NaRCAD: Terryn, thank you so much for speaking with us today about your experiences with detailing in the province of British Columbia. The BC Provincial Academic Detailing (PAD) Service certainly has a lot of ground to cover. Tell us about the program goals and geography.

Terryn: For reference, British Columbia is geographically larger than Texas, but the population of British Columbia is only about 5 million people. We provide our detailing services to family practice physicians, nurse practitioners, and a few other healthcare professionals. Our detailers each do more than 175 visits per year, and collectively, they see about 2000 providers per topic, which includes about a third or so, of all the family physicians in BC.
 
We have 12 detailers in total, half of whom are working in less densely populated areas. For example, the northern end of the province is mostly small communities with only 3-4 providers in each town. One year, one of the detailers drove over 17,000 km (10,563mi) for her visits alone!

NaRCAD: That’s an incredible amount of work that your detailers have been up to! And you yourself have been active in AD for a long time. What was your experience then like?

Terryn: I started in 1993 with the program that would one day expand to become the PAD service, and I detailed for about 7 years. I came back to academic detailing in 2008 as the coordinator of the provincial program. When I started in 1993, I had just graduated with my PharmD. I had read about AD and was excited to try something new.

You have to realize, at the time, technology wasn’t that advanced... I didn’t even have an e-mail address when I first started.  You couldn’t just send people a note and say “When would you like to meet?” It wasn’t simple to access people. 

​NaRCAD: How would you describe how AD has changed since you started?

Terryn: When I started, I was the first academic detailer in Canada. There were about 70 physicians that I would go out to visit for each of the topics I put together after having the content reviewed by a local physician specialist from within our own community. One of the things that has changed is the breadth of resources and the growth of the AD community. There are so many more people involved, content is more thoroughly researched, and the literature is more readily accessible through technology.

NaRCAD: Technology has certainly changed the way the world works, and it’s something that detailing programs are turning to more and more to tackle the challenges you’ve mentioned, such as trying to serve a large and scattered population with a limited team. We’ve seen the increased use of tele-communications to do detailing. What has your experience been with virtual detailing, also commonly called ‘e-detailing’?

Terryn: One of the things we value about AD is that truly interactive, face-to-face encounter and that ability to individualize sessions to the provider’s learning needs. Virtual detailing uses a different methodology altogether. I think there are advantages to virtual detailing, but sometimes I think that it’s not as simple as moving AD to a web platform. I worry about the personal elements you can lose, even when using a web platform where you can see each other. My detailers often end up making slides of the original materials, which sometimes turns the session into more of a presentation.

NaRCAD: Can you elaborate further on the nuances you’ve seen with this new approach?

Terryn: We started with something we called Technology-Enabled AD (TEAD) which was a limited study done to compare the efficacy of TEAD versus a traditional face-to-face visit. They found that there was an effective knowledge exchange during both types of sessions, but the time it took for TEAD was far shorter. However, when we added TEAD as an optional feature for our providers, we ran into multiple challenges, such as detailers and providers not being familiar enough with the technology. The large majority of our providers choose to meet in person when they have that option.

That said, virtual detailing has been useful considering BC’s terrain and rough winters. Some regions have winter 8 months of the year and travel is limited for safety reasons. We have used virtual detailing, but find that we need detailers that are tech-savvy and can guide providers through accessing the platform easily.

The key is maintaining the interactivity component and having the session not become a presentation. If we can embrace virtual detailing as its own, unique skillset, we may be able to take advantage of all of its benefits. I think that we’re also at a changing point in technology – the next generation of providers (and detailers) will have grown up with and be more comfortable using technology.

NaRCAD: There will be a lot of growth in detailing as we are able to incorporate more options into how we reach providers, with the emphasis being on building a strong relationship.

Terryn: The goal of AD has always been to have a clinician who values a discussion about the evidence, and then is able to incorporate the evidence into their own practice and drug therapy decision making. E-detailing is just another modality for doing that.

​We found that virtual detailing is most effective after establishing a prior relationship with the provider during a face-to-face visit. We received fantastic feedback from one provider who felt the virtual detailing session that he participated in from the comfort and privacy of his home allowed him to ask questions he might otherwise have avoided asking in a group setting. If we can use technology to build relationships like that, then ultimately isn’t that what we want?

​I would say that it is. 

Biography.
Terryn Naumann is the Director of Academic Detailing and Optimal Use at British Columbia’s Ministry of Health’s Pharmaceutical Services Division. She earned her pharmacy degrees from the University of British Columbia and completed a hospital pharmacy residency at St. Paul’s Hospital in Vancouver. Terryn began her career in academic detailing in 1993 when she worked at Lions Gate Hospital in North Vancouver as the clinical pharmacist for the Community Drug Utilization Program – the first academic detailing program in Canada.
 
