to access specialty services that offer MOUD. We’re looking at future projects where we can utilize pharmacists to increase MOUD prescribing in partnership with primary care providers. For instance, a primary care clinician could diagnose SUD and prescribe MOUD, while a pharmacist could monitor the patient throughout treatment. It would take a lot of burden off the clinicians and could possibly make them less resistant to prescribing it. ​

Anna: Using pharmacists as an integral part of the care team is an excellent idea – you’ll have to let us know if you receive additional funding for this work! Let’s wrap up with a final question. If another program decided to do a detailing project on harm reduction, what advice would you give them before they went out into the field?

Meghan: You need to take a step back and remember that there isn’t going to be instant behavior change among clinicians. For a topic this complex, it’s critical to have follow-up visits and continue to be a resource and support for clinicians.

Also, be understanding of clinicians and their experiences. They’re dealing with a lot and it’s not easy to change things all at once. Building a relationship and getting a clinician to commit to just one key message is a huge win.
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Want to learn more? Read about the harm reduction key messages used for this project and the development of those messages on our previous blog post.

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

Biography. Dr. Meghan Breckling is an Ambulatory Care Pharmacy Specialist at the University of Arkansas for Medical Sciences (UAMS) and is a trained Academic Detailer through the National Resource Center for Academic Detailing (NARCAD) within the Center for Health Services Research (CHSR) at UAMS’ Psychiatric Research Institute (PRI). She previously completed a PGY1 Pharmacy Residency and PGY2 Ambulatory Care Residency at the Central Arkansas Veterans Healthcare System (CAVHS). Currently, she is a part of a multidisciplinary academic detailing team comprised of a pharmacist, physician and physical therapist that provide evidence-based solutions, tools and support for chronic pain management to primary care providers across the state of Arkansas. ​

Curated By: Aanchal Gupta, Program Coordinator, NaRCAD

Over the past year, we’ve gained important insights from programs around the world by exchanging ideas at roundtable sessions, Peer Connection Program Gatherings, trainings, and our annual conference series. As we welcome in 2023, let’s reflect on some of the highlights that detailers and program staff have shared on our DETAILS Best Practices Blog over the past year. Enjoy!

Outside the Detailing Team: Leveraging Community Partners

• “I’m so lucky to be able to work in the office side-by-side a recovery navigator [who] helps link folks in the community to addiction services. We often share resources and try to work together to ensure that community health goals are achieved […] by making sure that the work people are doing is connected rather than existing within silos.” – Carolyn Wilson, Ledge Light Health District​

 

• “We’ve benefited from connecting with administrators of health systems. We approach them like business partners; it takes a special skill to communicate and work with an administrator. It’s important to have team members who understand how to communicate with leadership effectively to get that buy-in.” – Sandeep (Sonny) Singh Bains, PharmD, BCPS, Alosa Health

 

• “We [as detailers] attend a variety of community meetings. We know that many people living with HIV pass through community-based organizations. We want to make sure that those organizations are equipped with the correct information to get people the care they need through resources or referrals.” – Lexie Hach, MA, Iowa Health and Human Services Capacity Extension Program

 

• “If you’re just starting out, reach out to community partners and get a sense of what patients are experiencing and the challenges they’re facing before you start detailing clinicians. You’ll better be able to represent what is happening in the community and the resources that exist when you’ve done your research first!” - José Peña Bravo, PhD, Florida Department of Health

Detailing Visits: Preparation and Building Confidence
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• “I encourage my team to be persistent. We can't take the first “no” from a clinician as rejection. It might mean, “not now,” “I don't understand,” or “I haven't been exposed to this.” It doesn’t mean that they never want to have a visit with an academic detailer or will never change their prescribing behavior.” – Nicole Green, BSP, RPh, ACPR, DPLA, ThedaCare

 

• “Prior to your detailing visit, think about ways to slow down and limit the amount of information you share with the clinician so that the visit is of most value to them. You can do this by asking focused needs assessment questions and providing the clinician ample opportunities to speak and engage in the conversation.” – Chirag Rathod, PharmD, Illinois ADVANCE

 

• “Examine your own biases: When developing detailing tools, you need to make sure that you’re aware of your own biases and that your tools include the lens of equity, diversity, and inclusion. This is something we are actively working on incorporating in all our work at CEP.” – Trish Rawn, BScPhm, PharmD, Centre for Effective Practice

 

• “When you initially step into something new, you're outside of your comfort zone. Do you harness the fear and turn it into excitement for learning or do you shy away from it? It's important to step into it and remember that the goal is to better the communities that we live in. Take that excitement and run with it.” – Rachelle Woods, MSN, RN, Colorado Department of Public Health and Environment​

 

• “Be patient, be persistent (after all, you care and want them to be their best selves) and be persuasive with those that you’re detailing. You have a lot of natural talent, training, and experience to efficiently help people make informed decisions through detailing visits. Don’t limit it to therapeutic decision-making; extend it to the mental and emotional aspects of care as well.” – Zack Dumont, BSP, ACPR, MSPharm, RxFiles Academic Detailing Service

Thinking Outside the Box: Exploring AD Innovation
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• “Everyone brought something critical and unique to the table. Our administration team was instrumental in getting our visits booked and our director was transparent with our team throughout the process. [As a result] our team was excited, enthusiastic, and proud to have the opportunity to provide this education to clinicians in our province.” – Jennifer Carefoot, BSc, Pharm, BC Provincial Academic Detailing Service

