The DETAILS BLOG
Capturing Stories from the Field: Reflections, Challenges, & Best Practices
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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.
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Director’s Letter: Fall 2016 | Mike Fischer, MD, MS, Director of NaRCAD When the leaves start to turn here in Boston, we know it’s almost time for NaRCAD’s International Conference on Academic Detailing. This year’s 4th annual conference features several new and exciting sessions we’re excited to share with our community. #NaRCAD2016 highlights the work of innovators in academic detailing from many locations and organizations, ranging from large national health systems to small independent programs.  Diverse clinical topics will be featured at our interactive sessions, including pediatric developmental screening, smoking cessation in patients with serious mental illness, opioid misuse and overuse, screening for ADHD, and many others. Breakout sessions offer attendees a chance to work closely with leaders in the field, featuring in-depth and hands-on exploration of specific elements of academic detailing. Whether your focus is on training detailers, preparing clinical topic materials, or program evaluation, our dynamic breakout sessions offer a chance to network and acquire new skills.  Our conference is our largest event of the year, but our team has been busy this fall with other activities. At our Boston-based training in September we welcomed trainees from organizations across the country, all of whom concentrated on learning the techniques of academic detailing. We also spent two days this fall in San Francisco, working with the city’s Department of Public Health on an intervention to increase the use of pre-exposure prophylaxis (PrEP) for patients at risk of contracting HIV. We’re excited to continue supporting our partners at the SFDPH as they move forward on this important initiative.  Come join us at #NaRCAD2016! There’s only a month left to register, and space is limited. Check out our conference hub archival page to see what previous events were like, including on-demand video and program highlights. We’re excited that clinical outreach education has been such an effective strategy to address the pressing problems facing patients, clinicians, and health systems. This year, we know that the opportunity to learn, share ideas, and connect with experts will continue to ignite inspiration for our community’s important work in improving quality of care and patient outcomes in 2017 and beyond.  Biography.
Michael Fischer, MD, MS | Director, 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. There was a brief shining moment starting in the early 1970s, when I was finishing medical school, that lasted into about the mid-1980s. Primary care physicians (PCPs) seemed poised to rise above their lowest-in-medicine stature to become recognized for playing a central role in the entire health care system (as, of course, they had been doing all along). In medical centers throughout the country, growing interest in ‘health maintenance’ and its accompanying insurance designs seemed poised to catapult PCPs from the role of nerds to quarterbacks. Then, for reasons we don’t have the space to discuss here, in the following years in many settings, the quarterbacks got recast as gatekeepers, and then as switchboard operators. Delivering primary medical care remained as innately vital and sacred a job as ever, but the stature and daily work of the PCP (with the second P now standing for ‘provider’) became degraded in many settings. Morale sank, and PCP burnout and dropout became more common. What does all this have to do with academic detailing? A lot. One of the most frequent and visible ways that the quarterback-to-gatekeeper degradation has developed is in the role of clinical decision-making – for medications most often, but also about test ordering, specialist consultations, and many other choices the primary care clinician faces daily. In the Olden Times, which still survive in some pockets of our pathologically heterogeneous coverage system, these decisions are still left in the hands of the PCP, and are still made well or poorly by individuals. But increasingly, such choices are driven by formularies, prior authorization requirements, algorithms, and other restrictions. Sometimes these are thoughtful, evidence-based guidances that are useful antidotes to the occasional wild and crazy choices some practitioners occasionally make – ‘freedom’ which can on occasion lead to potential harm to both patients and health care budgets. But sometimes the restrictions are simple-minded, financially-driven, and disrespectful of the needs of specific patients and the nuanced judgment of the individual clinician. That’s where academic detailing comes in. There will always be a place for formulary limitations and restriction of the worst non-evidence-based decisionmaking. But wouldn’t we all rather live in a medical world in which decisions are primarily shaped by the informed decisions of a well-trained health care professional, updated through discussion of the latest data? Especially if that information was provided by another savvy clinician equipped to have a back-and-forth conversation about the basis and the pros and cons of trial findings, guidelines, and observational research? That would help primary care clinicians make better decisions without all the limitations of arbitrary insurance requirements, or computer-based algorithms that sometimes function as if they know Mrs. Johnson better than her doctor does. It could also pave the way for wider adoption of the evidence-based recommendations that the more enlightened policies seek to achieve. And clinicians could again feel more like the health care professionals we spent so many years learning how to be. Join us for Dr. Avorn's annual conference talk at #NaRCAD2016: Innovations in Clinical Outreach Education.  Biography.
