The DETAILS BLOG
Capturing Stories from the Field: Reflections, Challenges, & Best Practices
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Director’s Letter: Mike Fischer, MD, MS  The opioid crisis has been recognized as a major national public health problem, but it actually reflects a collection of many thousands of local crises playing out in individual cities and counties. Each region faces a distinctive set of challenges, driven by economic and social factors, local medical practice patterns, political environment and pressures, and many other considerations. Identifying and implementing effective solutions to address the opioid crisis requires developing an understanding of how these individual challenges interact, and what strategies are most effective in specific situations--one of which is academic detailing.  The NaRCAD team is partnering with the CDC (Centers for Disease Control and Prevention) and NACCHO (the National Association of City and County Health Officials) on an exciting pilot program working with local health officials to develop customized interventions to reduce opioid overdose and death. Four sites experiencing significant public health problems related to opioids were selected: Boone County, Kentucky; Bell County, West Virginia; Manchester, New Hampshire; and Dayton, Ohio.  Public health officials at each site identified a wide range of local stakeholders to participate in developing a community action plan and recruited trainees to complete NaRCAD’s academic detailing training course, which we customized to address the unique challenges that each community faces. We also developed a specialized online toolkit for these sites, including discussion boards, local resources, and printable resources.  A trainee from Bell County, Kentucky, delivers a key message. We traveled to each site in March and April of this year, facilitating hands-on trainings in the techniques of academic detailing in alignment with the CDC prescribing guidelines. Trainees came from diverse backgrounds, including pharmacists, nurses, public health officials, and students in the health professions, including pharmacy students, dental students, and medical school students. Plans for implementing AD varied by site depending on the local health care environment; some sites focused more heavily on appropriate prescribing of opioids by clinicians, while others prioritized increasing referral rates for patients with opioid use disorder (OUD), including access to medication-assisted treatment (MAT).  Practicing a concise introduction in Manchester, New Hampshire. As the AD trainees at each pilot site continue their work in the field, we’ll learn more about how these diverse strategies succeed, and how we can support adaptations to make academic detailing more impactful. This important collaboration has allowed us to form invaluable partnerships with CDC and NACCHO, leveraging national resources to improve local responses to this epidemic through plans that respond more precisely to local needs and priorities. We’re excited for this pilot program to serve as a model for future opioid safety AD interventions, and we’ll be providing updates here on the blog. In the meantime, tell us: what's happening in your local community around the opioid crisis? Sound off in the comments section below, and let us know if you think clinician-facing education could be a strategy that would improve outcomes for your community. And join us for our next training and our terrific annual conference to learn more about this and other exciting AD projects. -Mike  Biography.
Michael Fischer, MD, MS | Director of NaRCAD Dr. Fischer is a general internist, pharmacoepidemiologist, and health services researcher. He is an Associate Professor of Medicine at Harvard and a clinically active primary care physician and educator at Brigham & Women’s Hospital. With extensive experience in designing and evaluating interventions to improve medication use, he has published numerous studies demonstrating potential gains from improved prescribing. Read more.
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 Mike Fischer, MD, MS, NaRCAD Director Fall is the season for conferences, and the most exciting one for us is #NaRCAD2017: Combatting Threats to Optimal Care! This year’s conference is a great chance for everyone interested in AD to learn more, whether you’re part of a long-standing program or just beginning to learn about the versatility and effectiveness of implementing this strategy to improve health outcomes. Our agenda is up, so take a peek, and register if you haven’t yet!  The keynote presentations will provide critical insights for creating and sustaining AD programs in different settings. Dr. Zoe Edelstein will kick off Day 1’s programming, representing the New York Department of Health and Mental Hygiene. This keynote will teach us about their public health detailing intervention to increase use of HIV pre-exposure prophylaxis (PrEP). The New York program was originally founded in 2002, so Dr. Edelstein’s presentation will help anyone from a public health background understand how to both develop and sustain AD, and to adapt it for new and pressing health challenges.  Dr. Carol Havens from Kaiser Permanente will provide a detailed overview of the longest-running AD program in the US, a program that was developed with input from Jerry Avorn soon after the original AD studies were published. We look forward to being inspired by lessons learned from a leading integrated health care system’s ongoing commitment to improving the quality of care around opioid safety with clinical outreach education. The rest of our conference agenda draws almost entirely from proposals submitted by members of our NaRCAD network – we received twice as many proposals this year! We’re looking forward to our “Field Presentations” sessions, featuring empiric results from detailers on the ground; expert panelists from the CDC, state departments of public health, and clinical care sharing important impressions on clinician stigma on the critical issues of HIV prevention and opioid safety; and breakout sessions covering many of the practical issues and challenges that detailers face when bringing best evidence to clinicians. Of course, for many of us, the highlight of each conference is the annual update from Jerry Avorn on the state of AD--see his recent blog piece, “Who Do You Trust?” for a preview of what’s to come!  The NaRCAD team is excited by the knowledge that integral opportunities, connections, and partnerships will be created at our unique 2-day event. But as excited as our team and our extended community may be about the conference, it’s not the only terrific development underway at NaRCAD this fall. We’ve continued to provide training and support for groups from around the country and the globe, with 2 trainings in the techniques of AD this past September, and more planned this fall and winter! Keep your eyes on our Training Series page for the official announcement of our Spring 2018 AD techniques training, and contact us at any time about opportunities and resources to support your AD program. See you soon, -Mike Biography. Michael Fischer, MD, MS, NaRCAD Director