 

• “Dentists fall into a different healthcare model that’s often siloed; this results in isolation, making the interactive, 1:1 outreach model of detailing even more important – we knew we needed to bring the information and support directly to them in their dental offices.” -Adrienne Butterwick, MPH, CHES, Comagine Health

 

• “It’s critical that academic detailers continue to encourage primary care clinicians to discuss harm reduction with their patients and link them to services within their community. Academic detailers have the ability to empower clinicians to have difficult conversations with patients to reduce infections, overdose, and death.” - Anna Morgan-Barsamian, MPH, RN, PMP, NaRCAD

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Shuchin Shukla, MD, MPH, Faculty Physician, Mountain Area Health Education Center (MAHEC), NaRCAD Training Facilitator
 
Tags: Harm Reduction, Detailing Visits, Evidence-Based Medicine, Opioid Safety

Anna: Welcome to the DETAILS blog, Shuchin! You wear many hats - you’re an addiction medicine physician, an academic detailer, and an academic detailing trainer. Tell us how you got started with academic detailing.
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Shuchin: I had an interest in marginalized populations and did my residency in the Bronx in New York City. I was a clinician in HIV care for several years before moving with my family to Western North Carolina. Soon after we moved, I began working at our Area Health Education Center (AHEC) and it was evident that addiction was the primary public health and clinical issue that was causing the most harm in my community.

Fast forward a few years and one of my colleagues received a Centers for Disease Control and Prevention (CDC) grant and asked if I could attend a NaRCAD training to learn more about AD. The medical board and one of our pharmacists at the Department of Public Health were very interested in using AD for overdose prevention. We started with a pilot where we detailed 10 clinicians and slowly built our program. We now have multiple AD grants we’re working on, including one on adverse childhood experiences (ACEs) and one on harm reduction. ​

Anna: It’s definitely critical to have a community that supports the way you practice, as well your program’s AD messaging. Can you share a final tip for other detailers who are working on harm reduction?

Shuchin: Harm reduction is an emotional topic for a lot of people, especially folks who are in frequent contact with people who use drugs, like emergency room clinicians or people with lived experience in their families.
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With this topic, paying attention to the emotions of the clinician you're detailing and acknowledging those emotions before jumping into your key messages is much more important than any other topic I’ve worked on. Be patient and empathetic – every visit counts toward making a change. 

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

Biography. ​Shuchin Shukla, MD, MPH, was born and raised in New Orleans, Louisiana. He completed medical school and public health school at Tulane University and completed a residency in family medicine at Montefiore Medical Center in the Bronx, New York. He worked in the South Bronx for 5 years following residency, providing primary care for adults and children, as well as for adults living with HIV. He also served as medical director for Montefiore Project INSPIRE, a primary care-based Hepatitis C treatment program. He then moved with his family to Asheville, North Carolina, where he currently serves at Mountain Area Health Education Center (MAHEC) as faculty physician and Clinical Director of Health Integration.

​He is an associate clinical professor of medicine in the Department of Family Medicine at the School of Medicine, University of North Carolina in Chapel Hill, and is a Diplomate of the American Board of Preventive Medicine, Board-Certified in Addiction Medicine. Additionally, he is a Robert Wood Johnson Clinical Scholar. He leads on various initiatives and projects around addiction, HIV, Hepatitis C, homelessness, and the criminal justice system. His main experience as a detailer has been focused on improving evidence-based provider interventions related to opioids, pain, and addiction.

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Jennifer Carefoot, BSc, Pharm, Academic Detailing Pharmacist, BC Provincial Academic Detailing (PAD) Service.
 
Tags: Conference, COVID-19, Detailing Visits, Evidence-Based Medicine

Anna: Hi, Jen! Thanks for joining us on DETAILS today. Earlier this year, your team developed a detailing campaign in one week for the new COVID-19 treatment, Paxlovid, and presented on your work at our NaRCAD conference. I’m excited to learn more about this campaign. Before we jump in, can you give us some background about your organization?
​
Jen: The British Columbia Provincial Academic Detailing Service (BC PAD) launched in 2008 and provides academic detailing to the province of British Columbia. We have 12 full-time pharmacist detailers for the entire province. The program is publicly funded by the BC Ministry of Health and our topics are chosen based on their relevance to primary care clinicians. Here are some quick facts about our program:

• We’ve covered 21 topics since 2008
• We typically conduct about 1,400 to 1,800 academic detailing sessions per year
• We see about 3,500 to 5,000 clinicians per year in a 1-to-1 or small group format 

Jen: Paxlovid was getting a lot of press in the media at the time- it was the first oral treatment readily available for COVID-19. Clinicians knew they would have to know about this medication since their patients would be asking about it.

Anna: New information was coming out every day in the media, which isn’t very common for other detailing topics. How was your team able to stay up to date on the emerging evidence on Paxlovid and continue to keep clinicians up to date?
​
Jen: Our team was able to stay up to date through the excellent communication between our PAD director, Terryn Naumann, the CTC, and the Ministry of Health. We would receive updates via email or video conference daily. We also frequently met internally to share questions, successes, and challenges that we were experiencing in the field.

