Annual Conference, Off to Vegas for an HIV PrEP Training, & Our Team is Growing (and Hiring!)
A letter from the staff at NaRCAD
At NaRCAD, we're getting ready for our busy season, which lately, has become a season that lasts all year long. And we're happy for it--because that means we get to help more programs across the US and Canada figure out the most impactful ways to use academic detailing to promote sustainable change. Whether public health programs are looking to increase prescriptions of HIV PrEP for patients at high-risk, encourage more referrals to nutritionists for patients with diabetes, or improve access to treatment for people struggling with opioid use disorder, we're there to help them, from program conception to implementation and evaluation.
You may know that we offer bi-annual trainings here in Boston for health professionals to learn the techniques of academic detailing with our team of clinical outreach education experts through our 2-day, intensive, hands-on course. But did you know we also travel across the country to train teams on-site in their own communities? Through a partnership with the CDC, NACCHO, and previous funding from AHRQ, we've been on the road for countless successful trainings in early 2018, and we'll be wrapping up the year and heading into 2019 with a bang!
Our next stop is Las Vegas, to work with the Southern Nevada Health District on improving outcomes around HIV prevention this December. (And for once, we hope that "what happens in Vegas" doesn't "stay in Vegas"; our goal is to increase visibility and prescribing of HIV PrEP so that more clinicians everywhere are reaching the patients who need it most.)
Prior to December, we'll be busy here on our home turf for the fall, holding our now-full Fall Training on October 1 + 2, and our fantastic, annual international conference on AD on November 12 & 13. We hope you'll keep your eyes out for dates for our Spring 2019 Training (which will be announced by November!) and that you'll join us for our conference--this year is our 6th annual, and we're excited to announce our full agenda is live on our Conference Series page. Register today--space is limited for this event!
And visit our blog often--we'll be featuring new interviews this fall, showcasing best practices on topics like reducing polypharmacy, reducing opioid prescribing in rural counties, and increasing lung cancer screenings. Want to be featured? Contact us and tell us what you're working on! Our team is ready to custom-tailor our support, so we can offer you the best ideas, resources, and tools to help your program thrive.
We can't wait to see you this fall!
-The NaRCAD Home Team
(PS: Want to join our team as a Program Manager? Send us your resume & cover letter.)
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.
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).
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.
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.
As the Public Health Education Specialist for the WIC (Women, Infants & Children) program and the Opioid Task Force in Butte County, California, Stacy Piper, CLEC, acts as a regional liaison with the medical community as well as coalition's and various community partners. Learn more about Stacy in the bio at the end of this piece.
NaRCAD: Hi, Stacy! Thanks for joining us. Tell us a little bit about your work—we understand you, like many folks in public health, wear multiple hats.
As the Butte County Public Health Education Specialist for the WIC (Women, Infants & Children) program and the Opioid Task Force in Butte County, I act as a liaison with the medical community. I collaborate with hospitals, health care providers, public health programs, and community organizations to improve public health and continuity of care.
NaRCAD: Talk to us about detailing for the opioid crisis—you do this 1/4th of your time. How did you get started?
After providing educational detailing for the WIC Program funded at 30 hours a week, I was asked to be an Opioid Academic Detailer for Butte County. In preparation, I attended the Academic Detailer Training in San Francisco. The training provided by the CA Health Department, San Francisco Public Health Department's Substance Use Research Unit, and NaRCAD was one of the finest training experiences - even after the countless hours of extremely comprehensive training I received in the Pharmaceutical Industry.
Regarding impact on a local level, it is indescribable how every interaction with a healthcare provider is beneficial. Academic Detailing (AD) is an equal exchange of information. I consider it a huge responsibility, and a privilege, to be an educator for doctors and medical professionals.
I prefer the word “educator” instead of “detailer” because I have concerns that a “detailer” may be initially viewed as a salesperson. I love and respect that AD is not driven by attempting to influence medical professionals for personal gain. It’s all about helping providers improve health outcomes in patients with the entire focus of the conversation about the real people in their practice that need help.