Since 2008, Terryn has led BC’s Provincial Academic Detailing (PAD) Service, a team of 12 academic detailing pharmacists who conduct over 2000 academic detailing/small group learning sessions each year. She is a member of the Canadian Academic Detailing Collaboration, having served as chairperson and secretary. She has also been a facilitator at several of the Centre for Effective Practice’s Basic Academic Detailing workshops.

Trainee Update Series: Where Are They Now?
Bevin K. Shagoury, Communications & Education Director

Hi, Emily! We’re happy to reconnect with a NaRCAD trainee, and to feature your current work on this month’s blog. Can you tell us a little about yourself and how you ended up working at the National Colorectal Cancer Roundtable?
I’ve worked in public health for 12 years, and in seven of those years I’ve focused on cancer screening and prevention. I got to know NaRCAD while working at the Washington State Department of Health, where I designed their approach and curriculum to coach primary care clinics and health systems on quality improvement strategies to increase colorectal cancer screening. Then last summer I joined the American Cancer Society as the National Colorectal Cancer Roundtable’s new associate director.

​In this role much of my work is still focused on developing educational resources for providers, but I’m also involved in efforts to increase colorectal cancer screening through other channels, such as public education and policy. I learned so much about effective methods for conducting clinical education from the NaRCAD Academic Detailing training that I participated in back in October 2012. I’m grateful to have the opportunity to reconnect with NaRCAD, and thank you for the opportunity to share an update on my work!
 
Tell us a little bit about background and goals of the Roundtable.
The Roundtable, established by the American Cancer Society (ACS) and the Centers for Disease Control and Prevention (CDC) in 1997, is a national coalition dedicated to reducing the incidence of and mortality from colorectal cancer in the U.S., through coordinated leadership, strategic planning, and advocacy. Today, the Roundtable is a collaborative partnership with more than 100 member organizations across the nation. Through the efforts of several task groups, the Roundtable advances initiatives that focus on provider education, public education, health policy, quality and disparities issues.

Thanks in part to the work of many of our members, colorectal cancer incidence and mortality rates have dropped by over 30% in the U.S. among adults 50 and older in the last fifteen years, with a substantial fraction of these declines due to screening. Yet, despite the good news, colorectal cancer remains the second-leading cause of cancer death in the U.S. when men and women are combined.

The Roundtable is focusing on a great initiative called “80% by 2018.” What’s the story behind this movement?
To accelerate efforts to increase colorectal cancer screening, the Roundtable launched the 80% by 2018 initiative in March of 2014. 80% by 2018 is a movement in which hundreds of organizations have committed to substantially reducing colorectal cancer as a major public health problem and are working toward the shared goal of reaching 80% of adults aged 50 and older screened for colorectal cancer by 2018.
 
To date over 650 organizations – including medical professional societies, academic centers, survivor groups, government agencies, cancer coalitions, cancer centers, payers and many others – have signed a pledge to make this goal a priority. If we can achieve 80% by 2018, 277,000 cases and 203,000 colorectal cancer deaths would be prevented by 2030. You can learn more about 80% by 2018 and pledge your organization’s support on our 80% by 2018 webpage.

You attended a NaRCAD Academic Detailing Training a few years back to practice skills in clinical outreach education. Can you tell us a little bit about the highlights of your experience?
Academic detailing and practice facilitation are relatively new fields, so when I first accepted a job that included these skills I felt a little in over my head! I was up for the challenge, though, since I saw provider education and training as a way to move further upstream in making substantive and sustainable changes that would positively affect public health. It can take a while for new clinical findings to get implemented in primary care, so I saw that academic detailers and practice facilitators serve a key role in getting these findings into clinical practice.

​My two-day Academic Detailing Training with NaRCAD taught me practical skills to work in this role, and gave me the confidence to know I could be effective without a clinical background. The highlight was the role-playing and one-on-one feedback from experienced academic detailers. Their personal feedback was not something I could have found in a book or online training.
 
What tools from the training do you think are most relevant to active detailers in the field? 
Some of the most valuable tools I took from the training were the interpersonal skills needed to be effective as an academic detailer. The tips on how to solicit buy in after sharing a practice change was incredibly useful, such as asking: “does this sound like something you’d be willing to try in your practice?”

It was also really helpful to learn how to approach sharing a clinical update that could potentially make a provider feel as though they had been delivering inappropriate care. The training taught me how to navigate these discussions by saying that while something might be common practice it’s no longer supported by the latest clinical evidence. In my experience, providers were very receptive to learning new clinical updates when it was shared in such a way that they did not feel they were being reprimanded for not knowing already knowing the latest evidence.
 
Thanks for chatting with us. We’re happy to help get the word out about “80% by 2018” and looking forward to hearing the results of the initiative.
Thank you for the opportunity! I enjoyed reconnecting with you and reflecting on how my training with NaRCAD has enriched my work in clinical education. I’d like to encourage any readers that are interested in 80% by 2018 and efforts to increase colorectal cancer screening to learn about the campaign. And there are lots of great tools and resources in the provider education section of our website that might be of particular interest to academic detailers.

