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39 Comments
3/30/2018 01:12:57 pm
Hey to our friends @Kentucky--we miss you already! As our first site for academic detailing training and field work, we're seeing you emerge as leaders across this pilot site project and in your own county to make things better for those who use opioids in your community. I connected with Austin and Teresa yesterday on a call with Kabaye from NACCHO and was excited to hear that visits are already happening! Let's use this space to stay connected, troubleshoot challenges, and learn from each other. Talk soon!
Lutricia Woods
4/6/2018 11:20:09 am
Hi folks, I had my first visit with a doctor today, a dermatologist. It went very well. He was so passionate about doing something about the drug crisis, we spent more than 15 minutes, but stayed on task. I'm thankful he was my first. It was a good practice session with a doc who rarely prescribes. YAY me! Now on to the tougher ones. 4/9/2018 12:11:48 pm
Go, Lutricia! That's terrific. Glad to hear that the clinician wanted more time with you, and that you were able to practice. Let us know what you face as you continue to talk with clinicians who prescribe opioids more regularly and how it's going. 4/9/2018 12:13:04 pm
We're happy to hear that our Kentucky collaborative is in the field and doing well. Thanks for helping us adapt materials for other groups to use. And as always, tell us how we can help you as you move forward. Thanks!
Lutricia Woods
4/9/2018 03:56:34 pm
I have a thought/idea. Since we are trying to share ideas with physicians suggesting ways to reduce opioid prescribing using the 5 messages, what if we left them with a pocket-sized laminated card or magnet with the messages on it. (Sorry for the run-on sentence) the card could become a constant reminder on their desk or file cabinet. 4/10/2018 10:46:52 am
Love this idea--maybe taking the 4 pager and opening it up to photocopy (or print from the opioid toolkit directly!) the inside left bottom square that shows the 5 key messages, and having that square laminated. Others, what do you think? There are also other clinician-facing tools/reminders on the toolkit--any thoughts on which of those might be most helpful?
Lutricia Woods
4/11/2018 06:45:28 am
Bevin, The 4 pager is a great teaching resource, but there's lots of information on it. Having the 5 messages on a small card would make the messages more direct and on a format that could stand out in their view and in their mind much better than another piece of paper on their desk. I realize this idea could have been born from my personal learning style and may not resonate with others. :)
Austin Gambrel
4/12/2018 03:10:55 pm
I think definitely having a handout with the 5 key messages on it would be beneficial! I think thats something that most physicians would like to have and use especially if someone has questions as to why the doc might be trying something different. 4/12/2018 04:29:14 pm
Okay guys, you've got it. I have something re: 5 Key Messages in the works that'll be online in toolkit under the "Core Toolkit for Printing" by tomorrow morning. Check it out! 4/25/2018 10:01:16 am
@Austin--can you share some of your thoughts in a new thread about the challenges of getting a follow-up visit scheduled after having a good 1st visit? We talked about this via phone yesterday and I think it's a good thing to bring up--that follow up visits are very important, although not critical if you can't make one materialize, and that if you schedule a follow-up, you're more likely to have accountability from the clinician/provider to follow through with the behavior change you asked for during Visit #1. Thought, everyone?
Robin Tuttle
4/10/2018 12:39:29 pm
Hello all! Didn't realize we had a message board! I spent a while on the NarCad site last week listening to Dr. Fisher discussion about how detailing got started and been around for so long. I can now explain the program a little better because of it. My experiences have been mixed thus far. One doctor talking for almost an hour! To one doctor just wanting info and handout. I did manage to get promises from all to follow up! Sorry so long, just been a lot going on here!
Bevin K. Shagoury
4/12/2018 04:30:21 pm
Hey Robin! So great to hear from you! Glad our online resources helped get you ready to go. Glad folks have been interested in follow-ups. Was the doc who wanted to talk for an hour interested in making changes? What are some of the pushback/challenges you've received so far?