NaRCAD: Tell us a little about your background in pharma, and how this translates to your detailing work now.
I was a Senior Executive Pharmaceutical Sales Representative for 15 years in Northern California, advocating for immunizations and promoting various prescription drugs. This provided first-hand experience of the astonishing evolution in the Medical, Pharmacy, and Insurance industries. Understanding the basic dynamics of medical offices has helped me navigate and gain access at a quicker pace for AD. Also, understanding the business acumen component of running a medical practice has proven to be valuable in my recent interactions.
NaRCAD: You mentioned that you’re committed to providing value for clinicians and patients alike. Talk to us about how you share key messages with the clinicians you visit.
In my experience, to truly influence the behavior of a highly-educated and experienced individual, you must come to the table with the goal of learning. With attentive listening, you ‘hear’ the medical professional, and process what you have learned. Your intuition will guide you to ask the appropriate, insightful questions needed to evaluate his/her priorities and challenges. This is a beautiful thing, because trust starts to blossom and the partnership has begun.
You can then confidently tailor key messages, valuable resources and solutions that are closely tied to those needs and challenges you uncovered. You should begin to see the individual’s genuine desire to truly change behavior and habits.
NaRCAD: Talking about opioids is a sensitive topic. What’s some of the typical pushback you get from clinicians you detail about opioid safety?
The response to academic detailing really depends on the situation and the type of clinician and/or establishment I am working with. Sharing local opioid statistics compared to our state statistics is an eye opener! I try to paint real life pictures by telling true stories.
For example, I’m honest about my own family members who were innocently caught up in this crisis, including the true story about the day my sister’s husband accidentally took his prescribed opioid medication twice. My sister lost her husband that day.
NaRCAD: Along with telling true stories, how do you handle pushback and stay positive, encouraging clinicians to pivot?
Time, or lack of time, is the biggest culprit in keeping physicians from attempting to personally assist in ending the addiction cycle for patients. I passionately believe clinicians need more time with people on opioids.
It takes several visits with an office to start moving in the right direction. Working with the medical assistants, nurses, and/ office managers is a key component. They can often have influence, give advice or insight, and even advocate when you are not there.
Also, I review our county’s Safe Prescribing Guidelines. If clinicians cannot institute all items in the guidelines, I ask providers to choose what they can commit to doing and to think about some specific patients they can work with. I also ask them to consider prescribing Naloxone for patients on high doses of opioids (above 50 morphine milligram equivalents).
NaRCAD: What would you share with new detailers who are about to go into the field and use AD to tackle the opioid crisis?
I have a few reminders and tips for detailers:
Stacy M. Piper, CLEC, Public Health Educational Specialist
Butte County California Public Health Department
As a Public Health Education Specialist, Stacy was chosen to work with two CA State grant funded programs educating Medical Professionals, Hospitals and Community Organizations for the WIC Program and the Opioid Drug Abuse Prevention Program. She maintains an active involvement with the Butte County Opioid Task Force, as well as the Butte County Drug Addiction Prevention Coalition, ACE’s Coalition (Trauma Informed), Breastfeeding Roundtable Coalition, Butte County Breastfeeding Coalition, Mother Strong Coalition, and Perinatal Coalition. Stacy has had extensive training with the California Department of Public Health's Opioid Stewardship & Chronic Pain Detailing Program, ID Training, UCSD CLE (Certified Lactation Educator), Coalition & Equity Training, Advocacy Training and holds 14 years of ongoing training & certification in the Pharmaceutical Industry. She is a member of the team coordinating and orchestrating the 2018 Northern California Opioid Summit.
Guest Blogger: Deborah Monaghan, MD
Public Health/Academic Detailer
Colorado Department of Public Health and Environment
NaRCAD Training Alumnus
As the first and only detailer hired by the Colorado Department of Public Health and Environment, which serves 5.6 million people (about 3 million of which cluster around one metro area), the idea of building a detailing program from the ground up was incredibly exciting…and daunting. From the outset, it was important to determine the place of detailing within the community and establish its fit in the department’s mission.
