Tags: Training, Detailing Visits

We are proud to announce that our team at NaRCAD has trained over 1000 people in the techniques of academic detailing. We’ve conducted 60 trainings for detailers working on an amazing range of clinical topics since our first techniques training in 2011. Thank you for growing with us as we’ve expanded from two trainings a year to offering eight trainings in 2022. In honor of reaching this milestone, we’ve compiled testimonials from some of our trainees over the past 11 years.

"Just the right amount of didactic, practice, then putting it all together—I'm ready to develop materials & try it.”

“I now have the confidence to carry out a successful educational visit!"

​“The small groups were perfect for interacting, getting to know each other's backgrounds, and
made conversations and learning enjoyable."

“I came away with refined communication skills and improved clinical knowledge, thanks to the outstanding facilitators.”

“This was fantastic! I learned so much and [am] definitely more comfortable with detailing. It was friendly and open to mistakes, and I really appreciated it.”

“I walked away with great feedback, knowing my strengths and where I can improve.”

“It gave me great insights on the skills I need to be a successful detailer!”

“This training provides the opportunity to learn about AD in an interactive way that allows for growth though practice.”

We look forward to continuing to work with all of you. Read more testimonials on our testimonial page or share your training experiences with us below!
​
-The NaRCAD Team

An interview with Nicole Green, BSP, RPh, ACPR, DPLA, Director of the Ambulatory Pharmacy Services Program at ThedaCare, a healthcare organization based in northeastern and central Wisconsin serving both rural and urban areas.

By: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: Program Management, Detailing Visits, Opioid Safety

Aanchal: Hi Nicole, thank you so much for talking about your program with us today! You’re a pharmacy director at ThedaCare—tell us more about the academic detailing component of your programming.

Nicole: During the past four years working at ThedaCare, I’ve been studying ways in which pharmacists could serve as academic detailers to support opioid stewardship initiatives in order to positively influence prescribing. I was able to collaborate with other physician leaders as well as executive leadership who supported the program, gather data on opioid prescribing, and work on a proposal for academic detailing.
​
We created our first formalized detailing project, called the Ambulatory Pharmacy Services Program, in January 2021. We had four detailers kick off our program and we’ve now doubled our team with a total of eight detailers that have all been trained by NaRCAD. Our detailers are ambulatory pharmacists who are embedded in ThedaCare’s family medicine and internal medicine clinics, serving as both medication experts and pharmacy consultants for patients and providers.

Aanchal: It’s incredible how quickly your program grew! Can you tell us more about the areas you’ve been focusing on for academic detailing?

Nicole: Opioid stewardship is our main focus area for our detailing initiative. Our detailers identify patients who are candidates for Naloxone and work with clinicians to provide education to patients and their family members. The detailers also assess patients who have been on opioids for a long time and determine if they still need to be on them or if tapering should be considered.

The second focus area is comprehensive medication management services for our self-insured population. This includes having our detailers identify chronic disease management gaps and partner with our state employees to optimize care for patients to reduce cost and readmissions.
​
Our last focus area is to support our new heart failure clinic. Patients are referred to this clinic if they’ve been discharged from the hospital with heart failure or if they’ve been referred by a cardiologist. On initial visits, patients see a cardiology provider followed by an ambulatory pharmacist. Our role is to review the patient’s chart and provide recommendations to the team, as well as education to the patients. Our goals are to decrease readmissions and improve guideline-directed medical therapy.

Aanchal: Wow - your team’s impact is tremendous. You previously mentioned that you were able to double your detailing team in less than a year. What characteristics do you believe are needed to have a strong detailing team?

Nicole: Having in-depth knowledge about the clinical topic is extremely important. Detailing is also about building trust and strengthening the relationship with confidence. Detailers need to be confident, especially when they’re first starting out and are meeting with providers that they have yet to build a relationship with.
​
Detailers also need to be prepared to respond confidently and in a way that will still engage the providers in an open conversation. Providers typically don't understand that ambulatory pharmacists’ jobs are to assist patients to meet medication-related goals. There have been assumptions about why we’re delivering this service or why we’re meeting with clinicians. Clinicians ask questions such as, “Is it because I’m being targeted?” or “Is it because of my prescribing practices?”

Aanchal: Agreed; at NaRCAD, we know that having both clinical expertise and confidence communicating is essential to detail successfully. We know what makes a successful detailer – now let’s talk about what qualities you believe make you successful as a leader.

Nicole: The first quality that comes to mind is passion. I lead with energy and show my team how exciting this work can be. I think that's important because previously we didn’t have pharmacists embedded in primary care and patients didn’t have an option to book an appointment with a pharmacist for consultation. Our pharmacists are delivering a service that was not there before. They need to promote themselves and make others aware of how they can help.

Also, I like to be a strong advocate for my team. I constantly raise my hand saying that we can help with different initiatives or that certain projects are right up our alley.

​Finally, I encourage my team to be persistent. We can't take the first “no” from a clinician as rejection. It might mean, “not now,” “I don't understand,” or “I haven't been exposed to this.” It doesn’t mean that they never want to have a visit with an academic detailer or will never change their prescribing behavior. ​

Aanchal: These are all core elements in building a strong team. Some situations can feel defeating and having a strong leader that has your back is so important. Lastly, what advice do you have for someone who is new to managing a team of detailers?

Nicole: Prepare your detailers for the field with the most up-to-date clinical content so that they can interact with clinicians confidently.

Also, provide your detailers with training opportunities and use resources like NaRCAD. If you have the capacity, take it one step further by adding practice role play sessions among peers and allow new detailers to observe other detailers in the field. ​​​When training, help the detailers step out of their comfort zone within a group of people that they know before they step out of their comfort zone with a stranger.

Aanchal: Yes, having support and receiving feedback from peers is an important element of building a strong team. Thank you so much for sharing your perspectives with us, Nicole! We look forward to continuing to see your team grow and feature your work at our upcoming conference!  

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!​

BIOGRAPHY: Nicole Green completed her pharmacy education at the University of Saskatchewan, Canada followed by a hospital residency. She practiced for over a decade as a Clinical Coordinator primarily in the area of cardiology. She has completed year-long learnings through the AIMM (Alliance for Integrate Medication Management) collaborative as well as the ASHP PLA (Pharmacy Leadership Academy). She is the Director of Ambulatory Pharmacy with ThedaCare. She leads the comprehensive strategic plan to embed pharmacists within family and internal medicine clinics as providers and vital members of the primary care clinical team.  She has served as an Executive panelist with GTMRx (Get the Medications Right) and the Institute for Advancing Health Value.

Her program utilizes Academic Detailing as a means of building professional relationships, establishing credibility and influencing prescribing improvements. Much of her team’s work is related to Quality improvement initiatives in medication stewardship and safety as well as maximal performance in Pharmacy related ACO measures.

Nicole has worked with the ThedaCare cardiology team to build a collaborative Heart Failure Clinic where patients see both a cardiology provider and am ambulatory pharmacist.    

This series features tried-and-true practices from our AD experts. This week’s guest blogger is Zack Dumont, BSP, ACPR, MSPharm a NaRCAD Facilitator and Academic Detailer at RxFiles Academic Detailing Service.