To keep clinicians up to date, we chose to not provide them with the PowerPoint presentation from the detailing visits because the information and evidence was constantly changing. We’ve created 24 versions to date! Instead, we emailed a one-page resource to clinicians after our visits that included links to online resources that were updated in real time. ​

Anna: That’s one of the benefits of sharing resources virtually – the information can be updated and accessed quickly.

If you were told you had to create another campaign in one week, what would you do differently?

Jen: That’s a tough question! Would we have liked more detailers? Yes. Do I wish there were 24 more hours in my day? Yes. Would we have liked more clinical trial data? Yes. These are all things that are outside of our control. We did the best we could with the evidence and resources we had. I don’t know if we would do it any other way if we had to do it again under the same circumstances.
​
Anna: What you did worked. Do you have any evaluation data from clinicians that you can share? 

Jen: Our formal evaluation showed:

• 95% of clinicians agreed or strongly agreed that they felt more confident prescribing and/or making recommendations to support the safe and appropriate use of Paxlovid after our detailing visits
• For the treatment of mild to moderate COVID-19 and high-risk patients, the information that they felt was the most useful was:
  • the resource page
  • drug interaction checkers
  • trial evidence that we shared

Anna: I’m not surprised by these results! Your team has shown impressive data from myriad detailing campaigns. Before we wrap up, can you tell us how your partnerships and team helped make this campaign successful?

Jen: It’s important to partner with others who have expertise in the therapeutic area you’re detailing on. You don’t need to reinvent the wheel with evidence. Pull from data and evidence that other AD programs or reliable organizations have previously put together and be open to the idea that evidence changes.

Also, remember that it really does take a team! Everyone brought something critical and unique to the table. Our administration team was instrumental in getting our visits booked and our director was transparent with our team throughout the process. Our team was excited, enthusiastic, and proud to have the opportunity to provide this education to clinicians in our province.
​
Anna: Having a team that is open to a challenge and eager to stay up to date on evidence is so important. It’s not realistic for programs to have to create a campaign in a week, but if they ever find themselves in that situation, we know we can all turn to you and your team for support!

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

Biography. Jen is an academic detailer for the BC Provincial Academic Service since 2016 serving beautiful South Vancouver Island. She is passionate about translating evidence to practice, reducing polypharmacy and shared decision making. In her spare time, she enjoys running, gardening, travelling, and spending time with her family outdoors at the lake. ​

Tags: Conference, Detailing Visits, Stigma

Take a peek at the NaRCAD2022 conference materials on our Conference Hub.

Earlier this month, our team at NaRCAD hosted the 10th annual International Conference on Academic Detailing, “Celebrating 10 Years of Community Engagement.” We hopped on the virtual AD bus and heard from programs from across North America and beyond. This year, the conference featured campaigns focused on menopausal hormone therapy, initiation of antiretroviral treatment (iART), falls prevention, COVID-19, biosimilars, antiracist health care, polypharmacy, and opioids. The theme of community engagement was seen throughout the entire 3-day event, and we’re thankful to everyone who joined from around the world. Check out some of the highlights from our 2022 conference below.

Thank you for all your engagement and support throughout the last 10 years of NaRCAD annual conferences! We are humbled to see how much the AD community has grown and are excited to be able to feature innovations at our conferences that have informed your work over the years. Our team at NaRCAD will continue to provide space for everyone to come together to share ideas, ask questions, and network. 

We look forward to seeing you in 2023. 
​
-The NaRCAD Team

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
​
Tags: Primary Care, Opioid Safety, Evidence Based Medicine, Harm Reduction

Our team at NaRCAD has been working on an exciting new project developing harm reduction key messages for primary care clinicians in collaboration with the National Association of County and City Health Officials (NACCHO), Centers for Disease Control and Prevention (CDC), and consultants from Boston Medical Center.
​
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines harm reduction as an approach that aims to prevent overdose and infectious disease transmission, improve physical and mental health, and offer options for accessing treatment and other health care services for people who use drugs. Various harm reduction approaches have been proven to prevent overdose and death, injury, infectious disease transmission, and substance misuse. For instance, there is nearly 30 years of research that has shown that syringe services programs decrease transmission of viral hepatitis, HIV, and other infections. 

There are several other harm reduction approaches beyond syringe service programs, including:
​

• Peer support
• Naloxone
• Using drugs with another person
• Wound care kits
• Fentanyl strips
• Medications for Opioid Use Disorder (MOUD)
• Referrals for pre-exposure prophylaxis (PrEP)
• Medication lock boxes
• Safer sex kits to reduce infectious disease transmission

 
It’s critical that academic detailers continue to encourage primary care clinicians to discuss harm reduction with their patients and link them to services within their community. Academic detailers have the ability to empower clinicians to have difficult conversations with patients to reduce infections, overdose, and death. Our team developed the following key messages to support primary care clinicians in caring for patients who would benefit from harm reduction. These key messages are currently being piloted across the United States in a project funded by NACCHO.

Harm Reduction: Key Messages to Improve Outcomes for People Who Use Drugs

1. Assess factors that may contribute to risk of Opioid Use Disorder (OUD) for patients who use opioids.

2. Identify opportunities to reduce risk of harm using a patient-centered approach.

3. Offer Medications for Opioid Use Disorder (MOUD) to patients identified as having OUD.

4. Connect patients with community harm reduction services and other services that meet identified needs.

These evidence-based key messages can help clinicians provide support to their patients and build strong and trusting relationships with those who need it most. Building trust between clinicians and patients allows patients to feel heard and be open to seeking additional treatment, ultimately leading to improved health outcomes.

