 We're never going to stop telling you, our creative, dedicated, and talented community of clinical education professionals, how much we appreciate you. You've spent the past 3 years with us fully online, including our at our trainings, our annual summit, and our conferences. It's been lively and exceeded our wildest expectations of how truly connected and dynamic a virtual conference could be.
This year, we're finally back onstage in person at the Copley Fairmont Hotel in Boston. We couldn't be more excited to kick off a return to the kind of connections that only arise in a face-to-face setting. (For those of you who want to join us virtually again, we'll be having an interactive livestream option--learn more on our Conference Series Page!) To say thank you and stoke the 'in-person' excitement, we're having a FLASH GIVEAWAY: for the next 24 hours, the first 10 people to share 1 thing they're most excited about @ #NaRCAD2023 in the comments below will receive a code for free in-person registration. You'll be contacted by our team within the next day with your code! (*This offer is only for new registrants for this specific promotion.) See you in a few weeks! -The NaRCAD Team Sound off in the comments: What're you looking forward to most in person @ NaRCAD2023?
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Curated by: Aanchal Gupta, Program Coordinator, NaRCAD Tags: ADvice, Rural AD Programs Academic detailing programs face unique challenges in both rural and urban communities. Rural communities often encounter barriers with both clinicians and their patients having limited access to resources, as well as the difficulty they both face in navigating geographic barriers. In the latest edition of the AD-vice blog, we’ll explore past conversations with public health and healthcare professionals working to close the gaps for patients in rural populations.  CAPACITY-BUILDING & RESOURCE SUPPORT
 COLLABORATION AND COMMUNITY SUPPORT
 ADDRESSING STIGMA AND HEALTHCARE ACCESS
We hope the insights shared in this edition of AD-vice will inspire implementation of strategies on community support, access, and more in your AD programs. Check out our updated Program Planning Hub for examples and guides on how to build and sustain detailing programs as well as resources to support frontline clinicians!
Best, The NaRCAD Team Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD Tags: Stigma, Evidence-Based Medicine, Health Disparities, Conference Missed our event? Check out the AD Summit videos and materials on our Summit Hub.  We’re fresh off of the excitement of hosting our Academic Detailing Virtual Summit, “A Deeper Understanding of Our Impact on Patient Care.” In prioritizing patient-informed care more than ever before, we explored patient narratives through live interviews, workshops, and special panels, all within a virtual space. Innovations included AD for criminal justice involvement, care delivery redesign for veterans, affirming care for transgender and nonbinary people, and patient-informed communication on sex positivity in HIV prevention. Take a peek at some of the highlights from our event below! AD Fireside Chat: A New Spin on a “Keynote Address” We opened our AD Summit with a real-time interview featuring the originator and co-founder of NaRCAD, Dr. Jerry Avorn, and the National Director of the Veterans Affairs Pharmacy Benefits Management Academic Detailing Service, Melissa Christopher. Audience members were excited to throw ideas around and ask questions about:
Program Development Workshops: Attendees Led the Charge! Our revamped course catalog of workshops invited attendees to be in the director’s seat, as well as behind the scenes as co-creators in small groups. Participants created resources that we’ve published on our website and social media channels, sharing creativity and expertise with the larger AD community. Our workshops covered a wide range of topics including:
 The Pleasure Project Special Panel: Understanding Critical Care Needed for Formerly Incarcerated Patients The outstanding team from New York City Department of Health and Mental Hygiene (NYCDOHMH) shared their groundbreaking detailing campaign, “Public Health Detailing for Criminal Justice Involvement”, with an audience that was hungry for innovation around inclusivity. The NYCDOHMH team shared NYC clinicians’ understanding of formerly incarcerated patients’ care, including clinicians who met the campaign with stigma, and those who were grateful to see such a campaign being implemented. Best Practices Spotlight: Prioritizing the Patient Experience For the first time in NaRCAD’s history, we highlighted leaders in the field who’ve been prioritizing the patient experience. The San Francisco team created space for conversation and discussion about gender-affirming care and ways to encourage safe clinical environments for transgender and nonbinary individuals through language, storytelling, and community outreach. We also heard from the Arizona team about the importance of pleasure being part of a patient’s sexual health history and the role of a detailer in supporting these conversations between clinicians and patients.  Inclusivity Roundtable: Real-time Script Creation
We wrapped up our AD Summit with a roundtable session where attendees co-created a scripting resource to empower detailers to combat stigma during visits. We asked attendees to come up with responses to the stigmatizing comments below. A five-page resource was created in 60 minutes! 1. “I can’t believe patients keep coming back without having lost weight. They’re clearly not trying hard enough, and not making healthy food choices.” 2. “I don’t want those patients at my practice. They’re so difficult to handle and are really just looking for another opioid prescription. Treatment won’t work for them.” 3. “I’m so tired of keeping up with all these different pronouns. You’re either a man or a woman. It gets in the way of providing care.” 4. “I don’t need to use an assessment tool. I can always tell when someone’s at high risk of contracting HIV.” We want to continue these conversations, hear about your team’s innovations, and share resources in person this fall at our annual conference in Boston, MA. We hope to see you there! -The NaRCAD Team A special thank you to all of our AD Summit attendees and presenters as well as our partners at the Agency for Healthcare Research and Quality. For more information on our presenters, you can view the AD Summit Program Book. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD An interview with Adriane Apicelli, MSW, Project Manager, Harm Reduction Projects, University of New Hampshire, College of Health and Human Services. Tags: Harm Reduction, Detailing Visits, Evidence-Based Medicine  Anna: Hi, Adriane. Harm reduction is deeply meaningful to many individuals – can you share why harm reduction is meaningful to you? Adriane: The core principles of harm reduction, such as self-determination, mutualism, and self-advocacy, resonate with my personal and professional values. I firmly believe that individuals are the experts in their own lives, and it’s essential that people have access to the necessary resources, materials, and support systems to ensure their safety and well-being. Harm reduction also offers a powerful framework that facilitates a shift within communities that moves away from moralization and stigmatization of individuals who use drugs. It’s easy to blame individuals for their behavior, but it’s far more challenging to critically reflect on how systems and decisions put people in those circumstances in the first place. Anna: By embracing harm reduction principles, people within our communities can foster empathy and understanding for those facing challenges with substance use. Everyone deserves the same dignity, respect, and access to necessary resources. Can you tell me about the harm reduction detailing project you’ve been working on in collaboration with the National Association of County and City Health Officials (NACCHO)? Adriane: We’re currently focused on detailing elected officials in the State of New Hampshire, including city counselors, mayors, and senators. The opinions and decisions of elected officials shape the harm reduction service landscape – they make decisions that either enable or constrain available resources. Anna: Recognizing the influential role of elected officials is crucial when working on public health initiatives, including harm reduction. What is the overall goal of your current detailing project?  Adriane: We want to empower elected officials to make informed decisions that increase capacity of harm reduction services based on the needs of their communities. We’re currently encouraging elected officials to establish direct connections with individuals who use drugs so they can integrate the expertise from those with lived and living experience into decision-making processes regarding laws, policies, and resource allocation. Anna: Actively listening to those with lived and living experience helps to better understand how to support specific populations. How did your team decide to focus on encouraging elected officials to directly connect with people who use drugs? Adriane: During the development of our detailing project, we consulted with local syringe service program (SSP) participants and asked them how they think elected officials can better understand substance use and harm reduction. The overwhelming response was for direct communication between individuals who use drugs and elected officials, or having elected officials spend the day with them to understand their experiences firsthand. We’re trying to figure out how we can facilitate these approaches to ensure the safety and ethical treatment of SSP participants. We’ve also been exploring the possibility of forming advisory committees to incorporate the perspectives of individuals who use drugs in the decision-making process in a safe and supportive environment.  