Jerry Avorn, MD | NaRCAD Co-Director Dr. Avorn is Professor of Medicine at Harvard Medical School and Chief of the Division of Pharmacoepidemiology and Pharmacoeconomics (DoPE) at Brigham & Women's Hospital. A general internist, geriatrician, and drug epidemiologist, he pioneered the concept of academic detailing and is recognized internationally as a leading expert on this topic and on optimal medication use, particularly in the elderly. Read more.  Bevin K. Shagoury, Communications & Education Director After another terrific 2-day Academic Detailing Training course here in Boston, it's easy to see how each new training class brings its own unique energy and important clinical interventions to the table. On September 19th and 20th, 2016, trainees from nearly every corner of the U.S. map joined us to learn the core, social marketing techniques of successful clinical outreach education.
 While each training has its own unique group discussions and trainees, our 2-day course always includes presentations on the evidence base and history behind academic detailing, the best ways to evaluate evidence for your intervention, the foundation of behavior change theory for academic detailing, how to use educational materials in an effective way. We lead interactive discussions, group activities, breakout role-plays, and for each training class, we customize a session encouraging the class to use the virtual resources on our Learning Center.  We hope you'll join us at a future training, and please join us for our upcoming conference this November, an exciting opportunity to engage in hands-on workshops, learn about best practices from experts in the field, and meet others doing similarly important work. Stay tuned for an upcoming announcement of dates for our Spring 2017 training course--registration will open in January 2017. Learn more about our amazing staff and facilitator team, and explore our blog's interviews and events recaps to see how NaRCAD supports and highlights health education professional who are using academic detailing to improve health outcomes, one educational visit at a time.  Biography.
Bevin Kathleen Shagoury | Communications & Education Director Bevin manages NaRCAD’s external communications, working to magnify the impact of clinical education programs via strategic partnership development, best practices highlighting, and access to virtual learning platforms. Read more. An Interview with Mass Mental Health CenterFeaturing Mark Viron, MD, adult psychiatrist & Director of Health Home Services at the Department of Mental Health’s Massachusetts Mental Health Center (MMHC) in Boston; Assistant Professor at Harvard Medical School. NaRCAD: We’re excited to talk about your program because it focuses on such an important population, and such a specific topic that’s been a focus of public health initiatives across the nation. Tell us about Massachusetts Mental Health Center (MMHC).  Mark Viron: MMHC is a Department of Mental Health (DMH) community mental health center in Boston that has provided mental health services for over 100 years to people with chronic and persistent mental illness. Its ultimate goal is to help people maintain meaningful and productive lives in their community. In 2013, to better address the significant unmet primary care needs of our patients, we launched the Wellness and Recovery Medicine (WaRM) Center. The WaRM Center offers co-located and integrated wellness and primary care services for all MMHC patients.
NaRCAD: Why, historically, have rates of tobacco use been higher in folks with serious mental illness (SMI)? Why has there been resistance for clinicians to promote tobacco cessation for this group? Mark: It’s a complicated issue. There are risk factors that increase the rate of smoking in this group and these are coupled with obstacles to getting appropriate treatment. People with SMI are overrepresented among populations that face social and environmental conditions that are typically associated with an increased prevalence of smoking – poverty, unemployment, limited education, etc. Obstacles to quitting include limited availability of resources, lack of clinician involvement, and poor social/peer support.
 The strategy of AD: 1:1 clinician-facing outreach. NaRCAD: Agreed! What do these AD-focused, 1:1 visits between trained physician educators and psychiatric prescribers entail? Mark: The visits are 20-30 minutes long and follow the typical detailing visit structure. Visits are conducted by me, a psychiatrist at MMHC, or Gail Levine, MD, an internist and the Medical Director of our primary care clinic. We meet with the prescribers in their offices, and begin by asking open-ended questions to assess their needs and learn about their successes (and challenges) in addressing tobacco use with their patients. We celebrate successes and validate challenges, and then pivot to sharing evidence-based information and key messages that may help them address these issues with greater success. We conclude the visit by reviewing steps the prescriber can take to increase successful tobacco treatment, and provide a copy of our detail aid, along with a few high-yield references.  Click to see complete detail aid. A key ingredient to our success has been our detail aid. A great psychiatry resident (now attending), Kathryn Zioto, worked with Gail and me and the NaRCAD team to develop a detail aid about tobacco treatment in people with serious mental illness. The detail aid contains cutting-edge, evidence-based information in clear language with colorful graphics. It includes information about the MMHC’S Smoke Free Team, and highlights our three “asks”, which helps clinicians frame their conversations with patients:
NaRCAD: We enjoyed working on this important project with you, and we know how important great materials are in engaging clinicians to consider behavior change. That said, how have psychiatric prescribers been responding? Mark: The response has been quite favorable. It's been rewarding to sit down with colleagues and learn from their experience and expertise and to be able to offer some useful information about tobacco treatment and the Smoke Free Program. The one-on-one detailing encounters, even as brief as they are, give us quality time with our colleagues to focus on their individual concerns and questions. We probably get as much information as we give!