Dr. Fischer is a general internist, pharmacoepidemiologist, and health services researcher. He is an Associate Professor of Medicine at Harvard and a clinically active primary care physician and educator at Brigham & Women’s Hospital. With extensive experience in designing and evaluating interventions to improve medication use, he has published numerous studies demonstrating potential gains from improved prescribing. Read more. Mike Fischer, MD, MS, Director of NaRCAD | January 2017 Director's Letter Growth. Support. Engagement. These words characterized 2016 for NaRCAD, and have us planning for an exciting 2017. In 2016, we had our most successful and impactful year to date. Our community has grown to over 1000 national and international supporters of clinical outreach education.  At #NaRCAD2016, our 4th annual conference on academic detailing, the agenda reflected what’s happening in the field, composed largely of ideas and presentations submitted by you, the members of our network. Keep your eyes open for our Call for Presentations on our NaRCAD Conference Series page— #NaRCAD2017 will be held here in Boston on November 6th & 7th, 2017 and applications for presentations will be accepted starting March 1st. After this past year’s success, we’re even more committed to providing customized support to individuals, groups, and large organizations working on clinical outreach education.  In addition to our core training sessions in Boston (our next session is March 30th & 31st), we’re continuing to offer on-site topic-specific trainings, customized workshops, and special educational sessions on the principles and practice of AD. In addition to providing direct support, we’ve been excited to successfully connect people and programs with each other, allowing for the exchange of ideas and best practices among both national and international experts. We’re proud of our ability to meet our partners where they are, whether they’re starting, expanding, or adapting AD interventions, and this year, we’re looking forward to supporting and improving your work.  We started this process by sending you our first annual community survey in December, and we thank our many members who responded. (You can still weigh in if you have thoughts, although our raffle is over!) We’ve listened to your insightful suggestions, and we’re already taking action to support your needs. This year, we’ll be launching the new COrE (Clinical Outreach Education) Series, exploring AD program development, specific clinical content, and other topics you’ve suggested. Featuring AD experts, the NaRCAD team, and using both interview and live webinar formats, the COrE Series is a great opportunity for advanced learning, support, and collaboration. Stay tuned for more information! We’ll also be increasing engagement opportunities via our Partner Network; we’ll be reaching out individually to learn more about your current work, and we’ll offer an interactive site where you can make your own partner connections with experts working on similar topics. As we grow even more in the coming year, your ideas and reflections remain invaluable. You don’t have to wait for us to contact you! We invite you to be in touch with our team and tell us more about your program—what challenges you’ve faced, what successes you’ve experienced, best practices you’d like to share, programs you’d like to know more about, and the resources you need to help you succeed. -Mike  Biography. Michael Fischer, MD, MS, NaRCAD Director
Dr. Fischer is a general internist, pharmacoepidemiologist, and health services researcher. He is an Associate Professor of Medicine at Harvard and a clinically active primary care physician and educator at Brigham & Women’s Hospital. With extensive experience in designing and evaluating interventions to improve medication use, he has published numerous studies demonstrating potential gains from improved prescribing. Read more. Director's Letter, Summer 2016 Mike Fischer, MD, MS, NaRCAD Director Summer is in full swing, but we’re already looking ahead to #NaRCAD2016, our 4th International Conference on Academic Detailing, which we’ll host this fall on November 14th & 15th in Boston. We received a wonderful response to our first-ever call for proposals, with submissions from across the country and around the world, making the 2016 conference our most exciting and community-informed meeting yet. Our team was inspired by the innovative and diverse proposals we received. Following in the footsteps of previous conference series programming, this year’s applications demonstrated a dedication to improving the quality of care and patient outcomes. #NaRCAD2016 applicants showcased success across a broad spectrum of AD interventions: in outpatient and inpatient settings, in public and private systems, and for a wide range of clinical topics. We’re thankful to all who applied for #NaRCAD2016, and we encourage those who are just beginning to roll out an intervention to consider applying for next year’s conference. Along with presentations from our selected applicants, this year’s program will include carefully designed content from leaders in the field, interactive learning sessions, and networking opportunities, including an evening reception. This year will be your chance to learn about cutting edge interventions being implemented across the globe, to share your unique perspective and experiences, and to collaborate with a thriving community of clinical outreach education colleagues. In that spirit of collaboration, we’re always eager to hear from you, the members of our learning network. We can support your AD programming with expert techniques training, materials development, evaluation, or by highlighting your work. We’re also dedicated to personally connecting our network members to one another, working to amplify our community’s knowledge, tools, and impact. Take a minute to tell us what resources you need, to explore our Learning Center, or to join the conversation—either virtually, or in Boston in November.
We’ll see you at #NaRCAD2016—registration is now open, and space is limited! If you have questions, let our team know. -Mike |
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