Our team is looking forward to continuing to explore harm reduction and updating our key messages based on the results of the pilot through NACCHO.

If your program is interested in collaborating with our team on future harm reduction work, or any other clinical topic, please reach out to us at [email protected].
​
Want to learn more?
Stay tuned to learn about the results of the pilot and how clinicians responded to these key messages in the field. You can also join our discussion forum to interact with peers who are working on harm reduction!

​Bevin  K. Amira
NaRCAD Deputy Director

Tag: Conference

The “before times” are out of reach, and there’s a real beauty in that. Without forcing ourselves to look through rose-colored glasses, our team at NaRCAD has no other choice but to see you for who you are: creative, interconnected, and peer-led, now more than ever. You’re the bosses of adaptation, in ways you may not recognize, or even believe. So let me tell you more about who you are.
​
To repeat an over-used word from society at large, “resilient” applies to our community, but it’s not the word that matters most. Being “resilient” overshadows other truths: we’re often tired, under-resourced, and we need peer engagement. All can be true at once, and they are. Our team is here to remind you that not only is needing each other more than okay, it’s to be celebrated.

You’ve all responded to the AD-specific Bat Signal: you’re a mirror for each other, consistently boosting one another’s morale. The community you’ve built together is founded on the simple strength of admitting that we need each other, we need to feel good about where we are in this moment, and excited about where we’re going next.
​
Where you’ve emulated that excitement most of all is during our community dialogues: our regular virtual gatherings, our Peer Connection Program, our shout-outs to one another during our convenings, trainings, and behind the scenes in 1:1 e-mails. We can have the most effective AD programs out there, but if we’re not witnessing each other’s reality, we’re going it alone. 

At our 10th conference, we’re proud to see the arc of where we started a decade ago; where we were once focused mostly on data-specific outcomes, the focus is now on each other. From building a program to training and evaluation, no longer do we have community members who must start from scratch. NaRCAD is pleased to witness the shift from 2012, where we led the charge, to 2022, where you lead the charge.

Thank you for being the collaborative innovators of this conference, and of AD successes across the globe. We look to you to lead us into 2023—for now, take in these next 3 days with pride.

In just one week, NaRCAD will be hosting the 10th International Conference on Academic Detailing. Our conference series has continued to reach new heights. From 62 attendees at our first conference in 2013 to over 300 attendees at our 2021 conference, we’ve had the pleasure of providing a space to collaborate with others in the field and hear from AD programs across the globe.
​
With topics ranging from opioid safety, stigma, program management, HIV prevention, falls prevention, antiracist health care, and more, we look forward to seeing the field continue to grow at this year’s conference. In honor of reaching this milestone, we’ve compiled testimonials from some of our past conference attendees.

“I never miss the NaRCAD conference! I always come away with new insights into evaluation strategies, ways to extend the reach of our program, and novel settings and topics where AD is filling a practice gap.”

“The NaRCAD conference provides a great opportunity to learn new and different strategies for academic detailing – sustaining a program, team building, effective virtual visits – and to have open discussions about common challenges (recruitment!) and successes (solid needs assessments).”
 
“The NaRCAD team always offers a welcoming and insightful environment to teach, learn, and engage with people across the globe from all facets of an AD program, and I have built solid connections through it.”
 
"I really enjoyed hearing about effective ways we can improve our practices.
It was interactive and I took notes that I am excited to implement in my detailing work." 
 
​“I have so much great information to take back to colleagues, from starting a detailing program from scratch to learning how to support and strengthen a team of detailers.”

Head over to our conference page to learn more and register for NaRCAD2022. Join us on the week of November 7th to celebrate your accomplishments in AD, strategize with others in the field, and learn about innovative interventions from around the world. We hope to see you at our conference!
​
To read more testimonials, visit our testimonial page or share your experiences with us below!
​
-The NaRCAD Team

Covid was just the most dramatic and recent example of issues that all of us interested in academic detailing have been grappling with for years. It was like a student coming to class one day to confront a surprise pop quiz that will determine three-quarters of the grade. Those who had been diligent all semester could deal with it handily, while those who hadn't been paying enough attention are astonished and devastated.  It’s the same for the transmission of clear information about most of the medical conditions our programs confront every day.
 
The pandemic was just the most striking recent example of the good effects of getting this information-transfer right, and the terrible consequences of getting it wrong. We've seen this movie before, in preventing and treating cancer, diabetes, heart disease, maternal and infant mortality, and a host of other conditions for which we have good preventive and therapeutic options to teach about to save lives (and huge costs) by handling that information transfer well, or lose lives and treasure if we do it ham-handedly.

It's been estimated that by early 2022, the risk of illness and death from Covid was determined more by the flow of information than by the biology of the virus. That sounds dramatic, but it’s probably been equally true for years for the other conditions noted above. The pandemic was like a controlled experiment: when confronted by the same infectious agent (more or less) and the same preventions and treatments, some health care systems and communities did much better than others. True, the problem was often lack of access; but another major cause was lack of good transmission of accurate knowledge.