Shortly after joining the team, I presented the intended scope of my work at a department meeting--and it generated tremendous interest in the use of academic detailing for public health initiatives far beyond the current planned intervention. This served to solidify the potential value of clinical education outreach to leadership throughout the department. Lessons learned are continually surfacing as we move into year two, and a few key concepts are worth sharing.
Particularly in the early stages of program establishment, it was essential to stretch resources and leverage partnerships. NaRCAD connections with other detailing programs facilitated the exchange of print resources, protocols and lessons learned, saving valuable development time.
Through CDC-funded capacity building visits, I shadowed detailing teams at two other health departments' AD programs (San Francisco Department of Public Health and the New York City Department of Health & Mental Hygiene), which provided a framework for our own program’s function.
At every opportunity, I presented our detailing goals to community partners and stakeholders, resulting in many connections to medical providers, which, in turn, generated most of our initial provider visits. Submitting articles for local clinical practice newsletters and magazines also established recognition and trust in the state’s new detailing initiatives.
Once provider-facing detailing visits began, two things became quite clear:
Providers crave connection to their public health department.
Providers want regional data.
In a state with both urban and rural/frontier areas, urban clinicians wanted to be seen as “boots on the ground” to impact large populations by treating their own patients, while rural providers wanted to be acknowledged as part of the team and directed to resources they could access remotely. All clinicians, both urban and rural, wanted the latest disease and health data for their county, zip code, and even census tract level to compare to the rest of the state.
It has taken multiple attempts to get in the door in many practices. However, after a detailing visit, most providers are outspoken that they found the session worthwhile, and we've used this opportunity to ask for referrals to other providers who might be open to visits. The time investment has also enabled two-way communication allowing us to get a “finger on the pulse” of regional health and disease, particularly in the more rural areas.
The initial time invested to establish relationships with providers was high, but the rate of return has justified the investment. With a new detailing program, the responsibility falls to the detailer to establish credibility, both in resources provided as well as in value for time spent.
If I were starting a detailing program again, or could support new programs who were just getting started, I would love to be armed with these lessons learned:
Establish as many protocols, procedures and resources as possible.
Just start! Even if every detail isn’t in place, start visiting with providers. (The steep learning curve of on-the-ground visits is incredibly valuable and will continue to shape and improve your methods.)
Document everything! As methods change and processes improve, document what is changing and why. Document with the goal of sharing not simply a starting point and a finished product but an entire story.
Be willing to adjust in real time. Providers will have varying needs from one to another and from one day to the next, and our flexibility will ultimately strengthen the relationships we are trying to build, allowing academic detailing to have the greatest possible impact.
Deborah Monaghan, MD
Public Health/Academic Detailer, Colorado Department of Public Health and Environment
Deborah joined CDPHE in 2016 as the Department’s first detailer and currently provides clinical outreach on HIV prevention and sexual health. A graduate of the University of Mississippi School of Medicine, internship took Deborah to Drexel University in Philadelphia, Pennsylvania followed by residency at St Mary’s Hospital in Grand Junction, Colorado. She will complete her MSPH through the University of London School of Hygiene and Tropical Medicine in 2018. Initial response from the provider community receiving detailing has been overwhelmingly positive, and Deborah hopes to facilitate expansion of detailing efforts into other branches of public health to impact more Coloradans.
Director's Letter | Mike Fischer, MD, MS
The entire health care system is grappling with uncertainty. What will happen to the provisions of the Affordable Care Act? Will clinicians and health systems face major changes in how they are expected to provide care and how they are reimbursed? Will state and local public health agencies have support for the many initiatives undertaken in recent years?
As we wait for answers to these questions, the role of academic detailing is more important than ever. AD programs will face new challenges, and will need to understand how AD can be adapted to fit changing constraints and still have a beneficial impact on clinician engagement, the quality of care, and patient outcomes. At NaRCAD, we look at this unpredictable environment and see a mandate to collaborate and innovate, working with our partners to develop and evaluate novel ways to implement AD.