We’ve just celebrated the 5th anniversary of NaRCAD, the only national resource center and network advancing clinical outreach education. We’re also celebrating a terrifically successful 2015. Highlights included running two sold-out academic detailing techniques trainings here in Boston; traveling to San Francisco and Oklahoma City for two customized off-site trainings; and bringing everyone together for #NaRCAD2015: Motivating Change, Transforming Care, our most successful annual conference so far.
 
We’re proud of it all, and more, including the brand-new NaRCAD Website—enjoy and explore a new gateway to academic detailing, including more interactive resources and expanded opportunities for connection, learning, and sharing. With so much to celebrate from 2015, we’re setting the bar high with big goals for the year ahead. Here’s what we’ll be up to in 2016, with you as our partners:
 
Transformative Trainings: Registration for our May training in Boston is open and already filling up fast! We’re also happy to be in high demand for at least 5 “on-the-road” educational sessions and related projects across the US this year.  If you want to learn more about the ways we can share our resources and expertise to help your clinical outreach education program grow and succeed, let us know—we’d love to learn about what you’re doing and see how we can help.
 
#NaRCAD2016: Collaborating to Create Change. Our annual conference is the capstone of the year, so mark your calendars for November 14-15, 2016. What’s new this year? #NaRCAD2016 will feature opportunities to submit a proposal to showcase your clinical outreach education experience, data, and insights with the rest of the NaRCAD community. Keep your eyes on your e-mail and our conference page for more details about submission, coming soon.

​More Collaboration for Improved Health Outcomes: With 5 years of partnerships under our belt, we’re continuing to connect every day with new colleagues working in the field of AD and clinical outreach education. We’re excited to keep expanding our community and creating opportunities for deeper collaboration across programs. We invite you to stay connected as we continue to publish new blogs and interviews, feature partners on our network directory, expand our Learning Center offerings, and recommend evidence-based health news and events on our social media feeds.
 
Most of all, our team wants to hear from you! Drop us a note to tell us what you’re doing, and tell us how we can help strengthen your program and highlight your successes.
 
​See you this year!
Dr. Mike Fischer

Kicking Day 1 off and setting the tone for the entire event, NaRCAD Director Dr. Mike Fischer warmly welcomed our packed room at Harvard Medical School’s Martin Center by encouraging collaboration, connection, and sharing. Our Day 1 Keynote Speaker Dr. Carolyn Clancy, the CMO of the Veteran’s Health Administration, described the VHA’s work to improve pain management in the veteran population while addressing the challenges of medication abuse and overdose. Dr. Clancy shared strategy and data behind the national effort and the critical role of academic detailing in it, connecting attendees to a big-picture view that can be adopted to look at other health epidemics and interventions.

Our first expert panel presented Practice Facilitation in Primary Care. Andy Ellner moderated the session, leading panelists Ann Lefebvre of North Carolina's AHEC Program, Lyndee Knox of LA Net, and Allyson Gottsman of HealthTeamWorks to discuss strategies, contextualize their work in relation to academic detailing and quality improvement, and share their personal approaches to challenges in primary care behavior change.  Allyson Gottsman’s much-appreciated analogy that practice facilitation is not unlike “leading a fisherman to a well-stocked pond” resonated with panelists and participants alike. Many attendees who were actively engaged in practice facilitation in their daily work shared that the panel helped them to think about their work in a new way.

The afternoon’s breakout sessions offered attendees multiple tracks with AD-related topics to explore: deconstructing and analyzing a 1:1 AD visit, exploring the skills needed to manage an effective AD program, and strategizing on ways to identify and harness stakeholder support when initiating a new program or strengthening an existing one.

The afternoon closed with two presentations; the first, by Terryn Naumann of the Canadian Academic Detailing Collaboration (CADC), offered participants a view of the power of synergy and teamwork, the historical context of the CADC’s creation and growth, and the future of the collaboration.

More examples of successful practice change were illustrated by the morning’s Themed Plenary on the Intersection of Public Health and AD. Dr. Phillip Coffin of the San Francisco Department of Public Health shared the success of an intervention focusing on co-prescribing of naloxone to reverse opioid overdose deaths in San Francisco. Another successful AD intervention was presented by Michael Kharfen of the Washington D.C. Department of Health, who highlighted the successful implementation of AD programs to increase HIV and Hepatitis C screening and treatment.

The afternoon featured our second Expert Panel, this time on the role of AD within integrated healthcare systems. Moderated by Dr. Mike Fischer of NaRCAD, panelists Joy Leotsakos of Atrius Health (MA), Sameer Awsare of Kaiser Permanente Medical Group (CA), and Valerie Royal of Greenville Health System (SC) shared their experiences using AD in systems at different stages of development. Attendees had the opportunity to discuss this topic further in the afternoon’s breakout sessions, which also included a session on practice facilitation, as well as third session to continue to explore AD and public health partnerships.