Curated by Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

Tags: Detailing Visits, Stigma, Training

Model the compassion you expect from others.
​
In recent years, the academic detailing community has been trying to recognize the harmful role of stigma in many clinical settings and to include stigma reduction in our detailing messages. In applying this framework, we encourage an empathetic view of people who experience stigma. They don’t choose to have addictions, exhibit certain behaviors, or to be ‘villainous’. We can all agree they don’t deserve harsh judgment and criticism. 

I invite you to bring forth your most charitable mindset for a moment and apply that same framework when you encounter stigma during a detailing visit. Imagine that the clinicians or people you detail hold stigma not because they want to stigmatize others, but for some more relatable reasons: they’re impressionable, they’re naïve, they’re vulnerable. In the same way that a clinician wouldn’t expect someone with a substance use disorder to suddenly recover if harshly confronted, we can’t expect the person who stigmatizes to respond to similar tactics.
​
Be patient, be persistent (after all, you care and want them to be their best selves), and be persuasive with those that you’re detailing. You have a lot of natural talent, training, and experience to efficiently help people make informed decisions through detailing visits. Don’t limit it to therapeutic decision-making; extend it to the mental and emotional aspects of care, as well.

Balance and refine your self-reflections.

Alone or with a colleague, find a quick and easy way to debrief after each visit – save the more intense feedback for quarterly or annual reviews. Maybe it’s asking two simple questions like, “What went well?” and “What could have gone better?” and taking a moment to reflect on each.
​
And, just like AD visits which are 90% prep and 10% execution, the more the better when it comes to ‘prepping’ your self-reflection questions. So, “What went well?” could be more specific to one of your strengths:

• How did I bring my warmth and friendliness to the visit?
• What did I do that helped explain the evidence as well as I’m known for?

Your “What could have gone better?” question could focus on an area of improvement unique to you:

• Did I remember to listen more than talk? How many minutes did I spend doing each?
• Did I embrace the prescriber’s skepticism, or did I shy away from it again?

This isn’t easy, but it’s low risk with the potential for big reward… so I encourage you to jump in! 

Want more tips?
Stay tuned for the next installment in our Words of AD Wisdom series, and reach out to the NaRCAD team, subscribe to our network, or check out our discussion forum to hear more tips and ways to train your brain!

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Lexie Hach, Regional Health Specialist, Bureau of HIV, STD, and Hepatitis, Capacity Extension Program, Iowa Department of Public Health.
 
Tags: Detailing Visits, Evidence-Based Medicine, Stigma, Rural AD Program

Anna: Those are some impressive numbers across both the clinical and community settings. Thank you for letting us feature your detailing work and learn more about the impact your team is making in your state!

​Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography. Lexie Hach holds an Associate Degree in Nursing, Bachelor of Arts degree in Health Promotion and Women’s Health, and a Master of Arts degree in Community Health Education. Lexie is currently a Doctoral student in Public Health (DrPH) with an Epidemiology concentration at the University of Nebraska Medical Center (UNMC). 

Lexie has held positions in nursing, health education, public health, and healthcare marketing. Lexie has been with the Bureau of HIV, STD, and Hepatitis Capacity Extension Program at the Iowa Department of Public Health for over five years as a Regional Health Specialist (RHS). Lexie was previously with the bureau as a Disease Intervention Specialist (DIS). 

Lexie was instrumental in developing and implementing the RHS program in Iowa’s rural communities. In her RHS (academic detailing) role, Lexie educated a variety of different stakeholders on best practices related to HIV, STIs, and Hepatitis in central Iowa. Lexie has helped support the Sexually Transmitted Disease (STD) Program as a DIS due to COVID-19 and also helped as a COVID-19 contact tracer. Lexie was the previous workforce health department co-chair for Iowa’s statewide strategic plan to stop HIV in Iowa (Stop HIV Iowa). Lexie recently returned to her roots in the STD program and now serves as an Integrated DIS and Special Projects Coordinator, but continues to work alongside her fellow RHS colleagues.
 

By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Sandeep (Sonny) Singh Bains, PharmD, BCPS, Clinical Educator, Alosa Health. Alosa Health is a national leader in developing and implementing academic detailing programs to improve prescribing.
 
Tags: Detailing Visits, Evidence-Based Medicine, Primary Care, Training

Anna: Hi, Sonny! It’s wonderful to connect with you today and hear about your work as a clinical educator at Alosa Health. What has your clinical pharmacist journey looked like to date?
 
Sonny: I’ve been working for over a decade in hospitals and primary care. I completed my residency in hospital pharmacy, and as I continued to do administrative and clinical work in hospitals, my interests shifted more towards primary care and population health.
 
I’m originally from California where it’s common to have pharmacy involved in primary care. When I moved to Pennsylvania, a lot of clinicians didn’t understand why a pharmacist would be in a primary care setting and were skeptical of me and my role within the clinic.
 
Fast-forward 10 years, and almost every health system in Philadelphia has a pharmacist on their team within their primary care network. I’d like to think that I can take a little bit of credit for paving the way for pharmacists on primary care teams throughout our state!
 
Anna: That’s definitely something to be proud of. How did you end up being a detailer? ​

​Sonny: I’d been noticing a lot of overlap in the work being done in our primary care clinics by different members of the team. I ended up creating protocols to automate certain things for different chronic conditions and people would say, “Wow, this is brilliant.” It really wasn’t brilliant; I was using the same set of guidelines in the literature I was reading and was communicating that to clinicians to make workflows easier. 

​I didn’t know about the strategy of academic detailing at the time, but I knew I needed to educate clinicians. I was fortunate enough to be connected with Alosa Health and I now work for them as a full-time consultant. I work as a detailer and also help hire, interview, train, coach, and mentor new detailers on the team.
 
Anna: You were meant to be a detailer before you even knew what it was! Alosa has been working on diverse clinical topics over the years including, antiplatelets, atrial fibrillation, immunizations for elderly, serious illness conversations, chronic obstructive pulmonary disease (COPD), heart failure, dementia, atherosclerotic cardiovascular disease (ASCVD) prevention, diabetes, acute pain, chronic pain, and opioid use disorder. What have been some of the campaigns where you’ve felt you’ve made an impact?
 
Sonny: It’s a lot of fun to be working on so many different campaigns. Many of the topics fit right into my wheelhouse with my hospital and primary care background. Diabetes has been my favorite topic. I’ve been able to make a large impact for patients and care providers. We’re able to improve lives of patients (prevention of stroke/heart attacks) and improve outcomes for providers and health systems (financial incentives, quality ratings, etc.).
 
I’m also proud to be part of the pain modules. The opioid epidemic has impacted all of us in America and I’m glad to be able to do my part in helping to bring resources and evidence-based treatment to local providers in our community.

​Anna: It sure sounds like you’ve been able to make an impact! How has your work with Alosa evolved over the years?
 
Sonny: Alosa Health has been expanding and we have several new partnerships and collaborations throughout the United States. We started detailing only in the state of Pennsylvania and we’ve now expanded to numerous states. It’s been exciting to be part of the leadership team to help coach detailers, as well as create creative partnerships with local health systems to improve outcomes for patients. 
 
Anna: What challenges have come up as your program has continued to expand?
 
