The Patient & Attentive e-Detailer: Navigating a Stressed System During COVID-19
An interview with Mary Liz Doyle Tadduni, PhD, MBA, MSN, RN, Education Consultant, Independent Drug Information Service and Expert Training Consultant, National Resource Center for Academic Detailing
by Anna Morgan, RN, BSN, MPH, NaRCAD Program Manager
Tags: Detailing Visits, E-Detailing, COVID-19
Anna: Hi, Mary Liz! We’re excited to learn more about what the pivot to e-Detailing has been like for you as an expert academic detailer for over 16 years and a NaRCAD training facilitator. Can you tell us briefly how your role as an academic detailer at Alosa Health has changed since the COVID-19 pandemic began?
Mary Liz: The restrictions on in-person meetings has resulted in all of my detailing visits switching over to phone or video calls. The number of providers I’ve been detailing has also considerably decreased due to time constraints and office restrictions related to COVID-19. In terms of the topics I’ve been detailing on, our team has been maintaining focus on delivering our planned modules, but I do discuss the impact of COVID-19 quite a bit with providers.
Our current topic for Pennsylvania’s Pharmaceutical Assistance Contract for the Elderly (PACE) is dementia, which is important as it relates to COVID-19. Patients with dementia who reside in nursing care facilities in Pennsylvania can’t see their loved ones due to restrictive visiting policies. Primary care providers are dealing with the challenges and consequences of this every day – and academic detailers can’t ignore it.
Anna: It’s crucial that detailers understand the ways COVID-19 impacts the work of frontline care providers.
Mary Liz: Absolutely. With COVID, healthcare delivery has changed dramatically and there’s been a large increase in telehealth visits. Many providers in Pennsylvania are working from home and not going into the office or seeing only a limited number of patients in the office setting. Even if they are seeing patients in person, the process of seeing a patient has changed. The offices sometimes have front desk staff working from home and require patients to wait in their cars before entering the building. Primary care providers are still trying to adjust to all of this. You need to consider what is really happening on the ground for providers during your detailing visits – it’s part of your needs assessment. The needs of the primary care provider right now differ greatly from the pre-COVID era.
Anna: Assessing a clinician’s individual needs is an integral piece of a traditional academic detailing visit. How have you been able to implement AD in its intended form when detailing virtually?
Mary Liz: The original model of academic detailing with Dr. Jerry Avorn has always been 1:1, face-to-face encounters, but that doesn’t mean you can’t have a productive visit virtually. It’s just another venue to deliver the evidence. I really do believe that it’s better to be in person, but delivering the evidence, no matter what the platform, is better than having a provider not know what they need to deliver the best care.
Anna: You’ve carried out this traditional, in-person model for over 16 years – what challenges have you faced when detailing providers virtually, especially during the pandemic?
Mary Liz: Time has been a barrier due to the overall stress on the healthcare system. There are also more distractions when visits are done virtually because providers are taken out of a controlled office setting. A provider could be home with their kids, or even driving in a car during a visit. You never know where a provider will be during a virtual detailing visit.
Some offices in my area also aren’t picking up their phones, so you can’t have conversations on the phone or "stop in" for a cold call. Having a scheduled in-person visit with a provider is much easier than trying to connect with a provider over Zoom. You add another step to your process when you have to work through technology glitches.
Virtual platforms or telephone calls can also be difficult for providers who are visual learners. You need to be creative with the way you share materials. But there are many similarities to in-person visits; no visit is “one-size-fits-all”. You need to consider the provider, their situation, and their environment and decide what will be the best way to deliver the evidence.
Anna: You’re right! It’s never one-size-fits-all when it comes to academic detailing. This has become even more evident as programs around the world have pivoted to e-Detailing. Do you believe that virtual visits can be as effective as traditional, in-person visits?
Mary Liz: I do. It may not be as personal as an environment, but if you have a relationship with the provider, it shouldn’t matter whether it’s in person or virtual. I would continue to detail virtually in the future if a provider requested it, but I do favor in-person visits – it’s what I’ve done for so many years and I’d rather see the providers face-to-face. You get even more out of a detailing visit when you have that interaction.
Anna: There’s certainly something to be said about the impact of the original model’s focus on in-person, 1:1 interactivity; it’s what has been studied for many years as effective and impactful.
In a time where being flexible is critical, what are some tips you would offer to detailers during this time?
Mary Liz: It’s crucial that you’re attentive to the provider you’re detailing. Continue to focus on the needs assessment. While you need to communicate your key messages, if you aren’t doing a proper needs assessment, you aren’t operating under the guidelines of academic detailing, which is all about listening and being interested in how someone is practicing. This leads you to be able to provide the evidence in the most effective way.
Also, remember to be patient with providers! They’re still adjusting to this new world and they may even have questions about the impact of COVID-19 on the future of healthcare, as well as on their place within the healthcare system.
Mitigate that impact by offering providers community resources that will support them through the pandemic – if you do that, then you’re fully realizing the true purpose of academic detailing as a supportive service that’s customized to real-world challenges.
Dr. Mary Liz Doyle Tadduni’s background has included critical care and medical-surgical nursing, nursing administration, and hospital administration in major university teaching hospitals in the city of Philadelphia. Dr. Doyle Tadduni is a training facilitator at NaRCAD, and an academic detailer with the Independent Drug Information Service of the Alosa Foundation.
Dr. Doyle Tadduni is a BSN graduate of DeSales University. She completed her MSN, with a concentration in Nursing Administration, from Widener University.
Dr. Doyle Tadduni was awarded the MBA degree, with a concentration in Healthcare Management Services Administration, from Widener University where she was the recipient of the Healthcare Management Services Administration’s Student Excellence Award. Following her graduate work in both nursing and business, Dr. Doyle Tadduni completed her administrative residency at the Hospital of the University of Pennsylvania in Philadelphia. She completed her Ph.D. in Nursing from Widener University. Dr. Doyle Tadduni presented her doctoral research, “Terrorism Preparedness: Perceptions of Connectivity of Emergency Nurses of the Emergency Nurses Association,” at the 10th Annual Interdisciplinary Research Conference in Dublin, Ireland.
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