The conference’s closing discussion was led by Mike Fischer, who thanked not only the speakers, panelists, and session leaders, but the participants, whose willingness to share their experiences within an interactive setting was key in creating solutions to bring back to use in their daily work. The creative collaborations, exchange of resources, excitement in combating challenges in the field, and belief in the importance of AD for the future of healthcare transformation were felt by all at the closing of a very full and thought-provoking event.

Our Twitter feed tracks the event’s highlights through #NaRCAD2015, and you can catch our event photo album on our Facebook page. We invite you to explore these topics, learn about our speakers and attendees, and connect with us at the NaRCAD Conference Hub, where you can access on-demand video of all main sessions from the conference. Thank you again to all who attended, and to AHRQ for funding our series. Please stay in touch with us and each other, and continue the conversation and idea sharing below. ​
​We hope to see you in 2016!

Jerry Avorn, MD, NaRCAD Co-Director
Often, in discussing academic detailing programs with current or potential sponsors, the question comes up: “Wouldn’t it be cheaper just to deliver the message to a whole group of clinicians at once, instead of the much more cumbersome process of talking to prescribers one at a time?”  Sure, it would be cheaper.

So would just mailing (or e-mailing) memos to people telling them what to do, or requiring time-consuming groveling on 1-800-DROP-DEAD prior authorization numbers before a costly resource can be ordered. The problem is that cheaper solutions often don’t work, or don’t work well. We have decades of proof that putting health care professionals together in a darkened auditorium and subjecting them to a PowerPoint Tolerance Test does not reliably change behavior.

The main reason that academic detailing relies on one-on-one interactive communication is that it is the best way for the outreach educator to accomplish several key goals:

• Understand the clinician’s current practices, attitudes, and beliefs;
• Tailor a message specifically targeted to that person’s educational needs, and where he or she is coming from;
• Keep the learner engaged. (It’s harder to read e-mails, gaze out the window, or doze off if you’re in the middle of a conversation.)

​
Well-trained academic detailers understand this, and they use the interactivity to craft a real-time, care-improvement message that best addresses the learning needs (and attitudes and biases!) of the person they’re visiting. Less competent academic detailers force their “targets” to sit still while they administer a canned micro-lecture monologue, which works poorly.  They may feel they “got through all the points” they wanted to cover, but if there was no interactivity, no conversation, then the person they were talking at might as well have been falling asleep in a darkened amphitheatre.

We know this is the case from decades of experience and scores of randomized controlled trials. We also know, perhaps most compellingly, that when the drug industry wants to change what we know and about its products, it sends people to our offices to talk with us—it doesn’t rely only on the less expensive modalities of mailings, e-messages, and sponsored lectures.

So the next time someone suggests that it might be more inexpensive to just gather prescribers into a big room and have someone talk at them for an hour, agree with them. Then point out that it’s also less time-intensive to scarf down a Big Mac than eat a real meal, shoot off a series of emoticons rather than a personalized note, or listen to a ring tone of a Beethoven sonata rather than hear it performed by musicians. Cheaper isn’t everything.

Mike Fischer, MD, MS, NaRCAD Director
NaRCAD is thriving, thanks to the engagement and enthusiasm of our network of healthcare professionals working to improve patient outcomes. The best way to become more involved in that network is to join us for our 3rd International Conference on Academic Detailing. This year’s conference will be our most exciting and interactive event to date, with a stimulating 2-day program bringing together thought leaders for expert panels, best practices, breakout tracks, networking, and invigorating group discussions on innovations in the field.

Our keynote presentations will provide critical insights for everyone working to improve healthcare quality and patient outcomes. On Monday, Nov. 9th, Dr. Carolyn Clancy, Chief Medical Officer of the Veterans Health Administration, will highlight the VA’s use of academic detailing to address the epidemic of opioid overdose and misuse to save veteran’s lives. On Tuesday, Nov. 10th, Dr. Don Goldmann, Chief Medical and Scientific Officer at the Institute for Healthcare Improvement, will provide his insights on how to engage front-line clinicians in committing to change – drawing on IHI’s years of experience in promoting patient safety.

Many questions about academic detailing still need to be explored, new ideas generated, and connections made. We
need to foster solution-based discussion from a wide range of voices, representing clinical education, public health, practice transformation, government, the non-profit sector, hospital networks, academic institutions, and others. But the most important ingredient for the success of this event is you.

Join us as we work together to discover solutions, connect you with others that can amplify your impact and elevate your work, and share your experiences and insights on the best ways to navigate a rapidly-changing healthcare landscape. We hope you’ll join us this November 9th and 10th, and that you’ll help us spread the news about this unique, transformative event. See you in November!

Bevin K. Shagoury, Communications & Ed. Director

The NaRCAD team is heading into October with an afterglow from our latest 2-day training session with a truly dynamic group of outreach educators. Each new group of trainees inspires our team with their plans to use their new skills for innovative clinical education programming.