Sonny: The biggest barrier we’ve experienced, like many detailing programs, has been access to clinicians and the ability to set up visits. I’ve had relationships with clinicians and clinic staff in the past where I could have walked into any office at any given time, but I’ve lost a lot of those relationships with COVID and staff turnover. I’ve been working hard to reestablish relationships in the field and teach new detailers how important strong relationships are to our work as detailers. 

Anna: What approaches have you taken to reestablish relationships, as well as to gain access to new clinics?
 
Sonny: I like to partner with colleagues that I’ve worked with previously. I recently connected with a former colleague who’s a VP at a large healthcare organization and we quickly realized we could help each other improve patient outcomes and reduce cost. From this connection, I was able to get buy-in at the administrative level and accessed hundreds of prescribers. They even gave their clinicians a monetary incentive to meet with our detailers.
 
We’ve also benefited from connecting with administrators of health systems. We approach them like business partners; it takes a special skill to communicate and work with an administrator. It’s important to have team members who understand how to communicate with leadership effectively to get that buy-in.
 
Anna: It might take more time to get buy-in from administrators, but it opens so many doors once it’s done successfully. As we wrap up, can you tell us some tips to help our readers be effective detailers and communicators?
 
Sonny:

• Listen to the clinicians you’re detailing; if you're talking more than 50% of the visit, you're probably talking too much.
• Remember that you’re there as a service for clinicians to improve patient outcomes, so try to frame your visit as what’s in it for them, rather than how many key messages you need to get through.
• Clinicians who believe in your service will invite you back and refer you to colleagues. We all love being in the field and educating clinicians, but we can’t get there without first building strong and trusting relationships.

 
Anna: It’s so important to put the work in to build solid relationships with clinicians in order to be an effective detailer. Thanks for joining us on the DETAILS blog, Sonny - our AD community will gain a lot from the insights you’ve shared today!

Learn more about Alosa’s work: alosahealth.org/clinical-modules

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography. Sandeep is a clinical pharmacist with extensive clinical leadership experience in both acute care and ambulatory healthcare settings. He completed post-graduate training at Einstein Medical Center in Philadelphia and has since worked in clinical pharmacy leadership with large healthcare systems in the greater Philadelphia area. He is also the principal consultant at Bains Rx, LLC, a healthcare consulting firm dedicated to improving outcomes while reducing costs.

An interview with Rachelle Woods, MSN, RN, Nurse Consultant at the Colorado Department of Public Health and Environment (CDPHE).

By: Aanchal Gupta, Program Coordinator, NaRCAD
​
Tags: HIV/AIDS, PrEP, Detailing Visit

Aanchal: It's important to leverage others in the community to provide the best care and support to patients. Tell us about CDPHE’s prior successes with HIV PrEP detailing.
​
Rachelle: We had a public health detailer a few years back that focused on PrEP rollout. Between 2014 to 2019, PrEP use increased from 383 to 3,659 among Coloradoans. We’re now working on expanding our public health detailing program and have been focused on partnering with other local agencies to bring the best evidence to clinicians. The Denver Health and Hospital Authority has helped us disseminate relevant updates to providers so that we can better meet the needs of Colorado’s most vulnerable populations. ​

​Biography:
​
Rachelle Woods, MSN, RN brings an expansive clinical, leadership, and professional development background deeply rooted in OBGYN, STI/HIV, Family Planning, Transgender Health, and Infection Control to the Public Health Detailer role at CDPHE.  Rachelle’s passion for all things infectious has afforded her a career rich in opportunity to meet people where they are and engage in robust discussion surrounding STI/HIV transmission, prevention, biomedical interventions and resources, and personal wellbeing. Her audiences have spanned multiple platforms and have included clinical and non-clinical staff, patients/families, teens, and students. Rachelle is looking forward to applying her skills and experience in support and growth of the Public Health Detailer role at CDPHE.

Anna: Hi Trish! Thanks for joining us today. Your team has been working on a number of AD campaigns including, falls prevention, type 2 diabetes, benzodiazepine use in older adults, chronic non-cancer pain (CNCP), and opioid use disorder (OUD). Can you tell us about some of the other recent work you’ve been doing at CEP?

Trish: Our team’s academic detailing work is a big part of what we do, but CEP has other supports as well. We create clinical tools and resources on myriad clinical topics where practice gaps have been identified. Our most popular resource has been our COVID-19 Resource Centre to support primary care clinicians in adapting their practice during the pandemic. It’s become a massive resource that has had over 140,000 downloads.
​
Anna: Wow! That’s an impressive amount of downloads. One of the other priority areas where your team has identified practice gaps is OUD. This topic often has a lot of stigma associated with it. Is this something you’ve experienced with the opioid detailing campaigns?

​Anna: I can see how talking about OUD might make some clinicians feel uncomfortable. What types of resources has your team developed to support both clinicians and their patients to feel more comfortable having these conversations?  

Trish: For our academic detailing visits on opioids and CNCP we developed a resource called Talking Points with Patients, which includes scripts for clinicians to handle different scenarios. For example, one of the scenarios is about a patient asking for a dose increase for an opioid, but the clinician not agreeing that a dose increase will help manage their pain. We also have a Specific, Measurable, Achievable, Relevant, and Time-Bound (SMART) Goals resource to help clinicians set goals with their patients by taking the focus off the pain number scale and focusing on actions like, “What activities would you like to do if you had less pain?”

Anna: It’s clear that your team works hard to develop and tailor resources to support clinicians and patients. What kinds of local resources from your community are available for detailers to share with clinicians?

Trish: We often help clinicians find local resources through a program called The Healthline, which is a website that connects patients with social supports, like counseling, food, and safety. We’re also lucky to have Rapid Access Addiction Medicine (RAAM) clinics in our community that are a one-stop shop for patients with OUD where they’re assessed, given support and a plan for tapering, and referred to other community services.
​
Anna: It’s so important for clinicians and patients to be linked to local resources and know that they have a community supporting them. Can you share some data about how clinicians reacted to the opioid-specific campaigns overall?

​Trish: Absolutely! I can share some key findings from our opioid campaigns.
 
Opioid therapy for CNCP AD campaign (n=475):
After the detailing sessions, clinicians indicated they were confident in their ability to have a conversation about tapering when appropriate, even when the discussion was challenging (93.5%).
​
Non-pharmacological and non-opioid alternatives for CNCP AD campaign (n=323):
Clinicians indicated that after the detailing sessions they were confident in their ability to help patients: 

• Set practical (SMART) goals (92%);
• Work through a trial of non-opioid pharmacotherapy (96%);
• Work through a trial of non-pharmacological therapy (93%).

OUD AD campaign (n=250):
Clinicians indicated that the detailing sessions enabled them to support patients with OUD by:

• Referring to local supports and resources (74%);
• Referring to a specialist clinic (61%);
• Initiating opioid agonist therapy (51%); 
• Maintaining opioid agonist therapy (63.5%).

Anna: That’s incredible. It’s obvious that your campaigns have made a huge impact on clinicians. What advice would you give to other AD programs who are supporting clinicians in reducing stigma, especially as it relates to opioids?

Trish: I would recommend remembering three key points:
 
Examine your own biases: When developing detailing tools, you need to make sure that you’re aware of your own biases and that your tools include the lens of equity, diversity, and inclusion. This is something we are actively working on incorporating in all our work at CEP.