Anna: Advisory committees certainly help to ensure that voices and perspectives are heard and valued. Let’s transition to thinking about all of your detailing work to date – what makes you most proud to be a harm reduction detailer? Adriane: The people I detail. We shouldn’t underestimate how hard it is to change our minds, our attitudes, or our behaviors. It takes so much humility and effort to receive and integrate new information, especially when it counters your social values and beliefs. It’s an honor to work through that learning process with those that I detail. Anna: Do you have a specific example of that learning process that you can share? Adriane: I detailed someone who was initially hesitant to publicly announce that she prescribes buprenorphine because she was worried how that information would affect her patient panel. We ended up having a conversation about substance use stigma and its implications. We discussed that openly sharing that she prescribes buprenorphine serves as a powerful signal to patients, assuring them that she provides a safe environment to seek treatment. It also sends a message to other clinicians about the importance of prescribing this medication to patients who need it.  Anna: Having those types of honest conversations with people you detail is imperative to changing behaviors and reducing stigma at the individual and community level. Is there anything else you’d like to add before we wrap up today? Adriane: Remember that it’s much easier to build harm reduction capacity in collaboration with others. Last year, I collaborated with individuals from the public health department, a local hospital, the New Hampshire Harm Reduction Coalition (NHHRC), and a community volunteer to address a concern raised by a business owner regarding improperly discarded sharps on their property. We formed an informal work group and created a proposal aimed at piloting an anonymous syringe disposal project, installing two disposal units in the community. The disposal units were proposed to be on city property, so we needed buy-in from City Council to be able to do this. We recognized the power of engaging elected officials and presented our proposal to the City Council. Our proposal received unanimous support and it’s currently being piloted in the community. Collaborative advocacy and engagement with members of the community and elected officials can bring about positive change and enhance the health of all. Anna: We often have more power than we think when we collaborate with others who have similar goals. Detailing is an effective approach for encouraging collaboration and connection with experts in the community, including experts with lived and living experience. Thanks for joining us today, Adriane! We look forward to continuing to hear about your inspiring harm reduction work in New Hampshire. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation!  Biography. Since 2020, Adriane Apicelli has served as the Project Manager and primary academic detailer of the University of New Hampshire (UNH), Department of Nursing’s Harm Reduction Education and Technical Assistance (HRETA) project. She holds a Master of Social Work (MSW) from Boston College, where she also earned a Certificate in Management. In addition to her role with the HRETA project, Adriane serves as a nonprofit strategic planning consultant and has previously served as an adjunct professor for the Department of Social Work at UNH.
Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD Tags: Conference, Health Disparities We have exciting news at NaRCAD! We’re hosting our first-ever Academic Detailing Virtual Summit on June 22 & 23 from 12-5 pm ET. We’ve listened to what you’ve asked for, so we’re prioritizing hands-on skill-building, program development workshops, roundtables, and live interviews, with an emphasis on high interactivity and networking opportunities!  How is this different than our annual conference? It's unique in three ways: more creativity, more patient voices, and more in-depth workshops. Our Summit invites our community to build real-time resources with one another – it's a chance to create as much as to learn. Our lens will focus more on patient-informed care as we move closer to examining patient narratives. Each day, you’ll choose a workshop track where you’ll connect with experts and community members on topics that matter most to you. Here’s a sneak peek of our program development workshops (to view the entire agenda, visit our AD Summit webpage): Day 1 Program Development Workshops:
Day 2 Program Development Workshops:
Join us! Registration is NOW OPEN. You can access all the presentations and one workshop per day for a fixed rate of $89. As a special promotion, the first 10 people who comment on this blog will receive free registration for the event. Hurry – you don’t want to miss this!
We look forward to learning from all of you. See you there! -The NaRCAD Team Can't join our event? Join us at our annual conference in November in Boston, MA! Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD Tags: Opioid Safety, Harm Reduction  The NaRCAD team is back on the road! We had the privilege of attending the 2023 Rx and Illicit Drug Summit in Atlanta, Georgia, where we joined a diverse learning community of over 3,000 participants. We heard about best practices in prevention, treatment, and recovery for those affected by the opioid epidemic and engaged with experts from various fields who have developed innovative strategies to combat the crisis. We attended presentations, poster sessions, and booths from a wide range of professionals, including clinicians, law enforcement personnel, public health officials, lawmakers, attorneys, families, and individuals in recovery. It’s clear that we need to continue to work together across disciplines to reduce opioid use disorder and opioid overdoses within our communities.  While we were in Atlanta, we saw folks from our AD community who are working on opioid-specific academic detailing projects, including our colleagues at Alosa Health! If we didn’t catch you while we were there, please reach out to us at [email protected] and tell us about your experience in Atlanta! NaRCAD also had the opportunity to present with our colleagues from Comagine Health to share about our own collaborations and findings from a recent project, a 15-month clinic-based intervention called Improving Pain and Opioid Management in Primary Care (PINPOINT). The PINPOINT intervention was implemented in 36 clinics in Oregon and combined the Six Building Blocks, academic detailing, and practice facilitation approaches to improve pain management, opioid prescribing practices, and treatment of opioid use disorder in primary care settings.  A baseline survey of clinical staff and prescribers was conducted to assess knowledge, attitudes, and behaviors regarding opioids. The survey results suggested differences between clinical staff and prescribers in behaviors and attitudes about opioid therapy for treatment of chronic pain, familiarity with opioid prescribing best practices, and opioid-related policies and procedures. The participants who attended the conference session were eager to learn about how they could implement academic detailing programs in their own communities. We’re excited to share about the importance of academic detailing at future conferences and continue to learn and grow alongside all of you. Interested in submitting a proposal with the NaRCAD team at a future conference? Email us at [email protected]! Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Curated By: Aanchal Gupta, Program Coordinator, NaRCAD Tags: ADvice, Program Management, Training Academic detailing program managers oversee and coordinate all aspects of an AD program to ensure its success, impact, and strengthen the detailing team. They have a crucial role in achieving team goals. In this edition of AD-vice, we’ll look into how program management in AD contributes to team and program success.  Team Building and Support:
 Recruitment and Training:
 Interprofessional Collaboration:
Effective program management plays a crucial role in the success and support of academic detailing programs. We hope the insights shared in this edition of AD-vice will help in navigating and implementing strategies of team building, recruitment, training, and more. As always, our NaRCAD team is here to support you and your detailing programs! Best, The NaRCAD Team Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation! By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD An interview with Rocko Cook, Public Health Detailer and Public Health Detailing Program Manager, Detailing Improved Sexual Health (DISH), Arizona State University. Tags: Detailing Visits, Evidence-Based Medicine, HIV/AIDS  Anna: Hi, Rocko – thanks for joining DETAILS today! HIV prevention work is critical and often deeply meaningful to those working in the field. Can you tell me why this work speaks to you? Rocko: I found out I was positive for HIV and syphilis in 2002. I encountered firsthand the stigma and shame associated with these diagnoses. It was devastating, but it’s made me feel even more connected to the work I’m currently involved in. I’ve worked in various roles in the field of HIV prevention and care since 1994, just two years before medication was widely available. In the 90s, there was little support for people who tested positive for HIV from a care perspective, financial perspective, and housing perspective. We now have the medications and tools to prevent, treat, and support people with HIV. Despite this, there’s an urgent need to continue educating clinicians, staff, case managers, community health workers, and other people who are on the frontlines about these tools and resources. Academic detailing helps to close that gap and gives me the opportunity to live my passion of educating others about HIV.  Anna: Thank you for your openness in sharing your personal and professional experiences. Your passion for HIV prevention and care is evident. What’s the number one thing you want clinicians and staff in your community to do differently when it comes to HIV? Rocko: I’d love for them to change the culture of the entire clinic space and create a more welcoming environment for patients. There needs to be a focus on consistent communication coming from every professional a patient meets with when receiving care. All clinicians and staff need to be able to communicate with patients in a sex-positive way and in a way that connects with patients’ specific experiences, identities, and needs. They need to be comfortable communicating about sexual behavior, testing, and PrEP. It’s difficult to have these conversations. I've been doing this for a long time and I’m not perfect at it either, but once we practice and start getting comfortable with ourselves, then it gets a lot easier to be comfortable with patients. Anna: Modeling this type of communication during a detailing visit is key. It can help clinicians and staff feel more comfortable having the same conversations with patients. Can you share a story from the field about a positive response or reaction from someone you detailed? Rocko: There was an agency we worked with that hired a new physician, testers, and medical assistants for their mobile medical and HIV testing unit. They had never worked with this patient population, so our team did several trainings and 1:1 detailing sessions where we role played conversations with patients. We needed to bring them up to speed on how to have gender inclusive conversations and communicate with sex positivity. We had a lot of fun together. The team ended up going to Phoenix Pride to do a big testing event. We were delighted with their success in providing testing to the community and creating a welcoming and safe environment for people interested in being tested.  Anna: That’s a large event for the mobile unit team to tackle, while also succeeding in creating a safe space for all! Let’s talk a little bit more about the impact on patients. Can you share any data on the impact of your detailing work? Rocko: We have anecdotal evidence that folks are benefiting from our services. My colleague and I are closely involved in the gay community and people often tell us about their care experiences. We’re in an enviable position because we know a lot of people and hear things in passing. It helps us do a better job targeting our services; we can work directly with clinics that we’ve heard would benefit from detailing. I also recently connected with someone of trans experience who was tested at Phoenix Pride. They’ve had poor encounters in the past where clinicians and staff assumed the body parts they have. They shared that they had a positive experience with the mobile unit and felt comfortable throughout the visit. Being able to see our impact firsthand has been really motivating for me; it makes my heart sing. Anna: It’s rare to be so closely connected to the community that’s being impacted by your detailing work. It’s clearly been beneficial for your detailing efforts and getting your program up and running. Let’s wrap up with a final question - what has made you most proud of this project so far?  Rocko: I’m so proud of the way our team has come together and engaged with partners across the state. We’ve been able to leverage partnerships and community relationships to enhance program development, implementation, and dissemination. I’m also proud of our creativity in choosing our program’s name, DISH AZ (Detailing Improved Sexual Health). We send out a Weekly Special with a buffet of options on new evidence and information related to HIV prevention and care. We’re creating an active and robust network of professionals, while using food as our motivator! Anna: That’s an innovative way to keep your network engaged! We’re looking forward to hearing about your program as your team continues to expand its network and positively impact more people in the community. Thanks for chatting with us today and sharing your experiences, Rocko! Your passion for this work is palpable. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation!  Biography. Rocko Cook serves as the Program Manager for DISH-AZ (Detailing for Improved Sexual Health in Arizona), a program of the Office of Evaluation and Partner Contracts for the Southwest Interdisciplinary Research Center (SIRC) at Arizona State University in partnership with Arizona Department of Health and Human Services. Rocko began working in the field of HIV in 1994 and is a community leader with over 15 years of experience implementing prevention and care programs in Arizona, Ohio, and Kentucky. In addition to his duties as a program manager, Rocko has served as a public speaker, presenter at local and national conferences, and as a consultant and leader for HIV community planning groups. Rocko has been living with HIV since 2002 and is passionate about improving sexual health for all communities.
By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD An interview with Lindsey C. Beardsley, Individual in Recovery. This month, we’re looking through the lens of the patient experience, something that all detailers and clinicians work so hard to improve. We’re pivoting to an interview with a person with use disorder, her experience with use and recovery, and the ways in which the patient experience can encourage detailers and clinicians to continue working together to improve outcomes for those who struggle with substance use. Tags: Harm Reduction, Opioid Safety  Anna: Hi, Lindsey! We’ve never featured a patient’s experience on our DETAILS blog - thank you for sharing space with me and telling a vulnerable story. Let’s dive right in. Can you tell me about your background? When were you first introduced to substances? Lindsey: I was brought up in Cape Cod, Massachusetts with two loving parents and a lot of friends. I had a typical childhood, but I always knew I was different. I was extremely impulsive. I loved food – that was my first addiction. Then it was dance, then soccer, then horses. I did everything to excess. I was first prescribed opioids after a knee surgery at 13 years old, and again after a second knee surgery at 14. Something clicked in my brain when I used those medications, and it opened a door that I couldn’t close. I was shut off to all emotion and it felt good to not feel anything. My use progressed from taking prescribed medications for pain to using heroin and becoming homeless, struggling to meet my most basic needs. Using drugs gave me a false sense of power that I wasn’t like any of my peers and that I could do what I wanted because I was different.  Anna: We hear many stories from patients about substance use starting after pain medications are prescribed during adolescence. Despite the power that you felt when you used, were you ever worried about the health effects of your drug use? Lindsey: I dated someone in my teenage years, and we often used together. Cape Cod is a small community and within a few weeks of dating him, my mom heard that he had Hepatitis C. My entire family was devastated, but I didn’t care at all – I couldn’t see how it would affect me. I think back to all the times I shared needles and drug supplies. Even if I tried to use new needles, everything looked the same and would get mixed up in the rush of using with other people. I would always have a little fear inside of me that I would overdose on my first time using again after being in treatment, but that fear never stopped me.  Anna: We know that substance use disorder is a medical condition and patients need professional support. When you felt ready to address that fear and seek treatment, were there healthcare resources or community supports that helped guide you towards recovery? Lindsey: I’m lucky to be in a state like Massachusetts where we have a lot of resources that the rest of the country doesn’t have. I was a frequent flyer at our detox facilities. When I was admitted, I was always paired with a peer that was in recovery. I often knew the peer; it gave me hope to hear the stories of recovery from people I knew and previously used drugs with. I was assigned a counselor, and we would discuss my treatment goals and next steps. The counselor would walk through every community resource within several miles of me, like partial hospitalization programs, sober homes, Narcotics Anonymous (NA) meetings, 12-step programs, and syringe exchange programs. We also have a mobile harm reduction center in my community. Before it existed, a woman in recovery started a needle exchange program out of her home. She sparked a need and desire for our community to learn more about harm reduction.  