Robin Tuttle
4/20/2018 02:29:27 pm
The conversation started off like the one Dr. Mike and I had practiced! "Am I in trouble, you have my name on a list" kinda thing. After so convincing, he became very receptive to the data I had, and liked that Bell county had received the grant to get this information out. It ended up being a very productive discussion. 4/25/2018 09:55:49 am
@RobinTuttle--glad our role play ended up being realistic enough, and sounds like you handled that challenge ("Am I in trouble?!") really smoothly! Are you noticing that people you're visiting are gravitating towards certain key messages vs. others, or certain materials? Thanks for sharing some insights, and keep 'em coming!
Lutricia Woods
4/11/2018 06:38:46 am
I’ve had two visits so far and was able to cover all the messages. Both doctors engaged quickly and we had good conversations. I shared that we were sharing five specific ideas for then to use to help in reducing the number of opioid prescriptions, especially with patients they suspected were drug seeking, but for all patients they would like to see using less opioids too. The doctor I visited today pushed back on a couple, specifically, #1, saying he had also seen the study on Non-Opioid pain relievers, but felt some of his patients had pain levels requiring stronger meds, such as post-op patients, cancer patients and patients with degenerative disc disease. He also admitted he sometimes prescribed benzodiazepines for some patients, but monitored them closely for signs potential overdose.
Robin Tuttle
4/20/2018 02:33:08 pm
They turned out real nice too! However, I'm going to save them and use them as a handout on the second visit. I always feel like I should be giving them something. I wish I had a bunch of those really nice NaRCAD pens, they write really well, and I gave mine away. 4/25/2018 09:57:12 am
@Robin--glad you like the cards--you can thank Teresa for getting those turned around in a day! As far as the pens go, I happen to know someone who has about a million of them, so e-mail me a good address to ship them to you, and we'll get some sent your way! :) 4/25/2018 09:59:27 am
And great idea to use the Key Messages cards as a 2nd visit handout. Has anyone else used them yet and found that they're helpful? @Lutricia?
Lutricia Woods
4/11/2018 06:50:18 am
One issue I'm experiencing is in getting the appointments scheduled to speak with the docs. Usually, I speak with 2 and sometimes 3 people before I can get an appointment AND am placed on hold 1-2 times, not to mention getting cut off. I spent an hour last week scheduling 4 appointments. Does anyone have a secret code for getting to the correct person and saving time?
Bevin K. Shagoury
4/12/2018 04:31:50 pm
Hi Lutricia. I don't know that there's a secret code, because many times even known patients who call clinics have to go through the dance of the automated menu and the layers upon layers of gatekeepers. Keep tracking your hours so you're logging the preparation time you're putting in--anyone else having more success with this?
Nancy Barton
4/20/2018 12:46:13 pm
I am here Bevin! Actually I am on my way to my second visit this week. Yes it’s my day off and I have makeup and dress clothes on! Teresa said I was painfully missed with my sharp tongue on here so I’m checking in :) 4/25/2018 09:58:46 am
@Nancy--SO glad to have you on here! Teresa filled me in on your "drive-by" detailing (for those of you who are unaware of this new term, it means when you're walking by someone in the hall who you didn't plan on detailing to, but you decide to grab them while you can and have an impromptu session!) and that you were all dolled up on a weekend--we appreciate your extra efforts for this initiative! How did things go? Can you share some feedback (or pushback!) that clinicians are presenting?
Nancy Barton
4/25/2018 02:05:05 pm
Hey guys! I have had no push back thus far. I have a bit of an advantage because I see these people in the hallway at work and I grab their ear lol. I have had some interesting conversations with these providers, Most of them have already sensed the opioid problem and they are currently in the process of taking matters into their own hands. The biggest discussion topic for most providers is the need for a national PDMP. This would make their lives easier.