Make space for clinician experiences: It’s important to remember to be sensitive to the clinician perspective. There have been times, especially with opioids, where clinicians have had painful experiences with patients overdosing. Be aware of their perceptions and respectful of the trauma they may have experienced.

Know your patient population: Understand who the patients are, the trauma they’ve faced, and the stigma they may endure. Look at the experiences of your team, the clinicians, and the patients you’re working with and try to understand how these different perspectives all influence one another as you develop your resources.
​ ​
Anna: That’s beautifully said, Trish. Thank you so much for sharing about your important work in reducing stigma around OUD.  

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!​

Biography. Trish Rawn is the Clinical Service Director for the Centre for Effective Practice Academic Detailing Service. She is a hospital pharmacist who has been detailing for 6 years on topics such as antipsychotics in the elderly, opioid tapering, chronic pain, diabetes, falls prevention, and benzodiazepine deprescribing.

 
By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
An interview with Adrienne Butterwick, MPH, CHES, Senior Improvement Advisor and Academic Detailing Project Manager, Comagine Health. Comagine Health is a national, nonprofit, health care consulting firm that works collaboratively with patients, providers, payers and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system.

Tags: Detailing Visits, Evidence Based, Substance Use, Opioid Safety

Anna: Hi Adrienne! We recently saw you present on a panel where you spoke about your academic detailing project with dentists on opioid safety. Can you tell us a little more about how your team got started with this work?

Adrienne: In 2018, the CDC released funds to states through the Overdose Data to Action (OD2A) grant and the state of Utah selected academic detailing as one of the interventions they wanted to use. AD is one of the many different modalities that we use within my organization to reach clinicians to educate them and have an impact on the kind of care they provide.
​
The state began looking at specific regions and populations to target after we received the funding. Utah is unique in that it has a high number of adolescents undergoing surgery for wisdom teeth removal, which is one of the most common instances where controlled substances are prescribed.

A first prescription can be a huge turning point to potentially becoming addicted to a substance, especially at a young age. That’s when we decided to put together a team of two detailers to detail dentists. I was lucky enough to attend each detailing visit and collect data through pre- and post-surveys and answer any administrative questions that came up. ​

Anna: A detailer who can build empathy with clinicians and who has personal experience with a challenging topic is an important asset to have in a detailing program. What obstacles did you face as your team implemented this project?

Adrienne: Connecting with dental offices, in general, was tough. We first started by working with dental associations to get relationships in place. We submitted newsletter articles, attended meetings, presented at the regional conference, and sent our program’s information via their listservs.

We also Googled practices and found ones that had more than one dentist working in the office at a time. We’d cold call those offices and say, “It looks like you have a big operation – is there a way we could bring training in for your team for continuing education credits?”

Before leaving the visits, we’d ask the dentists for referrals to other clinicians and leave flyers behind. Relationships grew organically over time.

Anna: It sounds like the project began to build on itself fairly quickly. Did your team experience any barriers from the dentists during the detailing visits?

Adrienne: We had a lot of dentists who thought the opioid crisis wasn’t relevant to their practice and we knew that we had to find ways to tie it into their profession. Fortunately, dentists have historically been involved in public health movements because they hold a different type of relationship with patients that is closer than a typical relationship with a primary care provider. They see patients more frequently and can detect small changes in health quickly.

The dental profession was incredibly important in the tobacco cessation movement in the 1990s. They were instrumental in getting individuals to reduce or completely stop using tobacco. Dentists are also starting to be trained in domestic violence and human trafficking.
​
For the dentists who were hesitant about the relevance of our detailing visits, we would say, “You have this amazing relationship with patients that we don’t see in other parts of healthcare—here’s how you can make a huge difference!” or “I can understand how there would be a lot of fear to step out of your comfort zone; we have a lot of resources and materials to support you.” ​

Anna: Dentists truly have a unique relationship with patients that can be used to promote countless public health initiatives. Can you think of a time your team was able to empower a dentist to change behavior and encourage them to see their relevance in combatting the opioid crisis?

Adrienne: There was a dental group in a rural part of the state that had one dentist and a big support staff. We came in for a detailing visit and had a conversation with the entire office. 

After the meeting, one of the dental assistants pulled me aside and told me that a patient who had recently completed substance use rehab had visited the office in need of a procedure that would warrant prescribing an opioid. No one in the office knew what to do for pain control and they were all unsure how to approach the patient given his history. She said that because we came, she felt like she now knew how to have a conversation with him about the procedure and his safer, alternative options for pain management.

The dentist also shared that prior to our visit, he often didn’t know how to handle conversations about pain management and opioids and wasn’t sure if it was his job to do so. After our visit, he said he felt comfortable and confident doing this, and shared an anecdote of being able to create a safe space for an ongoing conversation with a recent patient.

Anna: It seems like your team has had such an impact by using one of the core elements of detailing – building relationships through empathy, validation, and support. Can you share some encouragement for readers who are considering having these conversations with dentists?

Adrienne: Be flexible and don’t come in with your own agenda – be sure to let the dentists drive the conversation and let them teach you along the way. It can be a rewarding yet challenging experience – don’t forget to celebrate the small wins on your journey!
​
Anna: Thanks for sharing this innovative approach to detailing, Adrienne! We’re looking forward to hearing about your continued impact with the dental community and beyond.

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!
 ​

Biography. Ms. Butterwick is a Senior Improvement Advisor at Comagine Health. She is currently working on quality improvement efforts directed by the Centers for Medicare & Medicaid Services (CMS) to improve quality of care for residents living in post-acute and long term care as well as assisted living and home health. She's also working on an initiative to increase advance care practices in those settings.

In addition, through a subcontract with the Utah Department of Health, Ms. Butterwick currently provides educational support for opioid prescribing to family medicine and dental providers. Her work with this contract has earned national recognition and has been presented at the RX Drug and Heroin Abuse Summit in April 2020 and the American Public Health Association’s annual conference in October 2020. She is currently also collaborating with faculty from the University of Utah regarding telehealth and advance care planning initiatives through the Utah Geriatric Education Consortium and Geriatric Workforce Enhancement Programs.

She completed her Bachelors of Science degree in Behavioral Science and Health at the University of Utah in 2007 and her Master's in Public Health at Westminster College in 2014. She has also earned recognition as a Certified Healthcare Education Specialist (CHES).
​
In her 15 years of public health project management she has also worked in rural health research, provider education programs and care management. She has a strong passion for quality improvement and public health. 

Words of AD Wisdom is a series that features tried-and-true practices from AD experts. Our guest blogger this week is Chirag Rathod, PharmD, a NaRCAD Facilitator and Academic Detailer at Illinois ADVANCE.
 
Tags: Detailing Visits, Evidence Based Medicine, Materials

​Simplify your messaging!
Prior to your detailing visit, think about ways to slow down and limit the amount of information you share with the clinician so that the visit is of most value to them. You can do this by asking focused needs assessment questions and providing the clinician ample opportunities to speak and engage in the conversation.

​Focus. Focus. Focus.
Resist the urge to cover too much content in your detailing aid during an AD visit. A more focused discussion on one section of your brochure can be more fruitful than trying to cover every key message during a single visit.