​This fall’s training class will pursue a range of goals in their programs, including:

• promoting provider awareness of diabetes management programs
• increasing Hepatitis C screening and testing for veterans
• increasing primary care referrals for mammography screening
• reducing antibiotic overprescribing, and
• increasing provider cultural competency when serving HIV+ patients who have been formerly incarcerated.

With attendees representing diverse geographic regions such as South Carolina, Norway, Washington State, and beyond, we were rewarded by this group’s eagerness to learn and to share fresh, new ideas on how to make our successful program even stronger.

Our program had a few new highlights to share, too—including an engaging presentation on theories of behavior change, led by Arielle Mather, MPH, NaRCAD’s Education & Training Manager. Setting the stage during Day 1 of our program, this foundational presentation reviewed behavior change models and theories that inform the practice of academic detailing, including Motivational Interviewing and the Theory of Planned Behavior. The presentation was met with enthusiasm and appreciation by trainees and facilitators alike, and many trainees requested more time to talk about these theories during breakout sessions.

Another new element of our program provided dedicated time on Day 2 for a lively group discussion on personalized support from NaRCAD. Trainees, staff, and facilitators brainstormed as a group the ways that NaRCAD could continue to bolster an active learning community through virtual resources, e-news, sharing of best practices, partner modeling, and 1:1 consultation.  As a final new feature of our program, we created time during the personalized support session for more role-play practice. Participants who wanted additional support prior to their final, recorded detailing session had the option to head to a breakout room and receive additional, personalized practice time with an expert facilitator.

As we start planning for our Spring 2016 AD Techniques Training program, we have many new ideas to implement, trainee-to-expert introductions to make, and best practices to feature. As NaRCAD enters our 5th year and prepares for our 3rd annual conference, we hope you’ll join our community of experts leading the way to improving health outcomes with engaging, clinical outreach education.

Behind the Scenes with Dr. Doyle-Tadduni, NaRCAD Training Facilitator
Editor’s note: In this series, DETAILS asks Academic Detailing (AD) Techniques Training facilitators how they lead by example, challenge participants, and ensure that trainees are ready to go out into the field. Dr. Doyle-Tadduni focused on her insights and tips to success in providing excellent clinical education by building strong detailer-to-clinician relationships based on evidence, clarity, and “intrinsic trust.”  
​
NaRCAD: Hi, Mary Liz! We’re looking forward to learning more from you about what it’s like to train prospective academic detailers. But first, tell us a little about how you became involved in detailing.

Dr. Doyle-Tadduni: I began working as an academic detailer about 10 years ago in Pennsylvania with the Independent Drug Information Service, which is sponsored by PACE (Pharmaceutical Assistance Contract for the Elderly). My clinical background in nursing and my teaching background within various university settings has served me well in this role as a clinical educator.

NaRCAD: What does a day of academic detailing look like for you? What successes and challenges do you see?

Dr. Doyle-Tadduni: My territory encompasses the westerns suburbs of Philadelphia where I visit physicians, nurse practitioners, and physician assistants. I see these providers in a variety of settings, including private practices, university-affiliated practices, and outpatient health care systems.

Since AD is a new concept to many practitioners, it’s essential to start your visit by educating providers about the importance of academic detailing and how it will benefit them and their patients. In this way, I’ve developed many long-standing relationships with providers who have said that AD has been very beneficial for their individual practices. It’s very gratifying in a follow-up appointment to hear that a provider has taken the evidence you provided and put it into practice, creating a positive outcome for patients.

NaRCAD: How do you build strong relationships with the clinicians you visit?

​Dr. Doyle-Tadduni: There needs to be an intrinsic sense of trust between a detailer and the provider. You may not gain the trust in the relationship during your initial visits, but when you provide clinicians with a full understanding of the importance of your visit, along with presenting educational materials that are credible and evidence-based, you promote trust and strengthen the relationship and gain clinician commitment to changing behavior for the better.

NaRCAD: You’ve facilitated quite a few trainings with us at NaRCAD. Tell us more about the course, and why you enjoy doing it.

Dr. Doyle-Tadduni: This course is a great support for both new and seasoned trainees in enhancing their detailing skills, as well as program managers who oversee a clinical education program and need a greater understanding of how best to run an effective program.  At the beginning of the training, the trainees absorb AD theoretical content and techniques, and on Day 2, they’re actively practicing the techniques and role playing different educational encounters in small groups.

The program trainees have been wonderful people to meet! I’ve had the opportunity to meet people from all over the United States, and some from Australia, Portugal, and Europe. It’s been very interesting being involved with the trainings and hearing about health care in other regions of the US and abroad. Despite the miles that separate all of us in our different demographics, we all have similar challenges in our respective health care systems.

NaRCAD: As a trainer, you “play” the role of the clinicians during breakout group sessions, presenting different personalities as well as various behavioral and content-based objections to the material or the visit. Tell us more about this part of the course.