At NaRCAD, we look at this unpredictable environment and see a mandate to collaborate and innovate.
Planning for NaRCAD2017, our annual conference, is well underway, and the call for proposals is open. Submit results of your current work or your ideas for panels and breakout sessions that will let you share your work and inspire colleagues.
To keep AD growing and thriving requires an active pipeline of newly trained detailers, which we have just added to with our recent AD Techniques Training on March 30 & 31, 2017.
This spring’s training class came to Boston to learn the techniques of academic detailing in order to support important interventions, including better use of smoking cessation treatment for patients with serious mental illness, increasing HPV vaccination rates, enhanced safety of opioid prescribing, and improving the care of chronic diseases such as COPD, HIV/AIDS, diabetes, heart failure, and kidney disease.
Our trainees hailed from Canada, Brazil, and around the U.S., including South Carolina, Rhode Island, Idaho, Massachusetts, Oregon, Texas, Kentucky, Connecticut, and Colorado, bringing their unique experiences and backgrounds to 2 days filled with hands-on learning opportunities. Stay tuned for upcoming details about our Fall 2017 training, to be held this September--dates announced soon!
What continues to motivate us during times of uncertainty is working with the NaRCAD community, and we want 2017 to continue to be a year of even deeper engagement. Submit to the 2017 conference, share your ideas, suggestions, and comments on our blog, or reach out to us directly. We’re excited to continue to support your work and to build new collaborations--tell us what you need as part of our community of clinical outreach educators. -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.
Expert Trainer Insight Series, Part 2:
An Interview with Amanda Kennedy, PharmD, BCPS, Director of the Vermont Academic Detailing Program
NaRCAD: Hi, Amanda! We’re looking forward to chatting with you. You’ve been an academic detailer for about 13 or 14 years—tell us about the Vermont program.
Amanda: The Vermont Academic Detailing Program was started in 1999, by Amy Jaeger, PharmD. I trained with Dr. Jaeger as a pharmacy resident. When she left Vermont in the early 2000s, she wanted to leave the program to someone who would be passionate about evidence-based prescribing in primary care.
So the job was mine! Amy unfortunately passed away unexpectedly in 2005, but her mentoring and passion for patient care has stayed with me, and has forever shaped the way I think about pharmacy and academic detailing.
We’ve evolved over time into a more organized program, with a grassroots focus of serving our state’s primary care providers. This commitment to service is how we succeed in building strong relationships with providers over time, and we infuse the spirit of service into all of our sessions.
NaRCAD: What challenges do you face that are specific to being a rural program?
Amanda: Our program has been stable, but it's been low budget over time. Despite being a small state, we face many challenges balancing the feasibility of delivering sessions to providers with our rural geography.
The evidence-base for academic detailing clearly demonstrates the value of a 1:1 ratio of academic detailer to provider. However, it doesn’t make sense for us to travel 2 hours each way to see one provider only to repeat the process the next day for a second provider within the same practice.
So we mostly deliver small group academic detailing sessions, as a way to serve as many providers as possible within our budget. We‘re mindful that “small group” means about 3 prescribers, which matches the types of practices we serve.
NaRCAD: Along with being a seasoned academic detailer, you also help us here at NaRCAD to train groups of new detailers at our Boston-based techniques trainings. Can you share some highlights?
Amanda: The power of the NaRCAD trainings is in the power of the individuals who attend. Realizing that other people are struggling with the same issues, and trying to address these issues with academic detailing, is so powerful.
NaRCAD: What would you tell someone who’s thinking about coming to a future NaRCAD training?
Amanda: I'd tell them to have fun with it! This training is a special opportunity to focus on how to best communicate with people around behavior change. It allows one to put aside specific topics and come together in a group to think about how best to deliver complex information.
The model applies across topics, allowing people from all types of programs to work towards a common goal. The training is hard work, but so rewarding, and offers the chance to learn and network with other trainees. The best part is that it’s immediately applicable upon returning to your program.
