Overview: The DETAILS blog presents a special two-part series of what it takes to build a strong provider-detailer relationship from the perspective of a long-time academic detailer and from one of her local physician partners that she's detailed for almost 15 years.
In Part One, we speak with Amanda Kennedy, PharmD, BCPS, who serves as the Director of the Vermont Academic Detailing Program and has been an active detailer since 2002. The Vermont Academic Detailing Program sees about 450-500 providers a year on 1-2 clinical topics. In Part Two, we hear from Dr. Robert “Bob” Schwartz, a Vermont family physician who reflects on his experiences with academic detailing visits with Amanda. Stay tuned for Part Two!
An interview with Winnie Ho, NaRCAD Program Coordinator.
Winnie: Amanda, thank you for taking the time to reflect on the relationships you’ve built through the years with local providers. What would you say are the key elements for building a strong provider-detailer relationship, and why?
Amanda: Trust and mutual respect. If the clinician doesn’t trust you, then it’s going to be very hard to make recommendations for practice change. Mutual respect goes both ways. As much as I am providing a service, I also expect the clinician to show up and be engaged in our visit, because only then can we have the kind of conversation that gets at the heart of the behavior change we hope to see.
W: Engagement is such a key component of these visits, especially for creating a safe space for providers to be open and honest with the detailers about their concerns and needs. I want to take you back to the start and ask you to reflect on what it was like to be brand new to AD. What advice would you give to a new detailer in those shoes?
A: Confidence is key. You can study and practice everything with your team, but at some point you have to get out there and just do it. Building that relationship requires confidence and the belief that you have something valuable to offer. When you only have a few opportunities a year to meet with clinicians, you have to capitalize on those moments.
It can be difficult to establish that rapport and trust when contact is infrequent. It’s about persistence, patience, and continuing to show the clinician that you want to be helpful. Some things can get in the way, such as not having the same clinical background as the provider you’re working with, and not always feeling qualified. But remember, you wouldn’t have been hired in this role you weren’t qualified!
W: That’s certainly important to keep in mind. You were also recently introduced to a new playing field – virtual visits. Compared to traditional in-person visits, what’s it like starting new relationships through e-Detailing?
A: Virtual visits can be efficient, because we eliminate the cost of travel, we can reach more people and more often. Most of the content of that first call is the same as in person. On a first visit, most of what you’re doing is the introduction of your work and your program. I’m transparent about everything with them.
I don’t bring up my materials or share my screen until that clinician has had the opportunity to ask me any questions they have. I give them a chance to see me as a person first, without distractions. This takes a few minutes longer virtually than in person, and it can be harder to gauge body language, but it’s an important first step in establishing a relationship.
W: That’s a good piece of advice for many programs making that transition into e-Detailing, as I know it was a big concern about starting these relationships over a new medium. Do you have an example of how maintaining these relationships can support better health outcomes for patients?
A: Yes. While our team was putting together information on a COPD campaign, I was meeting with Dr. Schwartz on a different topic. At the end of our visit, I told him about the next topic and asked him what was concerning him about it. He asked for more information on benzodiazepines and patients with COPD. While this specific information wasn’t included in the overall COPD campaign, I’ve personally been looking for good articles that would be helpful for his particular interest. In attending to this specific request, I’m showing him that I’m listening to and addressing his need.
W: That’s some strong needs assessment! And I’m sure that information will be put to good use. You’ve been in this field for 18 years - have you seen how your support has resulted in clinical behavior changes over the years?
A: The most rewarding thing for me is going into a clinic and seeing a tattered version of a handout we used five years go, or a clipped out table taped up on a board. That’s how you know your information has stuck around and has had a long-term impact.
Also, on visits, if a provider is struggling to think of how to incorporate a behavior change into their practice, I have stories from other providers and can provide suggestions and ideas that have worked for them. I can leverage a community of long-term relationships.
W: Have you found that these strong relationships allow you to get more out of a detailing visit, especially when there are some difficult conversations?
A: Yes, absolutely. It’s important to know, especially right now, that we’re suffering a community-wide trauma because of COVID-19. Out patients need their providers, but those providers have their own challenges going on too. There are family issues, financial issues, and community issues. Our jobs as detailers is to be a support as much as we can, and to help providers make beneficial changes for patients that are rooted in evidence.
We’re currently doing a topic on managing stress related to COVID, but before we get into how providers can help their patients, we pause and ask them how they’re doing. I’ve had providers share deeply personal information with me that can be important in understanding how to best support them in addition to them supporting their patients. They know that they can trust us.
W: As we wrap up, what would your final advice be to other detailers looking to replicate your success?
A: My advice? It doesn’t take 18 years to build a relationship with someone. It just takes enough of your effort to show that you’re really trying and taking opportunities to be of service. It means showing that you’re trustworthy, and that you’re going to respect and support them just like you’re promising them that you will.
(Part One of Two).
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Amanda Kennedy, PharmD, BCPS, is the Director of the Vermont Academic Detailing Program at the University of Vermont’s Office of Primary Care. She has also been an active academic detailer for nearly 20 years. Amanda regularly serves as a faculty facilitator for NaRCAD’s Academic Detailing Techniques trainings.
In addition to her role with academic detailing, Dr. Kennedy is a Professor of Medicine at the University of Vermont’s Larner College of Medicine. She currently serves in the Department of Medicine Quality Program, teaching and mentoring physician residents, fellows and faculty in quality improvement and health services research.
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