Bevin K. Shagoury, NaRCAD Communications
The excitement and breadth of content in this November’s 3rd International Conference on Academic Detailing exceed what we can capture in this blog post. The combination of exciting speakers, engaging panelists, expert breakout session leaders, and national and international attendees eager to problem-solve created a forward-thinking event that inspired all of us working on AD and related outreach educational activities. As you reflect on our event's highlights, we encourage you to access on-demand video, speaker biographies, session descriptions, and more at our Conference Hub resource page.
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.
The final presentation of the day was a lively one by NaRCAD’s co-founder and co-director, Dr. Jerry Avorn, who identified major obstacles to effective evidence-based communication in the current landscape of healthcare, and provided a future-centered lens through which attendees could envision how academic detailers can address these challenges. A full day of new ideas and connections culminated in a networking reception that gave attendees a chance to relax and connect socially.
Day 2’s morning opened with another engaging Keynote Speaker; Dr. Don Goldmann, CSO & CMO of the Institute for Healthcare Improvement, combined quality improvement theory with personal anecdotes, weaving in real-life examples of successful interventions to provide context and dimension to the theory that underlies all of our work.
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!
by Joy Leotsakos, PharmD
Who We Are. The Academic Detailing Service (ADS) of the Atrius Health Clinical Pharmacy Program provides clinically appropriate, evidence-based, cost-effective medication management in a multidisciplinary team setting. Our Clinical Pharmacy Program includes 15 clinical pharmacists (CPs) serving nineteen Internal Medicine and Family Medicine (IM/FM) ambulatory care practice locations. In the past four years, our program has evolved and transformed through evaluating our impact, absorbing and implementing internal feedback, and collaborating with others in the field, including NaRCAD.
Our Start. As the program manager of our ADS, I’ve seen our service grow and change. When we began our program in 2011, it was as an administrative mandate to meet with all IM/FM prescribers once per fiscal quarter to deliver messages about cost-effective prescribing and clinical quality. We started by formulating a menu of topics to cover in our ADS work each quarter, including individual clinician prescribing reports reflecting performance on prescribing initiatives from the Pharmacy & Therapeutics Committee, specific questions to survey clinicians on a clinical topic, targeted education for low performers on prescribing initiatives, and various other ‘hot topic’ clinical issues. CPs detailed individual clinicians via formal 1:1 scheduled appointments, and also did so less formally (such as by catching them in the hallways) or in larger groups during department meetings.
Is it Working? We documented our ADS activities by checking off the individual clinicians we detailed each quarter. At that time, there was no formal training for our CPs on how to conduct a detailing meeting. Unfortunately, this method of creating content for visits soon resulted in a large menu of topics so varied that each quarter’s detailing became unwieldy and too broadly focused. And our documentation, while it gave us a general sense of the number of clinicians detailed, did not tell us anything about the quality of this detailing.
Room for Improvement. Our group is fortunate in that our ADS activities have always been accepted and even expected by our IM/FM clinicians. We experienced almost no clinician resistance to our educational meetings. But in 2013, when attending one of NaRCAD’s 2-day Academic Detailing Training sessions, I learned that we could make changes to improve our services, as well as my own skills as a detailer. As a result, we altered the format of our ADS program, choosing to detail clinicians in a 1-1 or small group format of less than 4. We also selected a goal of 90% of clinicians receiving detailing at least once every quarter.
Evaluating Impact. We began evaluating the impact of the changes we’d made to our ADS, specifically choosing to look at its impact on a discretely measurable topic: reducing the unnecessary ordering of an ALT test (alanine transaminase) in patients on the ’statin’ cholesterol-lowering medications. We were able to demonstrate that our detailing of all IM/FM clinicians led to significant reductions in ALT ordering and meaningful cost avoidance for our organization.
Asking for Feedback. With NaRCAD’s support, we further refined our program in 2014 based upon feedback from an internal focus group. By soliciting honest feedback from the CPs about their detailing experiences, I discovered considerable variation in how they approached the menu of topics provided each quarter and came to understand that the continuous process of visiting with each clinician at their sites often felt stale and repetitive.
New Approach, New Results. We revised our ADS workflow to tie each round of clinician appointments directly to a specific and single P&T prescribing initiative. Furthermore, we developed a method to tag low performing clinicians for an ‘intense’ ADS visit and higher performers for a ‘touch’ ADS visit. We began this new workflow with an initiative to improve the use of evidence-based beta-blockers in patients with heart failure, a quality measure for the Medicare Pioneer Accountable Care Organization (ACO) project. Using this new approach, clinical pharmacists were able to deliver a fresh and meaningful message to the right prescribers, resulting in a change from 73.6% to 97.8%prescribing of evidence-based beta-blockers in this patient population.
Partnering with NaRCAD for Ongoing Learning. In March 2015, we coordinated with NaRCAD again, and they provided our group of clinical pharmacists with a 2.5 hour workshop to enhance our AD skills. I’d encourage anyone who does this type of educational outreach to make use of this invaluable resource. Of course, our Atrius Health Academic Detailing Service will continue to grow and change as we find additional ways to improve our workflows and messages. I look forward to continued collaboration with NaRCAD and with others in the field, so that we can all keep learning from each other and improve health outcomes through effective academic detailing.
Bio: Joy Leotsakos is a senior clinical pharmacist and the program manager for the Academic Detailing Service (ADS) of the Atrius Health Clinical Pharmacy Program. Joy joined Atrius Health in 2007 and became the program manager for the ADS program in 2012. Prior to joining Atrius Health, Joy worked as an assistant professor at Massachusetts College of Pharmacy and Health Sciences University in Boston, MA and provided ambulatory care pharmacy services to the South End Community Health Center also in Boston. Joy graduated with a Doctor of Pharmacy degree from Virginia Commonwealth University School of Pharmacy and then completed her residency in Ambulatory Care and Community Pharmacy at the University of Florida College of Pharmacy. Joy is the mother of one son, and enjoys salsa dancing, cycling and running in the summer and skiing in the winter. You can reach Joy by email at email@example.com.
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.
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