NaRCAD: That’s good advice—we agree that learning opportunities should be both challenging and enjoyable. In other news, we heard you recently presented at a U.S. House of Representatives Congressional Briefing. Tell us about that.
Amanda: I was invited to present at the briefing entitled, “Getting the Medications Right”: An essential ingredient in achieving the goals of H.R. 4878 – the Medicare Better Care, Lower Cost Act. The briefing was presented by the American College of Clinical Pharmacy and the College of Psychiatric and Neurologic Pharmacists.
The purpose of the briefing was to highlight pharmacists as members of the primary care team. I specifically presented some of my Vermont research that involved partnering pharmacists within patient-centered medical homes.
It was the perfect opportunity to showcase the innovative work we are doing here in Vermont. I think there was a great response from those who attended and for me personally, it was an absolute honor to be there.
NaRCAD: Thanks so much for taking the time to connect with us, Amanda. We’re delighted to have you as part of our core team of training facilitators, and we’re excited to share what you’re doing in Vermont with our community.
Learn more about Amanda Kennedy, or visit our Team Page to learn more about NaRCAD staff.
Join Us: NaRCAD's next training is open for registration.
Ask the Expert: Questions for Amanda? Ideas for us? Thoughts on detailing? Share your response in the comment section below for community discussion!
Bevin K. Shagoury, Communications & Education Director @ NaRCAD
We’ve just wrapped up our Spring Academic Detailing Training here in Boston, and we're excited to share a recap of an important event. With each new class of trainees, we see new ways that academic detailing can improve health outcomes for a variety of topics and populations.
This May 16th & 17th, the NaRCAD team hosted 18 trainees from across the U.S. and Europe. Our trainees represented programs looking to increase STD screening and sex education in Philadelphia, reduce overmedication of elderly long-term care residents across Indiana, teach safer opiate prescribing in Wisconsin, and implement other quality improvement initiatives in Ireland, Denmark, Georgia, Rhode Island, and North Dakota.
Everyone at NaRCAD would like to thank our fantastic, enthusiastic class of trainees for participating. We’ll be keeping in close touch as they go out into the field to implement important academic detailing interventions.
For other members of our community, we hope you’ll consider joining us this Fall at our next 2-day course on September 19th & 20th, 2016--it's the core of what we do. If it helps to convince you, 100% of our trainees from this week's course said they'd recommend our course to a colleague, so save the date, and be sure to register early as space is limited and seats fill quickly.
Registration opens on June 15th-we're looking forward to seeing you there!
Until then, remember: "Good information doesn't disseminate itself."
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:
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.
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.
An Interview with Paula Walker, Clinical Pharmacist
Baylor, Scott & White Health | Dallas, Texas
Tell us a bit about yourself. How did you get into care redesign and transitional care? I grew up in the area of Inman Square Pharmacy in Cambridge, Massachusetts. After graduating from Northeastern University in 1990, I began my career in community pharmacy. Soon after I entered the pharmaceutical industry, I spent many years representing the biological division of Rhone-Poulenc. I continued to keep connected with public health by practicing in the community part time; I’ve also been serving in a family practice clinic for over 8 years now. Three years ago, upon recommendation from our clinic director, I joined The Institute of Chronic Disease and Care Redesign at Baylor Scott and White Health in Dallas.
Tell us about the institute. What does your team focus on with regards to providing transitional care? What approach do you take?
Our multidisciplinary team focuses on improving outcomes among chronically ill older adults. Our innovative approach includes using advanced technology to identify patients at most risk for readmission. With a focus on heart failure, COPD, and pneumonia, patients are identified and supported as they transition from one level of care to the next. Our transitional care team encourages each specialty to work at the very top of their license to assist patients whose recovery is complicated by cognitive impairment, frailty, and social issues. Our team shares offices together so each discipline is available to all team members at all times. A strong team and constant communication is the key to our success.
What does a typical day or week look like for you in this field? How do you incorporate academic detailing techniques into your work?