​Open-ended questions will set you free!
There is limited usefulness in asking closed-ended questions (e.g., confirming something about the clinician’s practice). The use of open-ended questions can help you gain layered insight into the clinician’s practice and tailor the visit to them. Asking open-ended questions allows opportunities for the clinician to speak about their experiences in detail and for you to listen and deliver supportive, relevant key messages.

Prime your “AD Kitchen.”
In cooking shows, hosts show you how to prep a meal, pulling out the final, cooked meal from the oven in the following scene. For an AD visit, you should think about how you can prep your ‘ingredients’ for clinicians by making sure you’re well-versed in your materials and are ready to teach your clinicians how to adopt something practical and usable into their practice. Have a tool to share? Test it in advance of your visit, so you can confidently demonstrate effective use of the tool, leaving more time to discuss applying the tool successfully in practice with patients.

Biography. ​Chirag is a clinical pharmacist, academic detailer and instructor with Illinois ADVANCE at the University of Illinois-Chicago (UIC). He graduated with a Doctor of Pharmacy degree from Midwestern University in 2012 and has been working at UIC ever since. During his time at UIC, he has been involved in a number of collaborations with the College of Pharmacy, College of Dentistry, and College of Medicine in addition to teaching Medical Improv, which utilizes the techniques of improvisation to improve communication skills amongst current and future healthcare practitioners.
​
He has also been focused on academic detailing, including program planning, presentations to recruit organizations, creating educational material, training staff, facilitating role plays and providing individualized feedback, and detailing prescribers. He trained with NaRCAD in 2019 during their Spring Training Series to develop his skills as an academic detailer and has also presented at the NaRCAD annual conference. His interests include performing improv, podcasting, sports and hanging out with his sister’s dog. Fun fact: Chirag hiked Mount Kilimanjaro in February of 2022. 

We’re featuring a snapshot from academic detailer, Carolyn Wilson, a Senior Health Program Coordinator at Ledge Light Health District.
 
By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
Tags: Substance Use, Detailing Visit

Anna: Hi Carolyn! Can you walk us through how you gain access to clinicians?

Carolyn: Absolutely! When it comes to finding clinicians and getting them interested in our program, it’s really all about word of mouth. The clinicians quickly learn that the information I share is valuable and that I’m respectful of their time. I say things at the end of our visit like, “if you really enjoyed this session, the best compliment that I can receive is a referral to somebody else.” A referral or warm handoff always seems to work for me when gaining access.

I also do a little bit of cold calling on LinkedIn - I share information about our program and attach our flyer. I make sure to mention our continuing education credits, referral gift cards, and swag. Clinicians absolutely love our insulated travel mugs. We’re fortunate enough to have the funding to provide these incentives through our grant.  

Once I’m 1:1 with a clinician, I always try to set the stage during our first meeting, especially if I don’t have a relationship with them. I let them know that I’m a non-clinical health educator and that I have a background in public health. I like to say that I’m a health promoter, not a clinician.
​
I tell the clinician I’m working with that they know how to do their job, but I’m there to support them. I always thank them for their interest and time, which helps to build that relationship and open the door for follow up visits.
​
Bottom line - entice people and let them know your value! At the end of the day, you want clinicians to know that you’re there to help them and that they can access you whenever they need support. 

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!​

An interview with Parveen Ghani, MBBS, MPH, MS, Health Program Specialist III, Division of Professional Licensing, State of Utah.

by Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

Tags: Opioid Safety, Evidence Based, Training

Anna: Hi Parveen! You’re one of our training alumni who’s built a strong program over the past few years. We’re thrilled to be able to catch up with you! Can you tell us about yourself?

Parveen: I’m trained as a physician and have always wanted to work in public health. It was important to me to be able to make a difference in people’s lives.

I currently work in the Division of Professional Licensing at the Department of Commerce in Utah. I've been working as an academic detailer since my NaRCAD training a few years ago.

Anna: It sounds like the rest is history! Are there other detailers on your team who are helping you meet your program goals?
​
Parveen: I’m a full-time detailer for our AD program along with my colleague, Marie Frankos. We work with many of the same prescribers over multiple detailing visits and build strong connections with them. 

Anna: Can you talk to us about your detailing work in overdose prevention?

Parveen: Opioid overdose in the State of Utah is exceptionally high. We’re currently working with prescribers on the safe prescribing of opioids. Our state’s prescription drug monitoring program is called the Controlled Substance Database Program (CSD). The CSD includes both a Patient Dashboard and Prescriber Dashboard.

The Patient Dashboard is an electronic clinical decision-making tool that grants prescribers access to information regarding controlled substance prescriptions for individual patients. It contains records of a patient’s poisoning or overdose and any violations associated with a controlled substance. The Prescriber Dashboard, on the other hand, tracks each clinician's prescribing patterns and CSD utilization behavior.
​
Anna: We’ve seen a lot of success with detailing programs who work with clinicians to navigate their state’s prescription drug monitoring program, like your CSD. Does your state require prescribers to look at this database?

Parveen: Yes. According to the Utah Controlled Substances Act,

(a) A prescriber shall check the database for information about a patient before the first time the prescriber gives a prescription to a patient for a Schedule II opioid or a Schedule III opioid.

(b) If a prescriber is repeatedly prescribing a Schedule II opioid or Schedule III opioid to a patient, the prescriber shall periodically review information about the patient in:

(i) the database; or (ii) other similar records of controlled substances the patient has filled.

Anna: It’s so important to support prescribers in using a database like this, especially when there are mandates in place. What is the overall goal of your AD program?

Parveen: The goal of our AD program is to provide recommendations to prescribers regarding best practices in the utilization of the CSD per the Controlled Substance Database Act. This includes identifying individual prescriber’s prescribing and dispensing patterns of controlled substances, identifying prescribers who are prescribing in an unprofessional or unlawful manner, and identifying polypharmacy, doctor shopping, poisoning, or overdoses.
​
Anna: It sounds like your AD program is working hard to support clinicians in CSD utilization. What kind of resources have you developed for clinicians that work towards your program’s overall goal, and how do you make these materials accessible?

Parveen: We’ve created a toolkit that acts as a guide to help clinicians utilize the database and different resources within the community. During our in-person visits, we provide hard copies of materials that include screenshots of how to create a CSD account, reset CSD account passwords, and navigate the dashboards within the CSD. During our virtual AD sessions, we send these materials electronically. Additionally, we provide our contact information for further technical assistance, including our personal phone number, work phone number, and email address. 

We've made our toolkit available on our website along with prescriber FAQs. We’re continuing to update our website with helpful materials for clinicians.

Anna: Making resources like this so accessible is key. Can you share some reflections on visits where you felt like you made a difference or were able to offer technical assistance?
​
Parveen: I love helping prescribers, even if it is something as simple as walking them through the log-in process or resetting a password. I’ve had clinicians bring their entire medical team in for a detailing visit so that I can show everyone in the office how to use the database.
​
One prescriber even told me after a visit that they would be sharing my name with a colleague and that I should expect a call to schedule a detailing visit. It’s lovely to get these types of referrals from the clinicians.

Anna: Prescribers feeling thankful and impressed with your 1:1 support enough to refer you to their colleagues is a huge success! Let’s wrap up with one more question - what’s one tip you’d give to another academic detailer?

