Mike Fischer, MD, MS, NaRCAD Director
Tags: ​Conference, Director's Letter, HIV/AIDS, Jerry Avorn, Opioid Safety, PrEP, Training

​Fall is the season for conferences, and the most exciting one for us is #NaRCAD2017: Combatting Threats to Optimal Care! 

This year’s conference is a great chance for everyone interested in AD to learn more, whether you’re part of a long-standing program or just beginning to learn about the versatility and effectiveness of implementing this strategy to improve health outcomes. Our agenda is up, so take a peek, and register if you haven’t yet!

The keynote presentations will provide critical insights for creating and sustaining AD programs in different settings. Dr. Zoe Edelstein will kick off Day 1’s programming, representing the New York Department of Health and Mental Hygiene. This keynote will teach us about their public health detailing intervention to increase use of HIV pre-exposure prophylaxis (PrEP).  The New York program was originally founded in 2002, so Dr. Edelstein’s presentation will help anyone from a public health background understand how to both develop and sustain AD, and to adapt it for new and pressing health challenges. ​

Dr. Carol Havens from Kaiser Permanente will provide a detailed overview of the longest-running AD program in the US, a program that was developed with input from Jerry Avorn soon after the original AD studies were published.
​
​We look forward to being inspired by lessons learned from a leading integrated health care system’s ongoing commitment to improving the quality of care around opioid safety with clinical outreach education.

The rest of our conference agenda draws almost entirely from proposals submitted by members of our NaRCAD network – we received twice as many proposals this year!

We’re looking forward to our “Field Presentations” sessions, featuring empiric results from detailers on the ground; expert panelists from the CDC, state departments of public health, and clinical care sharing important impressions on clinician stigma on the critical issues of HIV prevention and opioid safety; and breakout sessions covering many of the practical issues and challenges that detailers face when bringing best evidence to clinicians. Of course, for many of us, the highlight of each conference is the annual update from Jerry Avorn on the state of AD--see his recent blog piece, “Who Do You Trust?” for a preview of what’s to come!

The NaRCAD team is excited by the knowledge that integral opportunities, connections, and partnerships will be created at our unique 2-day event.​ But as excited as our team and our extended community may be about the conference, it’s not the only terrific development underway at NaRCAD this fall. We’ve continued to provide training and support for groups from around the country and the globe, with 2 trainings in the techniques of AD this past September, and more planned this fall and winter! ​Keep your eyes on our Training Series page for the official announcement of our Spring 2018 AD techniques training, and contact us at any time about opportunities and resources to support your AD program.

See you soon,
-Mike

Guest Blogger: Deborah Monaghan, MD
Public Health/Academic Detailer
Colorado Department of Public Health and Environment
NaRCAD Training Alumnus

Tags: Detailing Visits, HIV/AIDS, PrEP, Training

​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.