My role is to perform the medication reconciliation on all of my patients and communicate any concerns with the appropriate providers. I attend weekly rounding with my team and need to be able to make and support any medication recommendations. In terms of using academic detailing techniques, our team practices evidence-based medicine in the care and treatment of our population with chronic disease. It’s also key for a pharmacist in this role to be able to communicate to providers quickly and effectively regarding drug selection, dosage, and titration. Learning and practicing the skills required to communicate effectively in this environment is essential. In a typical day I will consult with a geriatric specialist, cardiology, nephrology, APRN, social worker, and corporate administration. That is a lot of communicating!
You attended our Academic Detailing Techniques Training a few years back. What parts of the program worked well for you, and what are the most useful resources or information that you’re still using today? I found the skills learned during the NaRCAD training to be useful and confidence building. There is an art to being able to research information then applying it to support a recommendation in a short amount of time. NaRCAD brings together professionals from different disciplines that are focused on improving the communication of science-based information in their practice or facility. It is useful to connect with others that require these skills in their work. The small class size made it very easy to meet all the participants and learn from their experiences. I believe you can never be too experienced, and I constantly learn from the experience of others.
What are some future successes you’re looking forward to in your work and in the field in general? As we prepare to expand the Transitional Care Model at Baylor Scott and White Health under the population health infrastructure, I look forward to the pharmacist’s role to expand as well. Our goal of disease management, well above the national standard, will require evidence based medicine and the sharing of clinical information to all members of the care team. I look forward to continuing my relationship with NaRCAD—together we can help each other transform care, resulting in an improvement in the quality of life for our patients. And I’m looking forward to NaRCAD’s 3rd International Conference on Academic Detailing this November in Boston!
Biography: Paula Walker, Clinical Pharmacist, joined the Baylor Scott & White Health Transitional Care Team in 2012. Paula is the team pharmacist and oversees all medication reconciliation for their older adult population with heart failure, COPD, and pneumonia. Prior to joining BSW, Paula has worked in community pharmacy, clinic pharmacy (still active), and the pharmaceutical industry. Paula holds BS in Pharmacy from Northeastern University.
Bevin K. Shagoury, Communications & Education Director
Our most recent 2-day Academic Detailing Techniques Training was held here in Boston on May 4th and 5th, 2015, and it was a successful and exciting convening of 18 trainees from all over the country. Clinical pharmacists, nurses, and program specialists gathered in Boston’s downtown to learn and practice social marketing techniques to use when educating front line clinicians about new evidence and important interventions.
Our trainees will take these valuable skills back to a wide range of programs, with goals including improving health for veterans with PTSD, increasing referrals to smoking cessation programs, and strengthening chronic disease lifestyle management programs.
Many of us have attended trainings and conferences heavy on Powerpoint presentations and light on practicing tangible skills. At NaRCAD, we use a dynamic curriculum wherein we integrate role-play, interactive large and small-group discussion, live demonstrations of a successful academic detailing visit, reflection through videography, ongoing networking, and the chance to learn from experts, clinicians, and colleagues through practice and skills sharing.
After their training sessions are done, trainees move forward to establish new academic detailing programs, strengthen and develop existing ones, or use our techniques in other clinical education settings. And as their work continues, so does ours—we maintain contact with our trainees, providing critical resources and featuring their work on our website and DETAILS blog. This fall, we’ll be featuring partner profiles of many of our trainees’ academic detailing programs, so that our community can learn about the critical role these programs play in improving health outcomes.
Join us at our next training this September—a program one recent trainee describes as “an excellent program, with fabulous faculty, and a well-run, valuable service to the healthcare community.” We keep improving our curriculum to ensure that each of our trainees gets personalized support to make their work easier. Their appreciation and feedback helps us to refine our training, encouraging us to think about ways we can continue to provide the best resources available. As the field continues to grow, so do we—and our trainees tell us that we’re making an impact by leveraging their work, sharing best practices, and running “the best training I’ve ever been to—seriously!”
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.
Highlighting Best Practices
We highlight what's working in clinical education through interviews, features, event recaps, and guest blogs, offering clinical educators the chance to share successes and lessons learned from around the country & beyond.