Parveen: Find ways to collaborate. We can’t do it alone! Start working together with other programs and share information, especially community resources. We can really make a difference if we work together.
​
Anna: I couldn’t agree more. Making community connections and sharing information allows for great success in accomplishing goals for both small and large initiatives. Our AD community will be able to glean a lot from your program’s successes, and we look forward to sharing more of your team’s expertise in the future.

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

By: Aanchal Gupta, Program Coordinator, NaRCAD

Tags: Detailing Visits, CME, E-Detailing
​
You asked, we answered! Getting your foot-in-the-door to schedule a detailing visit is a challenge for many detailers. We’ve compiled some of our best tips about gaining access from our past interviewees on the DETAILS blog. 

Relationship Building:
​

• “Being invited to an all-staff meeting is often an excellent way to kick off an introduction to this important intervention and can result in follow-up conversations with individual clinicians. One benefit of meeting in small groups is that if a clinician hears a fellow clinician say that he or she is already prescribing PrEP, there may be more openness to discussing the topic; other providers might feel comforted in having a PrEP "ally", resulting in buy-in from the clinic overall.” – Alyson Decker, NP, MPH, San Francisco Department of Public Health

 

• “…although we try and limit group presentations, this has proven to be an effective strategy when entering into a new relationship. Once they get to know us and recognize the value of the program, they’re engaged in having us come back to conduct 1:1 visits on the follow-up and subsequent campaigns.” – Michelle Dresser, MPH, New York City Department of Health and Mental Hygiene (DOHMH)  

 

• “…I had learned strategies on getting in the door [at the NaRCAD training] that were useful in my effort. On a few occasions, the practice managers didn’t follow through on connecting me with the physicians. I got around this by utilizing physicians I knew in other practices to gain access to their practice. A lot of it comes down to how well you know the physicians.” - David O’Riordan, MPharm, MPH, PhD, University College Cork, Ireland

 

• “I always say that the receptionists in doctors’ offices are the most powerful people in the world. If you can’t get through them, you’re not going to get what you need.”– Lutricia Woods, RN

 

• “We had champions in the area that supported what we were doing, and we could use that to get our detailers in the door. Our program was also previously part of a demonstration project where providers were required to have an academic detailing visit as part of the initiative. I would say that our cold calls became “warm calls” during that time because all the offices and providers knew we were coming.” – Sarah Ball, PharmD, SCORxE

 

• “Whenever possible, I want to try to connect with people in a way that is the most seamless for them. And that's absolutely true for detailing too! I've had providers who want to meet over coffee and muffins at 6:00 AM because it's the only time they have in their day, or providers who need to pump their breast milk during our visit. I roll with it all and make sure I’m meeting providers where they’re at.” – Jacki Travers, PharmD, Pharmacy Management Consultants (PMC)

Incentives:
​

• “We also met with our medical board and asked them if our service could qualify as a mechanism for healthcare providers to receive their required pain management CME. They supported our request and that ended up being a huge win for our program. In addition to being detailed, clinicians can also get free CMEs.” – Alisha Herrick, MPH, CHES, Center for Health Innovation (CHI)

 

• “Not only is offering CME/MOC credits an educational incentive for providers, but it lends credibility to our messages.” - Meagan Shallcross, MPH, Colorado Assuring Better Child Health and Development (ABCD)

Tools:
​

• “We’re now working on trying some more targeted approaches, like Google Advertisements. For example, if a provider is googling "free pain management CME in New Mexico," our program might pop to the top of the list.” – Alisha Herrick, MPH, CHES, Center for Health Innovation (CHI)

 

• “One of our solutions has been what we call “virtual office hours”. In the calendar slots where a detailer has no detailing visits scheduled, they can hold open office hours, and we send out a promotional email about them to clinicians. Multiple clinicians can be there at once and chat about anything under the umbrella of the HIV care continuum.” – Ashley Allison, Oregon AIDS Education and Training Center (ATEC)

 

• “Near the end of 2020, we met with a couple of different video production agencies to learn more about creating a commercial [to use for gaining access to clinicians] and the resources required to make it come to life.” – Alisha Herrick, MPH, CHES, Center for Health Innovation (CHI)

 

• “We spent a lot of time looking into different platforms for automated appointment scheduling and ended up finding the Appointlet scheduling app. It allows us to manage all of our detailers’ schedules in a centralized place. It’s extremely intuitive and easy to use.” – Ashley Allison, Oregon AIDS Education and Training Center (ATEC)

• NaRCAD Materials Toolkit:
  • Introducing Your Campaign: Adaptable Community Letter (NaRCAD)
  • Adaptable Calling Script: Scheduling Detailing Visits (CDPHE)
  • Decision Tree: Setting up Access Points (CDPHE)
  • Opioid Academic Detailing Flyer Example (MAHEC)
  • Public Health Detailing Flyer Example (Utah AETC)
  • Academic Detailing Commercial (Center for Health Innovation)
  • Scheduling a Visit: Fax Template (RxFiles) 

• Scheduling/Outreach Tools:
  • Appointlet: Appointment scheduling platform
  • Calendly: Appointment scheduling platform
  • Survey Monkey: Pre- and post- evaluation questions
  • AETC HIV Care Tools App: Featuring free point‐of‐care tools for clinicians caring for people with – or at risk for – HIV infection
  • Pirate Ship Packet Materials: Sample detailing packet

 

• NaRCAD Conference Hub:
  • “Using Virtual Tools to Connect with Rural Providers” | Ashley Allison, Lead Training Coordinator, Oregon AIDS Education and Training Center (AETC)
    • Watch Video Recording (presentation begins at 36 minutes)
    • Download Slide Deck PDF
  • “Virtual Detailing: Creating Supportive Networks in a Digital World” | Kelsey Genovesse, PA-C, MPAS, Director of Utah Public Health Detailing, AIDS Education Training Center (AETC), University of Utah Infectious Disease
    • Watch Video Recording (presentation begins at 1-hour and 17 minutes) 
    • Download Slide Deck PDF​

An interview with Carolyn Wilson, a Senior Health Program Coordinator at Ledge Light Health
District. Ledge Light Health District is located in New London, Connecticut and is the regional health district serving the southern part of New London County.

by Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

Tags: Opioid Safety, Evidence Based Medicine, Substance Use

Anna: Carolyn, we’re thrilled to feature you on our DETAILS blog! I know you wear many hats – can you tell us about your current job role?

Carolyn: I’m a health educator working within primary prevention, an academic detailer, and the host of our health district’s television program called Healthwatch. Healthwatch covers topics like mental health, physical health, disaster preparedness, general public health, COVID-19, environmental health, and disease prevention. I’ve been with Ledge Light Health District for 11 years.

Anna: It seems like improving patient and community health outcomes is a common thread across all your roles. What primary prevention work or related projects complement your AD work?