Mary Liz practices with a trainee, teaching the importance of showcasing AD as a service that will create better outcomes for clinicians’ practices and patients.

Dr. Doyle-Tadduni: We present the trainees with many different role play scenarios where they can actively practice overcoming obstacles that get in the way of earning clinician commitment. Finding the right delivery of your messaging can be very challenging, depending on the environment, and every detailer will have a unique set of potential obstacles to face at each visit.

The key is to focus on the evidence, so that practitioners can realize how beneficial it will be to their practice. The training’s small group role play practice sessions provides trainees ample opportunity to practice, ask questions, perfect their skills, and be prepared to face inevitable obstacles in their own future visits.

NaRCAD: What do NaRCAD trainees need to have to be ready to succeed as a detailer? How does our 2-day training help to get them ready for success?

Dr. Doyle-Tadduni:  The trainees need to have an expert knowledge base of the clinical topic and related materials they’ll be presenting during a visit. They also need to present AD as an on-going resource. With busy practitioners being so tightly scheduled through the day, programs designed to assist them in improving how their practice runs is a plus. By the end of the two days of training, the trainees will have a strong foundation of clinical education techniques, and they’ll be forming ideas about implementing these efforts in their respective programs.

NaRCAD: Any closing thoughts or advice for new trainees, or first time detailers as they prepare to head into the field?

As long as you’re well-versed on the material you’re delivering, and you’re presenting yourself as an “ambassador of the evidence”, you’ll have the tools you need to ensure that an academic detailing visit is truly successful.

An Interview with Frank Leone on Treating Tobacco Dependence with AD

Dr. Leone directs Penn’s Comprehensive Smoking Treatment Program and was a former trainee with NaRCAD.

NaRCAD: Tell us a bit about yourself. How did you get into academic detailing?

Frank Leone: I’m a pulmonologist, and have been focused on the treatment of tobacco dependence for over 20 years.  In my early years, I had always been amazed at how infrequently my colleagues would approach the literature for solutions when facing this common problem in the clinic.  It seemed to me that they relied heavily on “common sense” approaches and techniques derived from misunderstandings, rather than consulting published guidelines and available standards.

I became interested in the behavioral economics of tobacco treatment decision-making in the clinic, and realized that traditional approaches to changing physician behavior might be inadequate for dealing with a cultural problem this well-entrenched.  We initially turned to NaRCAD for advice on Academic Detailing in 2011, and found the approach to have just the right potential to both meet the needs of the target audience, and allow us to deliver our message in a cost-effective and scalable way.

We were also given an opportunity to work with the Philadelphia Department of Public Health as they started up their efforts to influence the local provider culture around tobacco, and we’ve been “off to the races” working within our community, creating positive changes, ever since.

NaRCAD: What does your program focus on?  (What health issue does it address, and what clinician behavior are you seeking to change?)

Dr. Leone: Our Academic Detailing (AD) program focuses exclusively on tobacco dependence treatment.  As you can imagine, that problem cuts across a number of different audiences.  Our detailers work with physicians, psychologists, nurses, counselors and others to impact the rate at which tobacco treatment services are delivered in our area.  We use AD to address the limits in knowledge base around pharmacotherapy, as well as to shape the core assumptions about effectiveness of treatment in key patient populations (e.g. those with established lung disease or serious mental illness).

NaRCAD: Tell us about some of the growth you’ve seen and been a part of as it relates your program.

Dr. Leone: Our AD program has grown every year since its inception.  We started out focused on primary care physicians in underserved parts of Philadelphia.  From there, we expanded our target audience to include specialist physicians, nurses, and nurse practitioners.  Most recently, our audience has expanded to include behavioral health practitioners in both inpatient and outpatient settings.  Because of our success using AD to work with care providers from a variety of disciplines, we are currently exploring ways to extend AD principles to “system-wide” approaches to creating behavior change.

NaRCAD: What would you say are the greatest challenges you see in implementing this intervention?

Dr. Leone: Finding the right people to go into the field is imperative.  Over the years, I’ve been impressed that success during the AD interaction is less about what degree a person has, and more about the ability to be gently directive, while willing to truly listen.  Detailers need to be spontaneous and responsive to their audience, while at the same time keeping their inner eye on the target.  This is a skill that takes a little time and training to develop.  It sounds like it ought to be an easy thing to do, but we’ve found that an organized, logical, mentored approach to learning these skills is important to success.

NaRCAD: How about what works well? How do you know when you’ve been successful?

Dr. Leone: We always try to incorporate some sort of measurement tool into our AD projects.  It might be about knowledge, attitudes, or behaviors, but having a metric to gauge our impact is important feedback ensuring we stay on mark.  Our funders appreciate a concrete measure of change as well.

If I could figure out how to capture this, my favorite measure would measure the “A-ha!” moments that happen so often within the audience.  I love the look of epiphany in the clinician’s eye when a detailer has found a way to make the information relevant and transformative.  That’s when I know we’re really making change for the long run.