This should be a bracing call to action for academic detailing programs as well as the healthcare delivery system as a whole. If the effective dissemination of accurate, actionable facts can play such an important role in infectious disease, cardiovascular illness, diabetes, pediatrics, obstetrics, and nearly every other branch of health care, the good news is that the “pop quiz” of Covid that we’ve just lived through can remind us how much we can do to enhance that flow of education to transform the best science into the best practice – as well as the awful consequences of getting it wrong.

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

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with José Peña Bravo, PhD, Health Educator, Florida Department of Health in Duval County.
 
Tags: Detailing Visits, Evidence-Based Medicine, Opioid Safety, Data

Anna: Hi, José! Thanks for joining us on our DETAILS blog today. Your journey that led you to the academic detailing community is unique – can you share that journey with us?

José: Yes! My background is not originally in public health. I’m a biomedical researcher by training, specifically preclinical research using animal models. My dissertation work was on understanding the neurophysiological changes and different brain regions involved in behaviors related to substance use.
​
My intention was to stay in academia and start my own lab, but my plans changed during COVID-19 and the opportunity to work with the public health department in Duval County presented itself. It’s been a learning curve for me to switch my perspective from preclinical research to public health—it’s been an enjoyable journey so far!

Anna: I’m sure your biomedical research skills have a positive impact with clinicians during your detailing visits too, especially when clinicians want to discuss the neurobiology of substance use disorder. Speaking of visits, your detailing work is funded through CDC’s Overdose Data to Action (OD2A) grant, which seeks to prevent overdoses. Can you tell us about what the work for this grant looks like in Florida?

José: The OD2A project is a team effort across three CDC-funded jurisdictions in Florida. The health departments share that funding with various community organizations, and we all work toward linking patients with substance use disorder to treatment, mental health care, and care coordination services.

Our detailing team is closely connected to organizations and resources within our community, and we share these resources with clinicians during our detailing visits. We also have access to aggregate prescription data from our jurisdiction and are continuing to find ways to present and incorporate this data at our visits with clinicians. We share this data and other resources across our three jurisdictions.

Anna: We’ve found that many AD programs have been successful when they are closely connected to community resources. NaRCAD recently hosted a detailing training for OD2A recipients that you attended. What was it like to train with other jurisdictions working on the same project?

José: It was helpful to hear from other jurisdictions because they’ve all approached their AD work differently based on the gaps in care in their own communities. I was able to hear from AD programs in rural areas and the specific challenges that their patients face with lack of access to care (long travel times, stigma, etc.).
​
I also enjoyed practicing my detailing skills in a space where I felt comfortable making mistakes. It’s valuable to try things out and see how they’ll go before going out in the field. I learned a lot at the training and am excited to try out some of my new skills at my next visit. ​

Anna: Hearing from other detailers who are doing this important work with you is so helpful as you continue to think about and grow your own program. What advice would you tell other detailers working on the OD2A project?

José: If you’re just starting out, reach out to community partners and get a sense of what patients with substance use disorder are experiencing and the challenges they’re facing before you start detailing clinicians. You’ll better be able to represent what is happening in the community and the resources that exist when you’ve done your research first!

Anna: That’s terrific advice – a key piece of being an effective detailer is understanding the patient experience for the clinical topic you’re detailing on. So, what’s next for your work and Duval County?

José: We’re currently working with our epidemiology team to collect population-level data and present it concisely. We want to be able to efficiently share this data with clinicians in a way that gets their attention and has them compare it to what they’re experiencing in their clinics to ensure an interactive dialogue during detailing visits.
​
Anna: Using data to tell a story helps clinicians see the impact that they have in preventing overdoses and starts a conversation about organizations and resources that exist within communities for patients with substance use disorder. Thanks for sharing your OD2A work with us, José. We look forward to connecting with you and the other OD2A recipients at our conference in November! 

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

Biography. José’s background is in Neuroscience preclinical research with over 10 years of experience in the field. His graduate work focused on the study of rodent models of substance abuse and the neurophysiological changes associated with controlled-substance experience. He has additional experience as an undergraduate and graduate level lecturer in different biomedical research topics. José recently transitioned to a position as health educator as part of the Overdose Data to Action (OD2A) program at the Florida Department of Health in Duval County. His role involves the implementation of the academic detailing program including outreach to clinics, integrating novel data and information to education materials, and keeping track of different metrics associated with outreach and AD sessions.

Tags: Training, Detailing Visits

We are proud to announce that our team at NaRCAD has trained over 1000 people in the techniques of academic detailing. We’ve conducted 60 trainings for detailers working on an amazing range of clinical topics since our first techniques training in 2011. Thank you for growing with us as we’ve expanded from two trainings a year to offering eight trainings in 2022. In honor of reaching this milestone, we’ve compiled testimonials from some of our trainees over the past 11 years.

"Just the right amount of didactic, practice, then putting it all together—I'm ready to develop materials & try it.”

“I now have the confidence to carry out a successful educational visit!"

​“The small groups were perfect for interacting, getting to know each other's backgrounds, and
made conversations and learning enjoyable."

“I came away with refined communication skills and improved clinical knowledge, thanks to the outstanding facilitators.”

“This was fantastic! I learned so much and [am] definitely more comfortable with detailing. It was friendly and open to mistakes, and I really appreciated it.”

