The National Academic Detailing Service’s
Opioid Overdose Education & Naloxone Distribution (OEND) Program
Guest Blog Authors: Melissa Christopher, PharmD, National Director
Mark Bounthavong, PharmD, MPH, National Clinical Program Manager
In 2015, the Department of Veterans Affairs (VA) invested in the National Academic Detailing Service to improve the health of our Veterans to address the call to action for the opioid crisis. Through the Opioid Overdose Education and Naloxone Distribution (OEND) Program, our goals were to reduce harm and risk of life-threatening opioid-related overdose and deaths among Veterans.
Key components of the OEND program include raising awareness about the epidemic, 1:1 academic detailing visits with clinicians to provide education and training regarding opioid overdose prevention, opioid overdose rescue response, and issuing naloxone products. We developed direct-to-consumer marketing and other e-resources, including a video, Introduction to Naloxone for People Taking Prescribed Opioids.
We also created implementation tools, including population management dashboards to aid staff in evaluating risk factors of their patient population and distributing naloxone accordingly. Academic Detailers demonstrated to VA providers these resources to help raise awareness of opioid overdose risk for their patient panel.
Decision-makers believed that funding this program would yield a good return on investment. As part of the National Academic Detailing Service, it’s our responsibility to collect data and supply decision-makers with evidence on the value and success of our program. In other words, we’re accountable for answering the question, “Is academic detailing worth it?”
To answer this question, we performed several program evaluations of the National Academic Detailing Service from 2015 to 2017, one of which we just published in the Journal of American Pharmacists Association (JAPhA) (Trends in naloxone prescriptions prescribed after implementation of a National Academic Detailing Service in the Veterans Health Administration: A preliminary analysis.)
The evaluation found that our program improved naloxone distribution rates at a seven times greater increase for Veterans at risk for opioid overdose. These results provided key empirical evidence that VA’s strategy of academic detailing was working. Just as important, these findings also gave decision-makers what they needed—proof that their investment in an area of high risk to Veterans’ health paid off by improving care.
But we learned that another group of stakeholders was just as important as the decision-makers who funded the program—the clinicians that academic detailers visited to provide outreach education as a service. Academic detailers work with clinicians to help them change practice patterns, focusing on improving health outcomes in alignment with balanced, current evidence.
As clinicians commit to sustainable behavior change, these providers need to hear the feedback about how the time they’ve invested with their patients ultimately improves outcomes and, in this case, saves lives.
Sharing program results with the clinicians in this intervention also encouraged these providers to share their own results, many of which were stories of patients returning to the clinic to relate their experiences of using naloxone to reverse an overdose. These stories, along with reversal reports from the field that tracked the outcomes of naloxone kit distribution and subsequent use, also created a tangible “return on investment” for everyone involved.
We encourage other academic detailing programs to prioritize program evaluation as we have at the VHA—no matter the size of your program, if you’re thinking, “we can’t afford to do program evaluations,“ we stress that you can’t afford not to do them.
Measuring program work builds a case not just for the success of one academic detailing intervention, but for the success of future programs—a case for sustainability. Evaluation measures the quality of a program, analyzing results to look at a program’s impact, and allowing for process improvement adjustments to be made to streamline efforts and strengthen that impact. Evaluation cannot be optional, especially when lives are at stake.
We also recommend that the results from program evaluations are shared with other stakeholders, such as clinicians, in order to encourage and sustain their behavior changes. Leveraging results from well-designed evaluation is essential for academic detailing interventions to illustrate success, share value, and provide stakeholders and community members with a clear “Yes!” in answer to their overarching question: “Was the investment worth it?”
Melissa Christopher, PharmD
National Director, Academic Detailing, US Department of Veterans Affairs Central Office, Pharmacy Benefits Management (PBM) Academic Detailing Service
Dr. Christopher is the National Director of VA Academic Detailing Services, overseeing the implementation efforts for academic detailing expansion across all Veteran Integrated Service Networks since 2014. She received her Doctor of Pharmacy from Duquesne University, Pittsburgh Pennsylvania. She completed a Pharmacy Practice Residency and Post Graduate Year 2 in Pharmacoeconomics and Formulary Management at VA San Diego Healthcare System. Dr. Christopher conducted research in health outcomes and pharmacoeconomic analysis for several chronic disease management areas. In recent years, Dr. Christopher has embraced the mission to expand efforts for educational outreach by clinical pharmacists for improvement of evidence based care in Pain Management, Depression, Schizophrenia, and Posttraumatic Stress Disorder as well as other substance use disorders. Most of her program efforts focus on development of educational materials, outcome monitors, provider specific electronic audit and feedback tools to trend practice patterns with implementation efforts for the newly developed as well as fully implemented AD programs.
Mark Bounthavong, PharmD, MPH
National Clinical Program Manager, Academic Detailing Service, Veterans Affairs
Dr. Bounthavong graduated from the College of Pharmacy at Western University of Health Sciences. He completed a PGY-1 Pharmacy Practice Residency at the Veterans Affairs Loma Linda Healthcare System followed by a fellowship in Outcomes Research and Pharmacoeconomics at Western University of Health Sciences. He started his career at the Veterans Affairs San Diego Healthcare System as a pharmacoeconomics clinical specialist. During his tenure at the VA, Mark worked on identifying cost-effective strategies and formulary management; directed the PGY-1 Managed Care Pharmacy Residency; and completed a Master of Public Health from Emory University. Mark left the VA in order to pursue a PhD in the Pharmaceutical Outcomes Research and Policy Program at the University of Washington. He recently accepted a position at the VA as one of the National Clinical Pharmacy Data Program Managers in the Academic Detailing Service.
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.
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!”
Highlighting Best Practices
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