Trey Brock
4/25/2018 11:07:50 am
Hey everyone! My visits have been going well. I’ve had two doctors who were very responsive and were happy to help with what we’re doing. One interesting thing that occurred was with my visit with dr. Dubin was he explained to me his disgust for saboxone altogether. So that hurdle was imfun Tj try and cross. I just told him I understood and tried to focus on the other main points. He was very interested in wanting to help so In my follow up I gave him more information including the JAMA study. They seemed really pleased with that. 4/25/2018 11:23:15 am
@Trey--thanks for sharing some of your experiences. Can you give us a sense of why there seemed to be some stigma/pushback around suboxone/medication-assisted treatment? Let's also be careful not to name specific clinicians by name on this particular site, but if you want to let other folks in the group know about particular folks, we can chat offline/via e-mail about that. Anyone else having pushback around treatment offerings?
Nancy Barton
4/25/2018 05:36:03 pm
I haven’t had push back but the providers don’t like the suboxone clinics in our area. They say they are “unreliable”. They mostly talk about referring their patients to pain clinics. This is not the answer. However, suboxone has become a big part of the problem in our area as well as methamphetmine. Being in the ER and seeing drug screens all day everyday I can testify to that! 4/26/2018 10:48:52 am
@Nancy: When folks are feeling like the suboxone clinics in their area are "unreliable", are you getting a sense of the 'why' behind that? Also, are clinicians seeming open to certain key messages vs. others?
Lutricia Woods
4/25/2018 07:26:04 pm
I haven’t had any push back at all. I agree Nancy, they all seem to be aware of the problem and are concerned. I’ve shared the data handouts and suggested they can be used with patients as a way to open conversations with patients about the risks/dangers of using opioids and benzos beyond brief periods. I love sharing the message cards. 4/26/2018 10:47:25 am
@Lutricia, thanks for sharing your successes, and glad the key messages cards are so helpful. For "before and after visit data", have you been able to track which messages they're open to? When you share all of the key messages, are you finding they're more open to some rather than others?
Teresa Hunter
4/25/2018 10:01:04 pm
Good evening all! Bevin wishes for me to contribute to the "board". I am so proud of the detailing team in Bell County. Wow, I did good didn't I choosing this incredible group of people! The "pilot" pilot group of this project and you all should be proud of the efforts that are being put forth toward the clinicians in our area! Keep up the good work! You make me look good!!!! Lol 4/26/2018 10:55:13 am
@Teresa, you sure did! What an amazing group you all are. We're so delighted to have these 'stories from the front lines' coming in via this discussion board so often, it's exactly the kind of content that helps us help you!
Robin Tuttle
4/25/2018 11:54:51 pm
I've had the same experience with the suboxone too, docs not sure about trading the 1 addiction for another, citing that the clinics aren't 'weaning' as much as supplying them another means.
Lutricia Woods
4/26/2018 08:36:45 am
Robin, I hear the same comments. Providers aren’t excited about suboxone because patients are substituting one for the other and they feel our patients have inadequate access to treatment facilities. 4/26/2018 11:07:14 am
@Robin @Lutricia--yes, let's share that list, and I can put it up on the website's opioid toolkit! Also, has anyone heard from Kyle? I think he probably has a great list of resources, too! 4/26/2018 11:03:39 am
@Robin--good info, thanks--I'm going to reach out to Aleta Christensen from CDC to see if we can arm you all with some data around medication-assisted treatment that can be used when encountering the pushback that it's "substituting one addiction for another." In the meantime, great job handling the list of resources re: treatment in your area to give during a follow-up visit, and glad to hear that a clinician came to YOU for more info--that's terrific! I'll be in touch once I'm able to connect with Aleta.
Kyle Collett
10/11/2018 12:32:27 pm
Just wanted to stop in and say hi sorry it took me so long to join the group.. wondering how everyone is doing ? Wondering how everyone is progressing with there doctors etc? Also feel free to ask me anything.. would love to help anyone, anyway that I can !
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