Carolyn: Depending on what topic I'm detailing on, I lean into my primary prevention work or the harm reduction work that my colleagues are working on.
​
One of the larger initiatives I often share with clinicians during detailing visits is the Naloxone and Overdose Response App (NORA) project. The Department of Public Health developed a web-based application that can be downloaded directly to your phone. It has information about preventing, treating, and reporting opioid overdose. The app can be used by both folks in the community and clinicians. I also speak to clinicians about proper medication storage and disposal while promoting our “Take it To The Box” Initiative. ​

Carolyn: I detail a lot of advanced practice nurses (APRNs) and also work with them on some of my primary prevention projects. The overlap in projects helps me build strong relationships with these clinicians. I sometimes work with school-based health centers as part of my prevention work, and these health centers are typically run by APRNs. These centers act as an access point to care for many students and families. It’s essentially a primary care clinic right in the school.

The Child and Family Agency oversees the school-based health centers in southeastern Connecticut and reached out to me after a horrific event in a Connecticut middle school. A few months ago, a 12-year-old got access to fentanyl and brought it to school. He overdosed and passed away a few days later at the hospital.
 
We haven’t seen many overdoses in schools, but after this happened, a lot of schools started looking at their policies and school-based health centers wanted to have naloxone on hand. The medical director of the Child and Family Agency advocated for a policy that required all school-based health centers to have naloxone and to be trained in administering it.
 
Anna: What a devastating story. Have the school-based health centers been able to put these types of new policies into place?

Carolyn: When one of the clinicians from the Child and Family Agency reached out to me, she said, “Carolyn, I know you do this kind of work. You trained me in naloxone not too long ago during an academic detailing visit. I’d like to have a naloxone training for my nurse practitioners in the school-based health centers. I want naloxone available in all of our clinics.”
​
This type of request would typically be delegated to somebody else in our department, but because of the relationships I had built through academic detailing, I was asked to provide the training, and I did. As a result, the school-based health centers now all have access to naloxone and the clinicians know how to administer it.  ​

Biography. Carolyn Wilson is a health educator and prevention specialist serving as a program coordinator at Ledge Light Health District in New London CT for 11 years. Carolyn studied public health and health education at New York Medical College. Keenly interested in health promotion and behavioral science, Carolyn enjoys bringing her passions and talents to both primary prevention and academic detailing work. Carolyn has been serving as an academic detailer for over 2 years and enjoys speaking with clinicians about strategies to prevent opioid related deaths. Carolyn also manages the Groton Alliance for Substance abuse Prevention @Groton_Prevents. In her spare time, Carolyn enjoys serving on the Board of Directors for the CT Association of Prevention Professionals and Fiddleheads Food Cooperative. To connect with Carolyn, find her on LinkedIn.

An interview with Cheryl Radeloff, Senior Health Educator at the Southern Nevada Health District in the Office of Disease Surveillance.

By Aanchal Gupta, Program Coordinator, NaRCAD

​Tags: Detailing Visits, HIV/AIDS, PrEP

​Aanchal: Hi Cheryl, we’re looking forward to hearing more about your experience in the NaRCAD Peer Connection Program! How did you hear about the program and what encouraged you to sign up?
​
Cheryl: I found out about the 2021 Peer Connection Program from a NaRCAD e-blast and was intrigued with the idea of joining a learning community. I instantly knew that I wanted to sign up since it would be a place where I could feel comfortable asking questions. I gravitated to the fact that I would be communicating with other peers in the field during cohort gatherings and learning about approaches that we could emulate in our program. 

Aanchal: Yes, having that 1:1 time with your peer, as well as the cohort gatherings where other participants in the program come together, are added ways to network with the detailing community. Would you recommend this program to others that are interested in signing up?
​
Cheryl: Absolutely! You should sign up even if you're a seasoned academic detailer or new to detailing. You're going to get tips, insights, and resources to get you started in a welcoming environment. This is a field where you never stop learning so it’s not only an opportunity to share lessons learned, but to learn from others as well. There are people from across the world who have different experiences and expertise that you can take back to your program. 

Aanchal: One of the special aspects of the program is the sharing of resources and ideas. Are there any conversations that you had with your peer that made an impact on your detailing work or changed the way you thought about your program?
​
Cheryl: The time spent with my peer was invaluable. During changing times with COVID-19, it can be daunting, and you tend to wonder if you’re doing things right or where you should even start. She was so generous in talking through challenges such as funding, recruiting providers, and more with me. She even shared a PowerPoint that they developed to educate pharmacy students about academic detailing.
​
During the mid-point peer connection gathering, I was able to learn about a program in Chicago. They were very innovative; if they didn’t have an approach in place for their program, they designed it. Although my clinical topic may not be the same as others, there are still concepts and tools that I can model after these programs. 

Aanchal: It’s great to hear about these fruitful conversations you had and how there’s always something to learn from others in the detailing community. How would you describe your experience overall with the peer connection program?
​
Cheryl: Every time I attended a peer gathering, I always learned something and never had to question what I was gaining from these meetings. I think it’s essential to hear about what’s going on in the field. It’s difficult as we’re all busy people, yet it’s important not only for learning and development, but a necessary element to have peers to consult.
​
I found the structure of this program to be helpful as we were given the reins to set up 1:1 meetings with our peer match over several months. In addition to that, there were gatherings where the entire cohort could come together and connect which I appreciated. 

Aanchal: Those are some great takeaways, and we are glad to hear about the impact the program has had on your work! To wrap up, we’d love to learn more about what you’ve been up to at the Southern Nevada Health District.

Cheryl: I’ve been with the Southern Nevada Health District for 13 years. Along with being a detailer, I’m also the public health co-chair for our HIV prevention planning group. We meet a few times a year to talk about HIV prevention initiatives, as required by the CDC. I also work with many of our community-based organizations to talk about the fundamentals of HIV.

Academic detailing has been an important strategy for the work that we do. Our main AD initiatives we've been working on are uptake of PrEP and PEP. We have two PrEP navigators who've been educating the community about these initiatives. Lastly, congenital syphilis has been a big topic for us as we’re currently fourth in the country for the highest rates of syphilis.
​
Aanchal: Thank you so much for sharing your experience, Cheryl. We’re so glad that the Peer Connection Program has had a positive impact on your detailing work and can’t wait to hear more about your program’s AD initiatives in the future. We look forward to continuing these connections with our 2022 cohort!

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

​Biography: Cheryl Radeloff is currently a Senior Health Educator with the Southern Nevada Health District Office of Epidemiology and Disease Surveillance. Formerly she was Disease Investigation and Intervention Specialist II. She is also an adjunct professor of Sociology at UNLV as well as Women’s Studies at the College of Southern Nevada. She received her Ph.D. in Sociology from the University of Nevada, Las Vegas in 2004. Her dissertation “Vectors, Polluters, and Murderers: HIV Testing Policies toward Prostitutes in Nevada” explored the development of mandatory testing laws for legal and non-legal sex workers in the state of Nevada. Her work duties include serving as the public health co-chair for the Southern Nevada HIV/AIDS Prevention Planning Group as well as training community providers on Rapid HIV Testing. She is the co-author of multiple editions of Transforming Scholarship: Why Women’s and Gender Studies Students are Changing Themselves and the World with Michele T. Berger for Routledge Press.