“I walked away with great feedback, knowing my strengths and where I can improve.”

“It gave me great insights on the skills I need to be a successful detailer!”

“This training provides the opportunity to learn about AD in an interactive way that allows for growth though practice.”

We look forward to continuing to work with all of you. Read more testimonials on our testimonial page or share your training experiences with us below!
​
-The NaRCAD Team

An interview with Nicole Green, BSP, RPh, ACPR, DPLA, Director of the Ambulatory Pharmacy Services Program at ThedaCare, a healthcare organization based in northeastern and central Wisconsin serving both rural and urban areas.

By: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: Program Management, Detailing Visits, Opioid Safety

Aanchal: Hi Nicole, thank you so much for talking about your program with us today! You’re a pharmacy director at ThedaCare—tell us more about the academic detailing component of your programming.

Nicole: During the past four years working at ThedaCare, I’ve been studying ways in which pharmacists could serve as academic detailers to support opioid stewardship initiatives in order to positively influence prescribing. I was able to collaborate with other physician leaders as well as executive leadership who supported the program, gather data on opioid prescribing, and work on a proposal for academic detailing.
​
We created our first formalized detailing project, called the Ambulatory Pharmacy Services Program, in January 2021. We had four detailers kick off our program and we’ve now doubled our team with a total of eight detailers that have all been trained by NaRCAD. Our detailers are ambulatory pharmacists who are embedded in ThedaCare’s family medicine and internal medicine clinics, serving as both medication experts and pharmacy consultants for patients and providers.

Aanchal: It’s incredible how quickly your program grew! Can you tell us more about the areas you’ve been focusing on for academic detailing?

Nicole: Opioid stewardship is our main focus area for our detailing initiative. Our detailers identify patients who are candidates for Naloxone and work with clinicians to provide education to patients and their family members. The detailers also assess patients who have been on opioids for a long time and determine if they still need to be on them or if tapering should be considered.

The second focus area is comprehensive medication management services for our self-insured population. This includes having our detailers identify chronic disease management gaps and partner with our state employees to optimize care for patients to reduce cost and readmissions.
​
Our last focus area is to support our new heart failure clinic. Patients are referred to this clinic if they’ve been discharged from the hospital with heart failure or if they’ve been referred by a cardiologist. On initial visits, patients see a cardiology provider followed by an ambulatory pharmacist. Our role is to review the patient’s chart and provide recommendations to the team, as well as education to the patients. Our goals are to decrease readmissions and improve guideline-directed medical therapy.

Aanchal: Wow - your team’s impact is tremendous. You previously mentioned that you were able to double your detailing team in less than a year. What characteristics do you believe are needed to have a strong detailing team?

Nicole: Having in-depth knowledge about the clinical topic is extremely important. Detailing is also about building trust and strengthening the relationship with confidence. Detailers need to be confident, especially when they’re first starting out and are meeting with providers that they have yet to build a relationship with.
​
Detailers also need to be prepared to respond confidently and in a way that will still engage the providers in an open conversation. Providers typically don't understand that ambulatory pharmacists’ jobs are to assist patients to meet medication-related goals. There have been assumptions about why we’re delivering this service or why we’re meeting with clinicians. Clinicians ask questions such as, “Is it because I’m being targeted?” or “Is it because of my prescribing practices?”

Aanchal: Agreed; at NaRCAD, we know that having both clinical expertise and confidence communicating is essential to detail successfully. We know what makes a successful detailer – now let’s talk about what qualities you believe make you successful as a leader.

Nicole: The first quality that comes to mind is passion. I lead with energy and show my team how exciting this work can be. I think that's important because previously we didn’t have pharmacists embedded in primary care and patients didn’t have an option to book an appointment with a pharmacist for consultation. Our pharmacists are delivering a service that was not there before. They need to promote themselves and make others aware of how they can help.

Also, I like to be a strong advocate for my team. I constantly raise my hand saying that we can help with different initiatives or that certain projects are right up our alley.

​Finally, I encourage my team to be persistent. We can't take the first “no” from a clinician as rejection. It might mean, “not now,” “I don't understand,” or “I haven't been exposed to this.” It doesn’t mean that they never want to have a visit with an academic detailer or will never change their prescribing behavior. ​

Aanchal: These are all core elements in building a strong team. Some situations can feel defeating and having a strong leader that has your back is so important. Lastly, what advice do you have for someone who is new to managing a team of detailers?

Nicole: Prepare your detailers for the field with the most up-to-date clinical content so that they can interact with clinicians confidently.

Also, provide your detailers with training opportunities and use resources like NaRCAD. If you have the capacity, take it one step further by adding practice role play sessions among peers and allow new detailers to observe other detailers in the field. ​​​When training, help the detailers step out of their comfort zone within a group of people that they know before they step out of their comfort zone with a stranger.

Aanchal: Yes, having support and receiving feedback from peers is an important element of building a strong team. Thank you so much for sharing your perspectives with us, Nicole! We look forward to continuing to see your team grow and feature your work at our upcoming conference!  

