The DETAILS BLOG
Capturing Stories from the Field: Reflections, Challenges, & Best Practices
 Guest Blogger: Joseph Leishman Academic Detailer/Masters in Public Health Candidate Center for Clinical Management Research, Ann Arbor VA The University of Michigan School of Public Health NaRCAD Training Alumnus  NaRCAD: How did you get into AD? What were you doing before? Joe: I’m a graduate student at The University of Michigan School of Public Health studying epidemiology. As a student I started working at the Ann Arbor VA Center for Clinical Management Research on a lung cancer-screening project. Our project involves 8 different VA sites across the country. As we shifted into an implementation phase, academic detailing was selected as an implementation method. I transitioned to an academic detailer role because of my background in epidemiology, my understanding of lung cancer screening (LCS), and my ability to communicate these principles. I attended the NaRCAD academic detailing techniques training and things took off from there!  NaRCAD: Why is AD for lung cancer screening so important? Joe: Lung cancer screening can be more complex and complicated compared to other preventative services, and most primary care physicians have very limited time to discuss lung cancer screening with patients. There are a number of potential downsides to screening – false positives, overdiagnosis, invasive procedures, and complications from invasive procedures. The benefits of the screening outweigh the challenges, and we have developed a tool for doctors to quickly evaluate a patient’s lung cancer risk, facilitate shared decision making, and make personalized screening recommendations. NaRCAD: Tell us about the lung cancer screening detailing aid and related tools that you made with NaRCAD’s support. How was the process of developing the detailing aid? Joe: Our detailing aid contains background information on lung cancer screening and some of the key evidence behind our tool. It also outlines some of the reasons and benefits behind using this risk-based approach. We tried to keep the detailing aid simple enough that doctors could quickly understand the concepts with little or no additional explanation. This was our group’s first attempt at making something like this. We worked with NaRCAD during the creation of the detailing aid to improve the clinical content, layout, and language. There was a lot of trial and error to create the detailing aid. We ended up going through 10 versions before it was finalized.  NaRCAD: How did you decide what information was most important to put on your detailing aid? Joe: Initially, we started out with too much information. It was too complicated and wordy to effectively communicate our message. We tested it out with our team to see if our message was clear. It was obvious when sections of detailing aid didn’t work well. We really had to focus on narrowing down the main evidence and messages we wished to convey. We used the primary lung cancer screening evidence from the US Preventative Task Force and the National Lung Screening Trial. Our tool goes a step beyond screening eligibility to look at individual risk, life expectancy, and patient preferences, which help providers get past some of the difficulties and complexities of lung cancer screening.  NaRCAD: How does your website complement the detailing aid when you are 1:1 detailing? Joe: A link to the tool is embedded in the Computerized Patient Record System (CPRS), the EMR system that the VA uses. However, it can be also accessed outside the VA with a URL. What I typically do is I have PCPs pull up the website in their workspace after going through the detailing aid. I have providers role play with a sample patient, and I demonstrate how the tool could be used for that specific patient. Using the actual web tool in a detailing meeting really helps to reinforce our message. We feel like it increases the likelihood that it’ll be adopted in an actual clinical practice. NaRCAD: How have clinicians been responding to your campaign? Joe: So far there has been a decent response from the doctors we have worked with. Some of the doctors in the VA have met with detailers before which makes the initial contact easy. However, the most majority of the doctors I have met were receptive to my visits. We’ve been tracking the use of our tool before and after academic detailing at a site level. We don’t have exact numbers, but there has been an increase between before and after AD. We’d be happy to share more complete data in a future blog post.  NaRCAD: That'd be terrific, we'd love to share that when it's ready! What other reflections do you have from this process that you'd like to share with our community?
Joe: Academic detailing is a new approach for our group. It has been a real learning experience for discovering what does and doesn’t work and how to best address provider needs. For me, going through this process has been a lot of fun. I love talking with doctors about their struggles and being able to offer a tool that can help them better handle lung cancer screening with their patients.  We've been staying busy here at NaRCAD this spring! With public health challenges like the opioid crisis, and the continued need for HIV prevention, the team here at NaRCAD has been on the road for 5 trainings in 6 weeks, and we're not stopping yet! On February 14th - 16th, 2018, NaRCAD joined the amazing teams at San Francisco Department of Public Health and the New York City Department of Health and Mental Hygiene for an exciting initiative: A Public Health Detailing Institute on HIV PrEP and RAPID. Hosted in San Francisco's South Market neighborhood, 31 trainees attended, representing diverse public health departments from Texas, Connecticut, Alaska, Louisiana, Florida, Tennessee, Los Angeles, San Francisco, Mississippi, Michigan, Oregon, Nevada, Virginia, and beyond. These trainees joined the institute for a customized, 3-day event focusing on learning the techniques of academic detailing, along with showcasing best practices and success stories via special presentations and expert panels.  This past month, from March 7th through April 4th, 2018, NaRCAD hit the road four more times, as part of an exciting 4-site pilot project in partnership with our terrific colleagues at the CDC (Center for Disease Control) and NACCHO (The National Association of County and City Health Officials). Upon identifying counties and cities with the highest burden of fatal and non-fatal opioid overdose and high prescribing rates, the CDC selected Bell County, Kentucky; Boone County, West Virginia; Manchester, New Hampshire; and Dayton, Ohio as 4 pilot sites in which to convene with key community stakeholders and roll out community action plans, along with targeted academic detailing interventions.  Our work has involved launching on-location trainings at each of these pilot sites, focusing on providing front line clinicians with tools and support to improve outcomes for patients. Messaging and support for these campaigns include lowering prescribing rates, referring patients to treatment for opioid use disorder (OUD) including Medication Assisted Training (MAT), and using their state's PDMP (Prescription Drug Monitoring Program) to identify troubling patterns of use, which may, in turn, help to identify those patients who need more support and care.  Trainees at each site of these pilot sites work with us across two days to learn the structure of an academic detailing visit, practice role playing 1:1 visits with clinicians, and become experts at using educational materials (including a suite of materials constructed by the CDC based on their 2016 Opioid Prescribing Guidelines). Our pilot site trainees walk away from our trainings ready to actively engage with clinicians to assess individual needs and provide customized support, and encourage behavior change for the opioid crisis in their respective communities.  NaRCAD's team will continue to focus on launching new academic detailing interventions across the U.S. well into 2018, with upcoming opioid-specific trainings being carried out in late May in Albuquerque, New Mexico, with the University of New Mexico's Health Sciences Center, and in late June in Lansing, Michigan, with the Michigan Public Health Institute.  Our next all-topic, AD techniques training in Boston will kick off at the end of this month, where we'll train 24 health professionals from across the U.S.--we'll report back after that training and share lessons learned, highlights, slide decks, and clinical topics from represented programs, and we look forward to sharing those with our community.
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