Anna: Many people don’t have access to substance use resources in their community, especially harm reduction services. Here at NaRCAD, we’re trying to encourage primary care clinicians to be able to provide those linkages to care and harm reduction services. What does harm reduction mean to you? Lindsey: I was against harm reduction for a long time because I was very involved in a 12-step fellowship where the primary purpose was complete abstinence from drugs. Harm reduction was a shift in mindset for me, but it’s pretty cut and dried. We’re reducing harm, saving lives, and preserving a sense of family and community. When we reduce harm, we allow a mom to be a part of her family again, we allow her to get a job, we allow her to get off the street and out of harm’s way. Harm reduction can allow people to return home. Anna: It’s valuable to know that a 12-step program and harm reduction can co-exist. What message about harm reduction would you want to share with members of your community? Lindsey: Harm reduction doesn’t enable drug use – use is going to continue until the person is ready to seek treatment. A simple approach to harm reduction, like syringe exchange, prevents the spread of infectious diseases and reduces needles in public and community spaces. It prevents someone from contracting Hepatitis C when they use drugs. Anna: We know that harm reduction plays a huge role in preventing drug-related deaths and offering access to services. There are many approaches to harm reduction and even using just one approach reduces so much harm. Let’s transition to talking about patient care. How would you want your care to look, or not look, when seeking help for substance use from a clinician?  Lindsey: I’d want to seek care in a safe space where I could share what drugs I use and how I use them without being punished, judged, or arrested. I would also want a space to discuss what’s going on in my life with someone who is educated enough to help me. I honestly wouldn’t want to listen to a clinician tell me about treatment options while I can sense that they’re judging me. A lot of clinicians have been through at least one training on substance use, but those trainings don’t change core beliefs and morals. Those trainings don’t change the way a clinician looks at you when you tell them you use substances. Anna: That’s true – having a trusting relationship with a clinician where you can share openly and not be judged is critical to effective care. How could clinicians have meaningful conversations with patients about substance use, especially if they have preconceived notions? Lindsey: Clinicians need to learn to have open, non-judgmental, inclusive discussions. That starts with asking all patients about their mental health and substance use history. Educators can provide clinicians with scripting tools if they feel uncomfortable having these conversations. Also, including peer support in the plan of care can help take some of the stress off of the clinician. This can include reviewing community resources and continuing the conversation with patients, while also educating the clinician on substance use through sharing personal experiences. We need to support patients, peers, and clinicians in doing this work and doing it as a team. Anna: I’m hearing you talk about so many elements that clinicians can use to improve patient care, like scripting tools and peer support. We’re continuing to work on ways to support educators and clinicians – your ideas will certainly help guide us. Thank you again for sharing your insights and being open to this conversation. We look forward to connecting with you again in the future! Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation!  Biography. Lindsey C. Beardsley, an individual in long-term recovery, was born and raised in Cape Cod, Massachusetts. She was involved in many different sports growing up – gymnastics, soccer, and dance – but riding and working with horses quickly won over her time and heart from a young age. After many years of struggling with addiction, Lindsey walked into a treatment facility in August of 2018 and made the decision to stop using drugs one day at a time. Lindsey has been in recovery since September 21, 2018.
Curated By: Aanchal Gupta, Program Coordinator, NaRCAD Tags: Stigma, Primary Care, Data Time and time again we’ve heard about the challenges detailers face when tackling clinician stigma. Detailers have shared comments from clinicians such as, “We don’t take those types of patients” or “I don’t want to be known as the gay doctor.” Addressing stigma and fostering understanding with clinicians can often feel overwhelming for detailers. In this edition of “AD-vice” we shine a light on these issues and share experiences from our community on how they managed stigma during detailing visits.  Understanding Stigma
 Addressing Stigma through Education and Conversations
 Addressing Stigma through Data and Resources
Our team at NaRCAD is here to learn and support you as we combat stigma and continue to promote inclusivity. Check out our new Healthcare Inclusivity Toolkit for detailers for additional resources.
Best, The NaRCAD Team By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD An interview with Meghan Breckling, PharmD, BCACP, Ambulatory Care Pharmacist and Academic Detailer, University of Arkansas for Medical Sciences and Arkansas Department of Health. Tags: Detailing Visits, Opioid Safety, Harm Reduction, Evidence-Based Medicine  Overdose Deaths Rates per 100,000 people per County, Arkansas 2020 Anna: Hi, Meghan. Thanks for joining me on DETAILS today! Your team has done extensive work on pain management detailing, and you recently completed a pilot project on harm reduction in collaboration with the National Association of County and City Health Officials (NACCHO). Can you tell me a little more about this project? Meghan: Thanks for having me! We decided to target rural counties in Arkansas that have both high drug overdose deaths and naloxone administration rates. We previously created broad pain management materials for our other opioid safety detailing projects; this project took those materials to the next level. We looked at how we could better support clinicians in caring for their patients with substance use disorder (SUD) through a harm reduction lens. We provided clinicians with screening tools to help identify patients with mental health conditions and SUD to determine who could benefit from additional services. We even created a local resource guide for clinicians to easily connect patients to community services. The clinicians found that these accessible tools helped them have open conversations with patients.  Anna: I can imagine having something tangible to give to patients makes clinicians feel more equipped to have these conversations. What other resources were you able to share with clinicians? Meghan: We encouraged clinicians to utilize a new, free mental health resource called AR ConnectNow. This program provides immediate virtual care to all Arkansans dealing with mental health and substance use disorders. Clinicians were grateful for AR ConnectNow because mental health services are scarce in rural Arkansas; they’ve been sharing it with their patients frequently. Anna: You must have been proud to be part of a project that had such an impact on both patients and clinicians. How did the harm reduction lens inform your detailing visits for this project compared to your prior pain management-focused visits? Meghan: Many visits centered on communication with patients. Communication and empathy are two huge pieces to consider with this topic. We spent a lot of time asking clinicians about the conversations they have with patients and the types of questions they ask about substance use. We really wanted to understand what was going well and where there were gaps that we could help fill with resources and support. We also focused on naloxone prescribing and administration. We gave out free naloxone kits to all clinicians that they could either keep in the clinic or give to a patient who was having trouble accessing it. Clinicians were open to the idea of prescribing naloxone to patients who were at risk of overdose and open to keeping kits in their clinic in the event of an overdose. Our team had a lot of clinicians say during follow up visits that they felt more comfortable prescribing naloxone and were prescribing it more to patients and family members.  Anna: It’s impressive how you were able to clearly shift your focus from opioid prescribing to harm reduction and prioritize the relationship between the clinician and patient. Did you receive any pushback from clinicians on harm reduction? Meghan: Clinicians understood the need for harm reduction services but were more inclined to refer patients out rather than providing services within their clinics. For example, we found that a lot of clinicians were resistant to prescribing Medications for Opioid Use Disorder (MOUD), either because they were uncomfortable with the steps to do so, or they were told by leadership that they should not prescribe MOUD at their practice. It can sometimes take an hour or more for patients in rural areas to access specialty services that offer MOUD. We’re looking at future projects where we can utilize pharmacists to increase MOUD prescribing in partnership with primary care providers. For instance, a primary care clinician could diagnose SUD and prescribe MOUD, while a pharmacist could monitor the patient throughout treatment. It would take a lot of burden off the clinicians and could possibly make them less resistant to prescribing it.  Anna: Using pharmacists as an integral part of the care team is an excellent idea – you’ll have to let us know if you receive additional funding for this work! Let’s wrap up with a final question. If another program decided to do a detailing project on harm reduction, what advice would you give them before they went out into the field? Meghan: You need to take a step back and remember that there isn’t going to be instant behavior change among clinicians. For a topic this complex, it’s critical to have follow-up visits and continue to be a resource and support for clinicians. Also, be understanding of clinicians and their experiences. They’re dealing with a lot and it’s not easy to change things all at once. Building a relationship and getting a clinician to commit to just one key message is a huge win. Want to learn more? Read about the harm reduction key messages used for this project and the development of those messages on our previous blog post. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation!  Biography. Dr. Meghan Breckling is an Ambulatory Care Pharmacy Specialist at the University of Arkansas for Medical Sciences (UAMS) and is a trained Academic Detailer through the National Resource Center for Academic Detailing (NARCAD) within the Center for Health Services Research (CHSR) at UAMS’ Psychiatric Research Institute (PRI). She previously completed a PGY1 Pharmacy Residency and PGY2 Ambulatory Care Residency at the Central Arkansas Veterans Healthcare System (CAVHS). Currently, she is a part of a multidisciplinary academic detailing team comprised of a pharmacist, physician and physical therapist that provide evidence-based solutions, tools and support for chronic pain management to primary care providers across the state of Arkansas.