NaRCAD: You attended our Academic Detailing Techniques Training a few years back. What are the most useful resources or information that you’re still using today?

Dr. Leone: Truthfully, the greatest resource has been the continuing relationship with the NaRCAD team.  On multiple occasions during the conception and start-up phases of our project, we were able to touch base with professionals who had a large collective experience in diverse disciplines to get some great tips and suggestions.

On one specific occasion, I remember sharing a written detailing piece with the NaRCAD team. We had developed it in hopes of getting some feedback.  Not only did we get great advice, but it was professional advice – complete with references, examples, resources, and connections to the theoretical basis for the suggestions.  To me, this is the kind of interaction that helps my team grow and learn over time.

NaRCAD:  What does future success look like for you?

Dr. Leone: In twenty years, when you go visit your doctor for your annual check-up, and you hear him or her say, “Of course tobacco dependence is a chronic illness of the brain for which there are a number of effective treatments.  It’s hard to believe we used to simply tell people to stop!” –then you’ll know we’ve done our job well.
 
Biography:
Dr. Leone received his medical degree from the University of Pittsburgh, School of Medicine, and completed his postgraduate training in both general internal medicine and pulmonary / critical care medicine at Thomas Jefferson University Hospital. He also received his masters degree in clinical epidemiology and biostatistics from the University of Pennsylvania School of Medicine. Dr. Leone directs Penn’s Comprehensive Smoking Treatment Program, a clinical program of the Penn Lung Center, located at both Penn Presbyterian Medical Center, and the Perelman Center for Advanced Medicine. The new program provides state-of-the-art and individualized treatment to smokers, including those with co-morbidities.

Dr. Leone’s scholarship focuses on investigating advanced treatment strategies for tobacco use disorder, and on testing educational strategies for improving the care of the tobacco dependant patient.  Dr. Leone is a member of several professional and scientific societies, including the Society for Research on Nicotine and Tobacco, the American College of Chest Physicians, and the American Thoracic Society.  He has served the Commonwealth of Pennsylvania as a legislative appointee to the Governor’s Tobacco Use Prevention and Cessation Advisory Committee since 2001. Dr. Leone has been invited to speak at numerous lectures on topics of smoking treatment and pulmonary medicine, and has been published in a variety of clinical and research journals. He is board certified in pulmonary and critical care medicine. Learn more and review related publications on the University of Pennsylvania’s site.

Read more: Behavioral Economic Insights into Physician Tobacco Treatment Decision-Making : Leone, Frank

Mike Fischer, MD, MS
At NaRCAD, we work together with our many partners, collaborating on important interventions to improve patient health through clinical outreach education. This summer, we’re especially looking forward to a unique collaboration to improve cardiovascular health, as we travel to Oklahoma to support the Healthy Hearts for Oklahoma project, part of AHRQ’s EvidenceNow initiative.

EvidenceNow is a group of 7 large studies across the United States working to improve cardiovascular care in small primary care practices. Along with materials development and program support, the NaRCAD team will travel to Oklahoma City in July to train over 20 health professionals, teaching them how to provide the service of academic detailing to participating practices.  Focusing on the ‘ABCS’ (aspirin use, blood pressure control, cholesterol management, and smoking cessation), the professionals we train will carry out academic detailing visits in order to present best evidence to participating practices.

By using the skills and techniques of AD to assess the needs of clinicians and practices throughout Oklahoma, the detailers we train will gain commitment from clinicians to commit to practice change. The Healthy Hearts for Oklahoma project will visit hundreds of practices, tracking these practices’ behaviors over time. Ultimately, the evidence generated by Healthy Hearts and the other EvidenceNow studies will yield key insights about how best to bring evidence to diverse practice settings and improve the cardiovascular health of all Americans.

Supporting organizations that are carrying out important work such as this is at the core of who we are and what we do. The positive impact of academic detailing can be amplified with each new intervention, program, or even a single visit to a clinician. As we enter into our 5th year as the only nationally available resource center for for academic detailing, the strength of the relationships we build makes it possible for clinical outreach education to serve more practices and have a greater impact on patient health.

We’ll share highlights from the Healthy Hearts for Oklahoma project and other exciting collaborations with our subscribers this fall. In the meantime, we’d love to see you at a future Boston-based training, or at our 3rd annual International Conference on Academic Detailing this fall—join us as we work together to advance the field of clinical outreach education.

Spring 2015 Director’s Letter
​Mike Fischer, MD, MS, Director of NaRCAD
Despite the difficult winter weather in Boston, NaRCAD has been off to a great start so far this year. We’ve been very excited to begin several new initiatives with terrific partners. As we move forward through 2015 and beyond, we invite those of you reading our newsletter and following us through our blog or on social media to reach out about working together on similar efforts.