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

BIOGRAPHY: Nicole Green completed her pharmacy education at the University of Saskatchewan, Canada followed by a hospital residency. She practiced for over a decade as a Clinical Coordinator primarily in the area of cardiology. She has completed year-long learnings through the AIMM (Alliance for Integrate Medication Management) collaborative as well as the ASHP PLA (Pharmacy Leadership Academy). She is the Director of Ambulatory Pharmacy with ThedaCare. She leads the comprehensive strategic plan to embed pharmacists within family and internal medicine clinics as providers and vital members of the primary care clinical team.  She has served as an Executive panelist with GTMRx (Get the Medications Right) and the Institute for Advancing Health Value.

Her program utilizes Academic Detailing as a means of building professional relationships, establishing credibility and influencing prescribing improvements. Much of her team’s work is related to Quality improvement initiatives in medication stewardship and safety as well as maximal performance in Pharmacy related ACO measures.

Nicole has worked with the ThedaCare cardiology team to build a collaborative Heart Failure Clinic where patients see both a cardiology provider and am ambulatory pharmacist.    

This series features tried-and-true practices from our AD experts. This week’s guest blogger is Zack Dumont, BSP, ACPR, MSPharm a NaRCAD Facilitator and Academic Detailer at RxFiles Academic Detailing Service.

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

Tags: Detailing Visits, Stigma, Training

Model the compassion you expect from others.
​
In recent years, the academic detailing community has been trying to recognize the harmful role of stigma in many clinical settings and to include stigma reduction in our detailing messages. In applying this framework, we encourage an empathetic view of people who experience stigma. They don’t choose to have addictions, exhibit certain behaviors, or to be ‘villainous’. We can all agree they don’t deserve harsh judgment and criticism. 

I invite you to bring forth your most charitable mindset for a moment and apply that same framework when you encounter stigma during a detailing visit. Imagine that the clinicians or people you detail hold stigma not because they want to stigmatize others, but for some more relatable reasons: they’re impressionable, they’re naïve, they’re vulnerable. In the same way that a clinician wouldn’t expect someone with a substance use disorder to suddenly recover if harshly confronted, we can’t expect the person who stigmatizes to respond to similar tactics.
​
Be patient, be persistent (after all, you care and want them to be their best selves), and be persuasive with those that you’re detailing. You have a lot of natural talent, training, and experience to efficiently help people make informed decisions through detailing visits. Don’t limit it to therapeutic decision-making; extend it to the mental and emotional aspects of care, as well.

Balance and refine your self-reflections.

Alone or with a colleague, find a quick and easy way to debrief after each visit – save the more intense feedback for quarterly or annual reviews. Maybe it’s asking two simple questions like, “What went well?” and “What could have gone better?” and taking a moment to reflect on each.
​
And, just like AD visits which are 90% prep and 10% execution, the more the better when it comes to ‘prepping’ your self-reflection questions. So, “What went well?” could be more specific to one of your strengths:

• How did I bring my warmth and friendliness to the visit?
• What did I do that helped explain the evidence as well as I’m known for?

Your “What could have gone better?” question could focus on an area of improvement unique to you:

• Did I remember to listen more than talk? How many minutes did I spend doing each?
• Did I embrace the prescriber’s skepticism, or did I shy away from it again?

This isn’t easy, but it’s low risk with the potential for big reward… so I encourage you to jump in! 

Want more tips?
Stay tuned for the next installment in our Words of AD Wisdom series, and reach out to the NaRCAD team, subscribe to our network, or check out our discussion forum to hear more tips and ways to train your brain!

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Lexie Hach, Regional Health Specialist, Bureau of HIV, STD, and Hepatitis, Capacity Extension Program, Iowa Department of Public Health.
 
Tags: Detailing Visits, Evidence-Based Medicine, Stigma, Rural AD Program

Anna: Those are some impressive numbers across both the clinical and community settings. Thank you for letting us feature your detailing work and learn more about the impact your team is making in your state!

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

Biography. Lexie Hach holds an Associate Degree in Nursing, Bachelor of Arts degree in Health Promotion and Women’s Health, and a Master of Arts degree in Community Health Education. Lexie is currently a Doctoral student in Public Health (DrPH) with an Epidemiology concentration at the University of Nebraska Medical Center (UNMC). 

Lexie has held positions in nursing, health education, public health, and healthcare marketing. Lexie has been with the Bureau of HIV, STD, and Hepatitis Capacity Extension Program at the Iowa Department of Public Health for over five years as a Regional Health Specialist (RHS). Lexie was previously with the bureau as a Disease Intervention Specialist (DIS). 

Lexie was instrumental in developing and implementing the RHS program in Iowa’s rural communities. In her RHS (academic detailing) role, Lexie educated a variety of different stakeholders on best practices related to HIV, STIs, and Hepatitis in central Iowa. Lexie has helped support the Sexually Transmitted Disease (STD) Program as a DIS due to COVID-19 and also helped as a COVID-19 contact tracer. Lexie was the previous workforce health department co-chair for Iowa’s statewide strategic plan to stop HIV in Iowa (Stop HIV Iowa). Lexie recently returned to her roots in the STD program and now serves as an Integrated DIS and Special Projects Coordinator, but continues to work alongside her fellow RHS colleagues.
 

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Sandeep (Sonny) Singh Bains, PharmD, BCPS, Clinical Educator, Alosa Health. Alosa Health is a national leader in developing and implementing academic detailing programs to improve prescribing.
 