 NaRCAD AD Trainings: hands-on and interactive. NaRCAD: Two members of your team, yourself and Gail Levine, attended our AD Techniques Training in 2015 to prepare for this initiative. How has the training helped you provide this education to prescribers? Mark: Your training gave us an in-depth immersion into the world of academic detailing, helping us understand theories and evidence and think about implementation issues. Getting to practice detailing and getting feedback from experts in the field was invaluable, as was the ability to talk with people from around the country who are working on similar projects. NaRCAD's training is incredibly worthwhile – it was compact, comprehensive, and helped us acquire the needed skills to implement this project successfully.
 Provider education, engagement and activation are key, and AD provides a framework that has a proven track record in producing results in these areas. Plus, AD is efficient and easily implemented relative to other interventions--especially when you have assistance from NaRCAD! NaRCAD: Thanks for taking the time to connect with us. We’ve enjoyed helping to support this initiative with training and materials development! We look forward to continuing to learn about the impact you have on improving the health of people with serious mental illness, and sharing it with the community. We can't wait to hear more about this intervention at our conference this fall!  Biography. Mark Viron, MD is an adult psychiatrist and Director of Health Home Services at the Department of Mental Health’s Massachusetts Mental Health Center (MMHC) in Boston and an Assistant Professor at Harvard Medical School. He specializes in the treatment of psychotic disorders and the integration of primary and behavioral healthcare for people with serious mental illness.
He graduated from Tulane University School of Medicine and completed his psychiatry residency at the Massachusetts General Hospital/McLean Residency Program. He serves as an attending at MMHC’s partial hospital program, where he teaches and trains residents and medical students. He is also the project director for two grant-funded initiatives that aim to enhance MMHC’s ability to provide integrated primary and behavioral healthcare. 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  Director's Letter | Mike Fischer, MD, MS NaRCAD has jumped right into action in 2016! We’ve been getting out of Boston, working with colleagues across the country in a range of settings. As we’ve partnered with state and local public health agencies, long-term care providers, primary-care networks, and other organizations, we’ve seen how the principles of AD can be adapted to fit the needs of different clinicians and patients. The work of our colleagues teaches us how we can best support clinical outreach education, raise its visibility, and improve health outcomes together.
We want to hear how all of you are tackling these challenges, and we hope you’ll share your successes with us. We’re featuring best practices on our blog and connecting partner organizations, and we know that in-person connection at our annual conference is a highlight for many in our field. As we begin preparing for the 4th International Conference on Academic Detailing, we’re inviting you to submit your work for presentation at NaRCAD 2016. We hope you’ll take advantage of this opportunity to share your successes and challenges—the deadline is approaching fast, so get those submissions in, and feel free to contact the NaRCAD team with any questions about the process. And Save the Date for November 14th & 15th here in Boston—we’d love you to join us at the conference to exchange ideas and strategies with colleagues from across the country and around the world. At NaRCAD, we’re always expanding the range of services we provide, including our core training series on the techniques of AD, specialized workshops and seminars, and consultation on materials development for AD interventions. Let us know what we can do to strengthen your program and highlight your program successes this year.
Director's Letter 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  Attendees share resources during a networking break. 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.  Dr. Coffin of SFDPH and Dr. Fischer of NaRCAD 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.  Breakout leaders share a moment during the Day 1 session! 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.  Dr. Avorn gives a presentation one Tweeter called "pure gold" 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.  L-R Valerie Royal, Joy Leotsakos, Sameer Awsare, Mike Fischer. 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.  Happy to see our colleagues from Norway at #NaRCAD2015! 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! |
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