Training academic detailers is a core part of our mission, and we continue to have full registrations for our Boston-based training sessions, telling us that there’s an interest and a demand for our training course. This year we were thrilled to take our training on the road for the first time, working with the San Francisco Department of Public Health on several new initiatives, focusing on diverse topics including overdose prevention, increasing use of vaccinations in pregnancy, and HIV screening and treatment.  This July, we’ll again deliver training outside of Boston, this time in Oklahoma to help support a new AHRQ-funded project aimed at improving care for cardiovascular risk factors in primary care.

We also created and launched a new workshop for the experienced group of academic detailers at Atrius Health here in Boston. Similarly to our 2-day techniques training, we used role play and interactive group discussion to help clinical pharmacists work on overcoming barriers and obstacles.  Interacting with Atrius’s dedicated group of outreach educators has all of us thinking about how academic detailers can best maintain and develop their skills over time, and we’re interested in hearing about how existing programs approach this challenge. If you have similar experiences to share, let us know—we’re always eager to share best practices with our network community of detailers, programs, and supporters.

We want to hear from you. Your ideas matter–tell us how you’d like to collaborate, create new opportunities for academic detailing, and improve quality of care and patient outcomes.

by Bevin K. Shagoury, Communications & Education Director
NaRCAD spent January 12th and 13th, 2015 with the enthusiastic and talented public health professionals of the San Francisco Department of Public Health(SFDPH), teaching them the principles and practice of AD.  As with our prior trainings, the main goal was to ensure that trainees can understand and effectively practice AD techniques. This collaboration with SFDPH served as our first “on the road” training, providing an opportunity for our staff and facilitators to look closely at how to customize AD training to meet the needs of public health workers.

The SFDPH participants are developing and implementing programs to address needs in several important areas, including immunization programs, viral hepatitis outreach, HIV screening, reducing the risk of opioid overdose, and perinatal care. Like many of our prior trainees, this group was eager to learn about how to adapt the innovative, service-delivery model of AD to improve health outcomes by communicating effectively with front-line clinicians.

Throughout the training, SFDPH trainees and NaRCAD staff joined in brainstorming ways to implement novel strategies and techniques in their respective clinical areas to strengthen program successes, expand impact, and achieve long-term practice changes in San Francisco.

With academic detailing in their arsenal of intervention tools to change clinician behavior for the better, we look forward to seeing the ways in which our partners at SFDPH will improve health outcomes for the people of San Francisco.

by Arielle Mather, MPH, Education & Training Manager
On November 13th and 14th, 2014 NaRCAD hosted the Second International Conference on Academic Detailing. The focus of this year’s conference was on educational outreach in an era of rapid health care reform, with perspectives from prominent figures in government, research, and business. The conference explored a pressing clinical theme on each day, including presentations of academic detailing programs currently addressing these topics in the field.

After Dr. Jerry Avorn, NaRCAD’s co-director, opened the conference with a review of the past, present, and future of academic detailing, Dr. Joshua Sharfstein, Maryland Secretary of the Department of Health and Mental Hygiene, discussed the challenges of improving health care and outcomes for the residents of his state. Jean Slutsky, Chief Engagement and Dissemination Officer of the Patient-Centered Outcomes Research Institute (PCORI) reviewed the key principles for effectively communicating research results that improve patient health outcomes.

The clinical theme for Day 1 was prescription opioid use and overuse. Dr. Harry Chen, Vermont Secretary of the Agency of Human Services set the stage by reviewing the origins of current problems with opioid use and sharing details of his state’s initiatives for prescribing pain medication. This talk was followed by an interactive panel session that highlighted two academic detailing programs (in South Carolina and New Mexico) seeking to reduce opioid overuse and abuse. Small group breakout sessions allowed for more detailed conversation about these programs and other specific topics.

Day 2 of the conference began with an overview of the business case for evidence based practice, presented by Dr. Troyen Brennan, Chief Medical Officer of CVS Health. Daniel Wolfson of the American Board of Internal Medicine Foundation, followed with a presentation on the Choosing Wisely campaign, which is designed to engage clinicians in the critical questions of how to make healthcare safer and more efficient. Dr. Alice Bonner of Northeastern University began the conversation of the day 2 clinical theme: antipsychotic medication use in long term care. After Dr. Bonner’s introduction, two ongoing academic detailing programs (in Massachusetts and Saskatchewan, Canada) aimed at addressing this problem shared their insights.

The challenge of sustaining academic detailing programs was addressed by Frank May, who has successfully implemented programs in multiple settings internationally. Dr. Madeleine Biondolillo, Associate Commissioner at the Massachusetts Department of Public Health, made the final presentation, reviewing how academic detailing fits in with the other approaches that the state uses to improve health. In addition to the formal sessions, conference attendees from 15 US states, Canada, Europe, and Australia had a chance to interact informally, share ideas about academic detailing, and develop connections that will help support increased collaboration in the future.

The third installment of this AHRQ funded conference series will be held next year in November 2015. Finalized dates and registration information will be announced in the coming months. If you would like specific slide sets from any of the conference presentations, please email us.