Curated By: Aanchal Gupta, Program Coordinator, NaRCAD Over the past year, we’ve gained important insights from programs around the world by exchanging ideas at roundtable sessions, Peer Connection Program Gatherings, trainings, and our annual conference series. As we welcome in 2023, let’s reflect on some of the highlights that detailers and program staff have shared on our DETAILS Best Practices Blog over the past year. Enjoy!  Outside the Detailing Team: Leveraging Community Partners
 Detailing Visits: Preparation and Building Confidence
 Thinking Outside the Box: Exploring AD Innovation
2022 has brought a wealth of opportunity and innovations. We hope to continue that momentum with all of you as we head into the new year. Stay tuned for more AD-vice blogs in 2023.
Best, The NaRCAD Team By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD An interview with Shuchin Shukla, MD, MPH, Faculty Physician, Mountain Area Health Education Center (MAHEC), NaRCAD Training Facilitator Tags: Harm Reduction, Detailing Visits, Evidence-Based Medicine, Opioid Safety  Anna: Welcome to the DETAILS blog, Shuchin! You wear many hats - you’re an addiction medicine physician, an academic detailer, and an academic detailing trainer. Tell us how you got started with academic detailing. Shuchin: I had an interest in marginalized populations and did my residency in the Bronx in New York City. I was a clinician in HIV care for several years before moving with my family to Western North Carolina. Soon after we moved, I began working at our Area Health Education Center (AHEC) and it was evident that addiction was the primary public health and clinical issue that was causing the most harm in my community. Fast forward a few years and one of my colleagues received a Centers for Disease Control and Prevention (CDC) grant and asked if I could attend a NaRCAD training to learn more about AD. The medical board and one of our pharmacists at the Department of Public Health were very interested in using AD for overdose prevention. We started with a pilot where we detailed 10 clinicians and slowly built our program. We now have multiple AD grants we’re working on, including one on adverse childhood experiences (ACEs) and one on harm reduction.  Anna: We often tell programs to start with a small pilot before growing their programs so that they can identify what went well and where there are opportunities for improvement, especially on new detailing topics like ACEs (e.g., key message adoption, clinician response, etc.). You do a lot of education around substance use disorder and mentioned that your team received a harm reduction grant for AD – what does harm reduction mean to you? Shuchin: The goal is, simply enough, to reduce the level of harm that a person may be facing. Harm reduction means having no expectation of a person's behavior and accepting the reality of what people live and do without judgement. It’s about being open with patients so that they’re more likely to come back for a visit where you can continue to have a conversation with them about getting a little bit healthier. There’s evidence to support harm reduction. The research shows that providing harm reduction services, whether it's naloxone or syringe exchange, reduces harm, but also decreases substance use and helps people engage in substance use care and treatment. Anna: Do you see harm reduction being used with other topics beyond substance use disorder?  Shuchin: There are tons of examples of harm reduction that are built into everything we do. Seatbelts, masks, fire escapes, smoke detectors, vaccines, and the FDA regulatory agency are all forms of harm reduction. As a society, we’ve never looked at substance use through this lens because using drugs is so stigmatized. Anna: I imagine it’s difficult to have detailing visits with clinicians because of the type of stigma associated with it, such as thinking that it’s some sort of moral failing. How have clinicians responded to detailing visits on harm reduction? Shuchin: Most of the teaching about harm reduction is unlearning all the inaccurate information we've been taught. We're taught if you use drugs, you're a bad person and you should be penalized. I remember watching the show Cops growing up and there was always a person of color laid out on a car resisting arrest. Law enforcement would pull out a bag of cocaine from the car and say they’ve saved the community. None of this is right, but I saw that on TV as a middle school kid. It’s easy to generate a lot of negative energy about substance use disorder and substances in general from these shows, and clinicians are part of that thinking too. Asking clinicians to talk to their patients about harm reduction is a lot different than asking them to check their Prescription Drug Monitoring Programs (PDMPs) to ensure that patients aren’t receiving multiple prescriptions for controlled substances. Having a conversation with a patient takes empathy and thoughtfulness, whereas checking a PDMP does not. We’ve found that clinicians who have been the most resistant to harm reduction are those who have family members with substance use disorders. They are often angry, and rightfully so.  Anna: It’s imperative to be empathetic during detailing visits, especially on a topic that affects so many people. Let’s explore harm reduction from a different angle. How do your patients respond when you bring up harm reduction during your clinic visits? Shuchin: These are certainly challenging conversations to have, so you need to start off by letting patients know that they aren’t going to get in trouble for sharing this information and you need to acknowledge the trauma and stigma that surrounds substance use. Patients seem grateful that I approach conversations in a straightforward way that doesn’t stigmatize their use of drugs. I’ve never had a patient be offended or confused about why I was talking to them about harm reduction. Their eyes usually widen when I ask them things like how they use their drugs, how they cook their drugs, or where they get their drugs from. They often say, “I’ve never had a doctor like you.” Anna: You must spend a lot of time building trusting relationships with patients so that you can have these conversations. Shuchin: I do. It also helps that the organization I work for, our county commissioners, and our sheriff are all on board with harm reduction. There’s a lot of focus on Naloxone distribution among members of our community, such as law enforcement, first responders, and other clinicians. Our clinic prescribes a lot of medications for opioid use disorder, specifically buprenorphine, which is also a form of harm reduction. We have peer support specialists who meet patients where they’re at and start the conversation about harm reduction with them before they even have their first visit with me.  Anna: It’s definitely critical to have a community that supports the way you practice, as well your program’s AD messaging. Can you share a final tip for other detailers who are working on harm reduction? Shuchin: Harm reduction is an emotional topic for a lot of people, especially folks who are in frequent contact with people who use drugs, like emergency room clinicians or people with lived experience in their families. With this topic, paying attention to the emotions of the clinician you're detailing and acknowledging those emotions before jumping into your key messages is much more important than any other topic I’ve worked on. Be patient and empathetic – every visit counts toward making a change. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation!  Biography. Shuchin Shukla, MD, MPH, was born and raised in New Orleans, Louisiana. He completed medical school and public health school at Tulane University and completed a residency in family medicine at Montefiore Medical Center in the Bronx, New York. He worked in the South Bronx for 5 years following residency, providing primary care for adults and children, as well as for adults living with HIV. He also served as medical director for Montefiore Project INSPIRE, a primary care-based Hepatitis C treatment program. He then moved with his family to Asheville, North Carolina, where he currently serves at Mountain Area Health Education Center (MAHEC) as faculty physician and Clinical Director of Health Integration.
