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By April Hopcroft, Public Health Intern, NaRCAD An interview with Amy McWeeney, Public Health Detailing Specialist, New Hampshire Department of Health & Human Services Tags: Stigma, Hepatitis C  April: Hi Amy, and thanks for joining DETAILS today! I know you have quite an interesting professional path that brought you to the field of detailing. Could you tell me a little bit about your background and how you came to this work? Amy: Absolutely. My profession is as a physical therapist - including as a clinician, director of rehab, a professor of PT, and a department chair. When the college I was teaching at closed due to COVID-19, I came across a vacant position in public health and started working for the State of New Hampshire in the Ryan White Program. About a year later, an infectious disease Public Health Detailing Specialist position opened and I applied. The role of the Detailing Specialist is to collaboratively develop educational materials on infectious disease for healthcare professionals and provide in-person or virtual meetings to share these materials while identifying barriers to screening, diagnosis, linkage to care, and treatment. This role seemed to match all the things I enjoy - as it offers opportunities to expand on my clinical, teaching, interpersonal, and networking skills. I remember thinking, “This sounds fabulous.” I’m now entering my fifth year at the state, and my fourth year in the Detailing Specialist role. April: I can really sense your passion for building relationships and sharing knowledge with healthcare professionals. I first came across your work during an internship at New Hampshire Department of Health and Human Services on viral hepatitis. I know at that time you were providing hepatitis C detailing visits and using comprehensive tools in a packet called an action kit. Could you share what an action kit is and what prompted you to focus on hepatitis C? Amy: An action kit is essentially a toolkit of curated resources and best practices for healthcare professionals on a specific topic, such as viral hepatitis or sexually transmitted infections. The hepatitis C action kit was very collaborative, which was different from our typical detailing projects. It came out of an identified need during a conversation with our Viral Hepatitis Program Coordinator, and we also had external development and printing support from a contracted consulting group. It’s encouraging to think about past success stories and to think about what can be achieved with partners and collaboration.  April: That’s inspiring to think about all we can achieve through collaboration. Could you walk me through the process of developing the hepatitis C action kit and the key messages you chose to include? Amy: For this kit, we were lucky to have an internal Subject Matter Expert (SME) - the Viral Hepatitis Program Coordinator. The challenge was the SME had a wealth of knowledge and wanted to share it all. When you’re detailing, you can only focus on one to three key points - otherwise, you lose people during the conversation. It’s a demanding time for healthcare professionals and staying up to date can be incredibly difficult. There’s a widely cited study showing it takes 17 years for medical research to be incorporated into practice after it’s published in journals. Given this reality, the challenge was deciding what the providers truly needed to know and narrowing down to a few key priority points which provided the most meaningful and actionable information. Our main points were related to the CDC guideline recommending every adult be tested for hepatitis C at least once in their lifetime, since this was new information. I also wanted to highlight that sobriety is not required for a person to get hepatitis C treatment. April: Prioritization is such a key part of detailing, especially since you often have limited time with healthcare professionals. Can you share a story you use depicting the potential impact of the education you provide? Amy: Absolutely – I have a story I often share in my hepatitis C detailing visits that reflects the sobriety piece I mentioned previously. It’s about a patient who was living with HIV and was later diagnosed with hepatitis C. Unfortunately, their healthcare professional didn't offer hepatitis C treatment because the patient wasn't sober, and six months later, the patient passed away from hepatitis C. This is devastating given hepatitis C is curable. It was important to me to share this story and reinforce people don't need to be sober to get treatment. They can get treatment, they should get treatment, and they deserve treatment. April: What a powerful story – I know it will continue to resonate with me as an example of the types of gaps detailing seeks to fill. While this story is certainly discouraging, I’m energized by your commitment to countering these misconceptions and addressing all the different barriers that can prevent patients from getting the care they need. In that vein, I saw that you also included a lot of patient-facing cost resources in the hepatitis C action kit. What motivated you to include those? Amy: I have always felt I’m sharing all this great clinical information, but what good is it if patients can't pay for their medication? I think a lot about how to “close the loop” so people can access care and treatment. That’s the end goal.  April: I love that you’re always thinking about “closing the loop” to ensure everyone has the full assistance they need to access care, whether via commercial patient-assistance programs, medication assistance funds, or other cost-sharing programs. I know you’ve included these financial resources in other action kits, too, such as the Tuberculosis action kit. I hope this will inspire other detailers to consider how they can “close the loop” for patients. Let’s now turn to impact – can you share any findings on the outcomes of your detailing work? Amy: Sure! Our Viral Hepatitis Epidemiologist analyzed the effect of detailing on formal reports of hepatitis C cases by healthcare professionals to the state. For context, hepatitis C is a reportable condition in New Hampshire, meaning healthcare professionals are required to report any cases within 72 hours of a new diagnosis. She found a significant increase in provider reports in the six months after we started detailing on hepatitis C, compared to the previous six months. This has broader implications for public health, such as developing rapport with local healthcare systems through detailing which may improve disease reporting. April: Wow – that’s so neat the Viral Hepatitis Epi was able to analyze the impact of your detailing efforts. Let’s wrap up with a story from the field. Can you share an anecdote where you helped a clinician overcome a barrier to hepatitis C treatment? Amy: Detailing is about creating strong relationships and developing trust with healthcare professionals. Often, barriers only become visible when you have open, honest conversations. I remember one meeting with a pharmacy director about hepatitis C treatment. As we walked through the process of getting patients their medications, we realized she was completing extra insurance steps that weren’t needed. Those insurance requests were often denied, causing unnecessary delays. To be able to say, “Okay, there's this simple, small thing we can do to fix this - you were doing these extra steps, and we can actually get rid of those” was so satisfying – not just for me, but for the clinician and, most importantly, for the patients. Thanks to this one educational moment, hundreds of people are now going to get the care they need. Other times in my detailing sessions, I’ve met healthcare professionals who thought they needed to “watch and wait” for six months to see if acute hepatitis C would resolve on its own before starting patients on treatment. I made sure they knew treatment can start right away for anyone with an acute infection. Seeing the ripple effect of these small changes is incredibly rewarding. I love this job because you get to see the positive impact on the community firsthand. April: That’s great to have so many stories showing the impact of your detailing program. We’re looking forward to following the additional action kits you’re developing around tick-borne disease and sexually transmitted infections. Thanks for chatting with us today and sharing your experiences and passion, Amy! Have thoughts on our DETAILS Blog posts? Leave a comment!  Biography. Amy is a Public Health Detailing Specialist for the State of NH. In this role, she provides education to healthcare providers throughout the state around infectious disease. Amy researches, meets with subject matter experts, and creates materials for the detailing sessions. As a Physical Therapist for close to thirty years, she has had a robust career. Clinically, she has treated patients in a variety of environments, including outpatient with aquatics, inpatient rehabilitation, and geriatric care. Her leadership roles have included being a Director of Rehabilitation, Manager for Home Care & Hospice, a college Professor, and a college Department Chair teaching others physical therapy. Amy recently found a passion for Public Health in the Ryan White Care Program and was then promoted to her current role.
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