Tags: Detailing Visits, Evidence-Based Medicine, Primary Care, Training

Anna: Hi, Sonny! It’s wonderful to connect with you today and hear about your work as a clinical educator at Alosa Health. What has your clinical pharmacist journey looked like to date?
 
Sonny: I’ve been working for over a decade in hospitals and primary care. I completed my residency in hospital pharmacy, and as I continued to do administrative and clinical work in hospitals, my interests shifted more towards primary care and population health.
 
I’m originally from California where it’s common to have pharmacy involved in primary care. When I moved to Pennsylvania, a lot of clinicians didn’t understand why a pharmacist would be in a primary care setting and were skeptical of me and my role within the clinic.
 
Fast-forward 10 years, and almost every health system in Philadelphia has a pharmacist on their team within their primary care network. I’d like to think that I can take a little bit of credit for paving the way for pharmacists on primary care teams throughout our state!
 
Anna: That’s definitely something to be proud of. How did you end up being a detailer? ​

​Sonny: I’d been noticing a lot of overlap in the work being done in our primary care clinics by different members of the team. I ended up creating protocols to automate certain things for different chronic conditions and people would say, “Wow, this is brilliant.” It really wasn’t brilliant; I was using the same set of guidelines in the literature I was reading and was communicating that to clinicians to make workflows easier. 

​I didn’t know about the strategy of academic detailing at the time, but I knew I needed to educate clinicians. I was fortunate enough to be connected with Alosa Health and I now work for them as a full-time consultant. I work as a detailer and also help hire, interview, train, coach, and mentor new detailers on the team.
 
Anna: You were meant to be a detailer before you even knew what it was! Alosa has been working on diverse clinical topics over the years including, antiplatelets, atrial fibrillation, immunizations for elderly, serious illness conversations, chronic obstructive pulmonary disease (COPD), heart failure, dementia, atherosclerotic cardiovascular disease (ASCVD) prevention, diabetes, acute pain, chronic pain, and opioid use disorder. What have been some of the campaigns where you’ve felt you’ve made an impact?
 
Sonny: It’s a lot of fun to be working on so many different campaigns. Many of the topics fit right into my wheelhouse with my hospital and primary care background. Diabetes has been my favorite topic. I’ve been able to make a large impact for patients and care providers. We’re able to improve lives of patients (prevention of stroke/heart attacks) and improve outcomes for providers and health systems (financial incentives, quality ratings, etc.).
 
I’m also proud to be part of the pain modules. The opioid epidemic has impacted all of us in America and I’m glad to be able to do my part in helping to bring resources and evidence-based treatment to local providers in our community.

​Anna: It sure sounds like you’ve been able to make an impact! How has your work with Alosa evolved over the years?
 
Sonny: Alosa Health has been expanding and we have several new partnerships and collaborations throughout the United States. We started detailing only in the state of Pennsylvania and we’ve now expanded to numerous states. It’s been exciting to be part of the leadership team to help coach detailers, as well as create creative partnerships with local health systems to improve outcomes for patients. 
 
Anna: What challenges have come up as your program has continued to expand?
 
Sonny: The biggest barrier we’ve experienced, like many detailing programs, has been access to clinicians and the ability to set up visits. I’ve had relationships with clinicians and clinic staff in the past where I could have walked into any office at any given time, but I’ve lost a lot of those relationships with COVID and staff turnover. I’ve been working hard to reestablish relationships in the field and teach new detailers how important strong relationships are to our work as detailers. 

Anna: What approaches have you taken to reestablish relationships, as well as to gain access to new clinics?
 
Sonny: I like to partner with colleagues that I’ve worked with previously. I recently connected with a former colleague who’s a VP at a large healthcare organization and we quickly realized we could help each other improve patient outcomes and reduce cost. From this connection, I was able to get buy-in at the administrative level and accessed hundreds of prescribers. They even gave their clinicians a monetary incentive to meet with our detailers.
 
We’ve also benefited from connecting with administrators of health systems. We approach them like business partners; it takes a special skill to communicate and work with an administrator. It’s important to have team members who understand how to communicate with leadership effectively to get that buy-in.
 
Anna: It might take more time to get buy-in from administrators, but it opens so many doors once it’s done successfully. As we wrap up, can you tell us some tips to help our readers be effective detailers and communicators?
 
Sonny:

• Listen to the clinicians you’re detailing; if you're talking more than 50% of the visit, you're probably talking too much.
• Remember that you’re there as a service for clinicians to improve patient outcomes, so try to frame your visit as what’s in it for them, rather than how many key messages you need to get through.
• Clinicians who believe in your service will invite you back and refer you to colleagues. We all love being in the field and educating clinicians, but we can’t get there without first building strong and trusting relationships.

 
Anna: It’s so important to put the work in to build solid relationships with clinicians in order to be an effective detailer. Thanks for joining us on the DETAILS blog, Sonny - our AD community will gain a lot from the insights you’ve shared today!

Learn more about Alosa’s work: alosahealth.org/clinical-modules

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Biography. Sandeep is a clinical pharmacist with extensive clinical leadership experience in both acute care and ambulatory healthcare settings. He completed post-graduate training at Einstein Medical Center in Philadelphia and has since worked in clinical pharmacy leadership with large healthcare systems in the greater Philadelphia area. He is also the principal consultant at Bains Rx, LLC, a healthcare consulting firm dedicated to improving outcomes while reducing costs.