He is an associate clinical professor of medicine in the Department of Family Medicine at the School of Medicine, University of North Carolina in Chapel Hill, and is a Diplomate of the American Board of Preventive Medicine, Board-Certified in Addiction Medicine. Additionally, he is a Robert Wood Johnson Clinical Scholar. He leads on various initiatives and projects around addiction, HIV, Hepatitis C, homelessness, and the criminal justice system. His main experience as a detailer has been focused on improving evidence-based provider interventions related to opioids, pain, and addiction. By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD An interview with Jennifer Carefoot, BSc, Pharm, Academic Detailing Pharmacist, BC Provincial Academic Detailing (PAD) Service. Tags: Conference, COVID-19, Detailing Visits, Evidence-Based Medicine  Anna: Hi, Jen! Thanks for joining us on DETAILS today. Earlier this year, your team developed a detailing campaign in one week for the new COVID-19 treatment, Paxlovid, and presented on your work at our NaRCAD conference. I’m excited to learn more about this campaign. Before we jump in, can you give us some background about your organization? Jen: The British Columbia Provincial Academic Detailing Service (BC PAD) launched in 2008 and provides academic detailing to the province of British Columbia. We have 12 full-time pharmacist detailers for the entire province. The program is publicly funded by the BC Ministry of Health and our topics are chosen based on their relevance to primary care clinicians. Here are some quick facts about our program:
 Anna: Your team connects with many clinicians covering a vast geographical area! Can you walk us through the one-week development of the Paxlovid campaign that you presented on at our conference? Jen: Paxlovid was approved in Canada on January 17, 2022. The Province of BC quickly received doses and urgently needed educational sessions for clinicians in the province for safe and appropriate use of this somewhat complicated medication. The PAD team had the expertise in delivering pharmacotherapy and education through detailing visits; we worked with the Ministry of Health and the COVID Therapeutics Committee (CTC) to quickly develop materials. We were out in the field detailing within a week! Anna: That’s an impressive turnaround time to get your team prepared and out in the field! Were clinicians aware of Paxlovid when your team started detailing on the topic?  Jen: Paxlovid was getting a lot of press in the media at the time- it was the first oral treatment readily available for COVID-19. Clinicians knew they would have to know about this medication since their patients would be asking about it. Anna: New information was coming out every day in the media, which isn’t very common for other detailing topics. How was your team able to stay up to date on the emerging evidence on Paxlovid and continue to keep clinicians up to date? Jen: Our team was able to stay up to date through the excellent communication between our PAD director, Terryn Naumann, the CTC, and the Ministry of Health. We would receive updates via email or video conference daily. We also frequently met internally to share questions, successes, and challenges that we were experiencing in the field. To keep clinicians up to date, we chose to not provide them with the PowerPoint presentation from the detailing visits because the information and evidence was constantly changing. We’ve created 24 versions to date! Instead, we emailed a one-page resource to clinicians after our visits that included links to online resources that were updated in real time.  Anna: That’s one of the benefits of sharing resources virtually – the information can be updated and accessed quickly. If you were told you had to create another campaign in one week, what would you do differently? Jen: That’s a tough question! Would we have liked more detailers? Yes. Do I wish there were 24 more hours in my day? Yes. Would we have liked more clinical trial data? Yes. These are all things that are outside of our control. We did the best we could with the evidence and resources we had. I don’t know if we would do it any other way if we had to do it again under the same circumstances. Anna: What you did worked. Do you have any evaluation data from clinicians that you can share? Jen: Our formal evaluation showed:
 Anna: I’m not surprised by these results! Your team has shown impressive data from myriad detailing campaigns. Before we wrap up, can you tell us how your partnerships and team helped make this campaign successful? Jen: It’s important to partner with others who have expertise in the therapeutic area you’re detailing on. You don’t need to reinvent the wheel with evidence. Pull from data and evidence that other AD programs or reliable organizations have previously put together and be open to the idea that evidence changes. Also, remember that it really does take a team! Everyone brought something critical and unique to the table. Our administration team was instrumental in getting our visits booked and our director was transparent with our team throughout the process. Our team was excited, enthusiastic, and proud to have the opportunity to provide this education to clinicians in our province. Anna: Having a team that is open to a challenge and eager to stay up to date on evidence is so important. It’s not realistic for programs to have to create a campaign in a week, but if they ever find themselves in that situation, we know we can all turn to you and your team for support! Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation!  Biography. Jen is an academic detailer for the BC Provincial Academic Service since 2016 serving beautiful South Vancouver Island. She is passionate about translating evidence to practice, reducing polypharmacy and shared decision making. In her spare time, she enjoys running, gardening, travelling, and spending time with her family outdoors at the lake.
Tags: Conference, Detailing Visits, Stigma Take a peek at the NaRCAD2022 conference materials on our Conference Hub.  Earlier this month, our team at NaRCAD hosted the 10th annual International Conference on Academic Detailing, “Celebrating 10 Years of Community Engagement.” We hopped on the virtual AD bus and heard from programs from across North America and beyond. This year, the conference featured campaigns focused on menopausal hormone therapy, initiation of antiretroviral treatment (iART), falls prevention, COVID-19, biosimilars, antiracist health care, polypharmacy, and opioids. The theme of community engagement was seen throughout the entire 3-day event, and we’re thankful to everyone who joined from around the world. Check out some of the highlights from our 2022 conference below.  Welcome Addresses:
Field Presentations:
 Breakout Sessions:
Expert Panels:
Special Presentation: “Looking Inward: AD as an Intervention for Antiracist Health Care”:
Real-time Roundtable:
 Thank you for all your engagement and support throughout the last 10 years of NaRCAD annual conferences! We are humbled to see how much the AD community has grown and are excited to be able to feature innovations at our conferences that have informed your work over the years. Our team at NaRCAD will continue to provide space for everyone to come together to share ideas, ask questions, and network. We look forward to seeing you in 2023. -The NaRCAD Team A special thank you to all of our NaRCAD2022 presenters as well as our partners at the Agency for Healthcare Research and Quality! Check out the NaRCAD2022 program book for more information on the presenters. Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation! Honest Conversations: Supporting Clinicians in Linking Patients to Harm Reduction Services11/14/2022
By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD Tags: Primary Care, Opioid Safety, Evidence Based Medicine, Harm Reduction  Our team at NaRCAD has been working on an exciting new project developing harm reduction key messages for primary care clinicians in collaboration with the National Association of County and City Health Officials (NACCHO), Centers for Disease Control and Prevention (CDC), and consultants from Boston Medical Center. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines harm reduction as an approach that aims to prevent overdose and infectious disease transmission, improve physical and mental health, and offer options for accessing treatment and other health care services for people who use drugs. Various harm reduction approaches have been proven to prevent overdose and death, injury, infectious disease transmission, and substance misuse. For instance, there is nearly 30 years of research that has shown that syringe services programs decrease transmission of viral hepatitis, HIV, and other infections. There are several other harm reduction approaches beyond syringe service programs, including:
It’s critical that academic detailers continue to encourage primary care clinicians to discuss harm reduction with their patients and link them to services within their community. Academic detailers have the ability to empower clinicians to have difficult conversations with patients to reduce infections, overdose, and death. Our team developed the following key messages to support primary care clinicians in caring for patients who would benefit from harm reduction. These key messages are currently being piloted across the United States in a project funded by NACCHO.  Harm Reduction: Key Messages to Improve Outcomes for People Who Use Drugs
1. Assess factors that may contribute to risk of Opioid Use Disorder (OUD) for patients who use opioids. 2. Identify opportunities to reduce risk of harm using a patient-centered approach. 3. Offer Medications for Opioid Use Disorder (MOUD) to patients identified as having OUD. 4. Connect patients with community harm reduction services and other services that meet identified needs. These evidence-based key messages can help clinicians provide support to their patients and build strong and trusting relationships with those who need it most. Building trust between clinicians and patients allows patients to feel heard and be open to seeking additional treatment, ultimately leading to improved health outcomes. Our team is looking forward to continuing to explore harm reduction and updating our key messages based on the results of the pilot through NACCHO. If your program is interested in collaborating with our team on future harm reduction work, or any other clinical topic, please reach out to us at [email protected]. Want to learn more? Stay tuned to learn about the results of the pilot and how clinicians responded to these key messages in the field. You can also join our discussion forum to interact with peers who are working on harm reduction!  Bevin K. Amira NaRCAD Deputy Director Tag: Conference The “before times” are out of reach, and there’s a real beauty in that. Without forcing ourselves to look through rose-colored glasses, our team at NaRCAD has no other choice but to see you for who you are: creative, interconnected, and peer-led, now more than ever. You’re the bosses of adaptation, in ways you may not recognize, or even believe. So let me tell you more about who you are. To repeat an over-used word from society at large, “resilient” applies to our community, but it’s not the word that matters most. Being “resilient” overshadows other truths: we’re often tired, under-resourced, and we need peer engagement. All can be true at once, and they are. Our team is here to remind you that not only is needing each other more than okay, it’s to be celebrated. You’ve all responded to the AD-specific Bat Signal: you’re a mirror for each other, consistently boosting one another’s morale. The community you’ve built together is founded on the simple strength of admitting that we need each other, we need to feel good about where we are in this moment, and excited about where we’re going next. Where you’ve emulated that excitement most of all is during our community dialogues: our regular virtual gatherings, our Peer Connection Program, our shout-outs to one another during our convenings, trainings, and behind the scenes in 1:1 e-mails. We can have the most effective AD programs out there, but if we’re not witnessing each other’s reality, we’re going it alone.  At our 10th conference, we’re proud to see the arc of where we started a decade ago; where we were once focused mostly on data-specific outcomes, the focus is now on each other. From building a program to training and evaluation, no longer do we have community members who must start from scratch. NaRCAD is pleased to witness the shift from 2012, where we led the charge, to 2022, where you lead the charge. Thank you for being the collaborative innovators of this conference, and of AD successes across the globe. We look to you to lead us into 2023—for now, take in these next 3 days with pride. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Biography.
Bevin K. Amira, Deputy Director, NaRCAD Bevin manages NaRCAD’s strategic partnerships, building collaborations with public health leaders at the national and federal level. With career experience in building learning communities to increase engagement and sustainability, Bevin has expertise in creating interactive, interdisciplinary training curricula at healthcare-based non-profits. In collaboration with the dynamic NaRCAD team, Bevin facilitates NaRCAD's virtual and in-person learning sessions to encourage hands-on skill development and best practices sharing amongst peer programs. Read more.  In just one week, NaRCAD will be hosting the 10th International Conference on Academic Detailing. Our conference series has continued to reach new heights. From 62 attendees at our first conference in 2013 to over 300 attendees at our 2021 conference, we’ve had the pleasure of providing a space to collaborate with others in the field and hear from AD programs across the globe. With topics ranging from opioid safety, stigma, program management, HIV prevention, falls prevention, antiracist health care, and more, we look forward to seeing the field continue to grow at this year’s conference. In honor of reaching this milestone, we’ve compiled testimonials from some of our past conference attendees. “I never miss the NaRCAD conference! I always come away with new insights into evaluation strategies, ways to extend the reach of our program, and novel settings and topics where AD is filling a practice gap.” “The NaRCAD conference provides a great opportunity to learn new and different strategies for academic detailing – sustaining a program, team building, effective virtual visits – and to have open discussions about common challenges (recruitment!) and successes (solid needs assessments).” “The NaRCAD team always offers a welcoming and insightful environment to teach, learn, and engage with people across the globe from all facets of an AD program, and I have built solid connections through it.” "I really enjoyed hearing about effective ways we can improve our practices. It was interactive and I took notes that I am excited to implement in my detailing work." “I have so much great information to take back to colleagues, from starting a detailing program from scratch to learning how to support and strengthen a team of detailers.”  Head over to our conference page to learn more and register for NaRCAD2022. Join us on the week of November 7th to celebrate your accomplishments in AD, strategize with others in the field, and learn about innovative interventions from around the world. We hope to see you at our conference! To read more testimonials, visit our testimonial page or share your experiences with us below! -The NaRCAD Team Can't join our event? Visit the Conference Hub for highlights.
 Jerry Avorn, M.D. Professor of Medicine, Harvard Medical School Co-Founder & Special Adviser, NaRCAD Tags: Evidence Based Medicine, Jerry Avorn Inside the world of academic detailing, we’re all convinced of the clinical power of information transmission when done well, and of the harm that can result if it’s done badly or not at all. But outside our mighty little community, many are skeptical about whether pushing out accurate evidence really has such enormous effects. A silver lining of Covid-19 as it recedes a bit into the rearview mirror is that the experience can help us put some of those questions to rest once and for all. Many lives were changed by the effective, accurate transmission of medical reality about the virus, how to prevent its terrible consequences, and how best to treat people who are infected. Thousands of doctors and millions of patients were offered and acted on accurate information about covid, and the point was nailed down by its counter-factual: the millions of patients (and yes, some doctors and health care professionals as well) who received and acted on bad information, with tragic consequences. It was the same virus, more or less, the same vaccines, the same effective and ineffective treatments: sort of a controlled study in which effective transmission of evidence-based facts was lifesaving, and its opposite was often lethal.  Covid was just the most dramatic and recent example of issues that all of us interested in academic detailing have been grappling with for years. It was like a student coming to class one day to confront a surprise pop quiz that will determine three-quarters of the grade. Those who had been diligent all semester could deal with it handily, while those who hadn't been paying enough attention are astonished and devastated. It’s the same for the transmission of clear information about most of the medical conditions our programs confront every day. The pandemic was just the most striking recent example of the good effects of getting this information-transfer right, and the terrible consequences of getting it wrong. We've seen this movie before, in preventing and treating cancer, diabetes, heart disease, maternal and infant mortality, and a host of other conditions for which we have good preventive and therapeutic options to teach about to save lives (and huge costs) by handling that information transfer well, or lose lives and treasure if we do it ham-handedly.  It's been estimated that by early 2022, the risk of illness and death from Covid was determined more by the flow of information than by the biology of the virus. That sounds dramatic, but it’s probably been equally true for years for the other conditions noted above. The pandemic was like a controlled experiment: when confronted by the same infectious agent (more or less) and the same preventions and treatments, some health care systems and communities did much better than others. True, the problem was often lack of access; but another major cause was lack of good transmission of accurate knowledge. This should be a bracing call to action for academic detailing programs as well as the healthcare delivery system as a whole. If the effective dissemination of accurate, actionable facts can play such an important role in infectious disease, cardiovascular illness, diabetes, pediatrics, obstetrics, and nearly every other branch of health care, the good news is that the “pop quiz” of Covid that we’ve just lived through can remind us how much we can do to enhance that flow of education to transform the best science into the best practice – as well as the awful consequences of getting it wrong. Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation! Biography.
Jerry Avorn, MD, Co-Founder & Special Adviser, NaRCAD Dr. Avorn is Professor of Medicine at Harvard Medical School and Chief Emeritus of the Division of Pharmacoepidemiology and Pharmacoeconomics (DoPE) at Brigham & Women's Hospital. A general internist, geriatrician, and drug epidemiologist, he pioneered the concept of academic detailing and is recognized internationally as a leading expert on this topic and on optimal medication use, particularly in the elderly. Read More. By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD An interview with José Peña Bravo, PhD, Health Educator, Florida Department of Health in Duval County. Tags: Detailing Visits, Evidence-Based Medicine, Opioid Safety, Data  Anna: Hi, José! Thanks for joining us on our DETAILS blog today. Your journey that led you to the academic detailing community is unique – can you share that journey with us? José: Yes! My background is not originally in public health. I’m a biomedical researcher by training, specifically preclinical research using animal models. My dissertation work was on understanding the neurophysiological changes and different brain regions involved in behaviors related to substance use. My intention was to stay in academia and start my own lab, but my plans changed during COVID-19 and the opportunity to work with the public health department in Duval County presented itself. It’s been a learning curve for me to switch my perspective from preclinical research to public health—it’s been an enjoyable journey so far! Anna: I’m sure your biomedical research skills have a positive impact with clinicians during your detailing visits too, especially when clinicians want to discuss the neurobiology of substance use disorder. Speaking of visits, your detailing work is funded through CDC’s Overdose Data to Action (OD2A) grant, which seeks to prevent overdoses. Can you tell us about what the work for this grant looks like in Florida?  José: The OD2A project is a team effort across three CDC-funded jurisdictions in Florida. The health departments share that funding with various community organizations, and we all work toward linking patients with substance use disorder to treatment, mental health care, and care coordination services. Our detailing team is closely connected to organizations and resources within our community, and we share these resources with clinicians during our detailing visits. We also have access to aggregate prescription data from our jurisdiction and are continuing to find ways to present and incorporate this data at our visits with clinicians. We share this data and other resources across our three jurisdictions. Anna: We’ve found that many AD programs have been successful when they are closely connected to community resources. NaRCAD recently hosted a detailing training for OD2A recipients that you attended. What was it like to train with other jurisdictions working on the same project? José: It was helpful to hear from other jurisdictions because they’ve all approached their AD work differently based on the gaps in care in their own communities. I was able to hear from AD programs in rural areas and the specific challenges that their patients face with lack of access to care (long travel times, stigma, etc.). I also enjoyed practicing my detailing skills in a space where I felt comfortable making mistakes. It’s valuable to try things out and see how they’ll go before going out in the field. I learned a lot at the training and am excited to try out some of my new skills at my next visit.  Anna: Hearing from other detailers who are doing this important work with you is so helpful as you continue to think about and grow your own program. What advice would you tell other detailers working on the OD2A project? José: If you’re just starting out, reach out to community partners and get a sense of what patients with substance use disorder are experiencing and the challenges they’re facing before you start detailing clinicians. You’ll better be able to represent what is happening in the community and the resources that exist when you’ve done your research first! Anna: That’s terrific advice – a key piece of being an effective detailer is understanding the patient experience for the clinical topic you’re detailing on. So, what’s next for your work and Duval County? José: We’re currently working with our epidemiology team to collect population-level data and present it concisely. We want to be able to efficiently share this data with clinicians in a way that gets their attention and has them compare it to what they’re experiencing in their clinics to ensure an interactive dialogue during detailing visits. Anna: Using data to tell a story helps clinicians see the impact that they have in preventing overdoses and starts a conversation about organizations and resources that exist within communities for patients with substance use disorder. Thanks for sharing your OD2A work with us, José. We look forward to connecting with you and the other OD2A recipients at our conference in November! Have thoughts on our DETAILS Blog posts? You can head on over to our Discussion Forum to continue the conversation!  Biography. José’s background is in Neuroscience preclinical research with over 10 years of experience in the field. His graduate work focused on the study of rodent models of substance abuse and the neurophysiological changes associated with controlled-substance experience. He has additional experience as an undergraduate and graduate level lecturer in different biomedical research topics. José recently transitioned to a position as health educator as part of the Overdose Data to Action (OD2A) program at the Florida Department of Health in Duval County. His role involves the implementation of the academic detailing program including outreach to clinics, integrating novel data and information to education materials, and keeping track of different metrics associated with outreach and AD sessions.
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