​ 
By Anna Morgan-Barsamian, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD

Tags: Detailing Visits, Evidence Based Medicine, Pediatrics, Primary Care

​As we’ve jumped right into 2022 programming, our team at NaRCAD continues to support detailing efforts that improve outcomes for vulnerable populations, recognizing that patient needs are complex and often informed by social determinants of health. One critical topic for which we’ve developed resources focuses on detailing to improve patient health as informed by both adverse and positive childhood experiences. We’re seeing an increased need from our community members to support detailing efforts related to this critical topic. We partnered with the National Association of County and City Health Officials (NACCHO), Centers for Disease Control and Prevention (CDC), and consultants from Brigham and Women’s Hospital and Tufts Medical Center over the past two years to develop academic detailing materials for clinicians working with both adults and children. 

​The CDC defines adverse childhood experiences (ACEs) as traumatic events that occur in childhood, including abuse, neglect, and family dysfunction. These events are linked to poor health outcomes in adulthood like chronic health problems, mental health conditions, and substance use. When considering the impact of environment on health, the CDC notes that children are likely to flourish when they have safe, nurturing relationships. These supportive settings create the opportunity for positive childhood experiences (PCEs). PCEs can mitigate the effects of ACEs and toxic stress, promote healing from traumatic events, and foster healthy development and learning in children.

Encouraging clinicians to consider both ACEs and PCEs is a natural fit for clinical outreach educators. There are many reasons that clinicians may not be prepared to have conversations with patients about childhood experiences. Perhaps the clinician doesn’t have a behavioral health provider to consult within their practice, so they don’t know who to turn to if a patient discloses a traumatic experience. A detailer can encourage a clinician to explore this concern, as well as provide a list of local behavioral health providers in the community. 

​Another barrier may be that clinicians could feel hesitant to approach discussions related to trauma, or may not have the skills to do so with sensitivity. In this case, detailers can offer tools that illustrate supportive language that creates a safe environment for patients to share their experiences. Supporting clinicians in using evidence-based tools to build trust with their patients signals that it’s not only okay to talk to patients about this sensitive topic; it’s vital for clinicians to lead these conversations in order to ascertain their patients’ needs and promote patient-centered decision making.   

A detailer can encourage clinicians to adopt new behaviors through specific key messages, including asking clinicians to take the following steps to support adult patients:

• Ask patients general questions about trauma such as, “have you had any life experiences that you feel have impacted your health and well-being?”
• Use supportive language with patients who disclose trauma or ACEs to help build resilience such as, “thank you for sharing that with me. Have you talked about this before?”
• Document patient responses and communicate patient-identified strengths to the care team. Avoid documenting the details of the trauma itself and focus on the impact the trauma has had on the patient’s health and well-being.
• Create a plan in collaboration with the patient that encourages self-advocacy.

When clinicians are supporting pediatric patients, detailers can deliver this set of evidence-based key messages, encouraging clinicians to:

• Identify positive experiences and strengths of the patient by asking questions such as, “which adult(s) besides your parents is/are important part(s) of your life?” or “who could you call to help if there was an emergency?”
• Ask about social determinants of health. Understanding how family and community environments impact growth potential helps to improve health outcomes. Questions can address:
  • housing security
  • food security
  • transportation needs
  • utility needs
  • interpersonal safety
  • employment
  • family and community support
  • education
  • mental health
• Use a screening tool to evaluate potential ACEs if indicated. Formal questionnaires provide a structured way to identify adverse and positive childhood experiences, but routine screening for all patients is not currently recommended.
• Evaluate ACE screens based on the child’s current health. If abuse, neglect, or family disruption is going on, there may be an immediate need to intervene. If the child is safe, provide resources to the family and patient.
• Explore collaborative interventions with patients and families. Effective problem-solving of ACE challenges can foster and encourage post-traumatic growth.

With evidence-based tools, successful AD interventions related to ACEs can result in multi-faceted support for patients, such as stronger connections with community resources, mental health supports, and more trusting relationships between clinicians and their patients.
​
We hope to continue to explore this important and complex topic together as a community. If your program is currently working on an ACEs or PCEs AD campaign, or is interested in starting one, please reach out to us so we can support the development of your programming. We always love collaborating and learning more about the important work that you’re doing, and we hope to continue to build our resources and create toolkits in support of complex topics such as these that intersect with other behavioral health and prevention-focused AD campaigns.

By: Aanchal Gupta, Program Coordinator, NaRCAD

As we kick off 2022, it’s been incredible seeing the detailing community build on new and previous strategies over the past year.
​
We’re continuously learning and sharing insights together. Let’s take a look at some of the advice shared on our DETAILS Best Practices Blog this past year. 

Planning and Team Building: Communication, Trust, Building Morale
​

• “We spend a large amount of time talking in detail about stigma as related to cocaine use. It’s critical that our detailers are comfortable and knowledgeable when speaking about stigma, because it sets the tone for the providers, who then set the tone for their patients.” – Carla Foster, New York Department of Health and Mental Hygiene (NYC DOHMH)

 

• “Programs need to plan for time for back-and-forth communication and to engage as many viewpoints as possible [for their materials development process]. Our modules are accredited for continuing medical education and we have reviewers assess the detail aid to ensure accuracy. We also make sure that detailers, who will be using the material in the field, have an opportunity to try out the materials.” – Ellen Dancel, Alosa Health

 

• “You don’t need to know everything to be a leader, but you need to surround yourself with people who can collectively make decisions based on good information. Surround yourself with people who know more than you do, and listen to them.” – Liesa Jenkins, ONE Tennessee

 

• “Trust is essential for effectively exploring differences of opinion, and how to turn challenges into opportunities. Without it, you don’t get to understand where someone is coming from, or to truly grow and learn.” – Loren Regier, RxFiles Academic Detailing

 

• “For your work to be fulfilling and for you to have that sense of satisfaction, it needs to be meaningful. We want to know that the work that we do matters and that we're making a difference. I find that it can be hard to see that right away with academic detailing.” – Julia Bareham, RxFiles Academic Detailing

 

• “We previously defined success for detailers as the number of visits they had completed in a given period of time. Now, we define success as making a connection or having any type of interaction with office staff, whether that be with front desk staff, an office manager, or a clinician. Focusing on these small wins has been a morale booster for our detailers.” – Anna Gribble, Maryland Department of Health

 

• “I recommend starting recruitment efforts early [for the NaRCAD training] to allow plenty of time to find the right recruits in order to build a successful training cohort!”– Karen Curd, Midwest AIDS Training and Education Center in Indiana

Gaining Access to Clinicians
​

• “We worked with the pharmacy technicians on communicating the benefits our programs offered, with attention to utilizing accessible language and avoiding unnecessarily complicated healthcare terms.”– Natalie Miccile, Connecticut Early Detection and Prevention Program (CEDPP)

 

• “Utilize e-Detailing; it’s a wonderful tool! Many developers are coming out with apps to serve this new digital landscape that can assist in implementing e-Detailing successfully. It’s just a matter of finding the right tools by taking a little bit of extra time and patience to experiment.” – Ashley Allison, Oregon AIDS Education and Training Center (ATEC)

 

• “The 1:1 approach is something that separates AD from other tactics, and makes it easier for both clinicians and funding organizations to see you as unique. This work is worth it.” – Harald Langaas, KUPP – The Norwegian Academic Detailing Program

Conducting Field Visits: Resilience, Empowerment, and Leverage
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• “It takes time to educate providers. It also takes time to alleviate some of those misconceptions that this is “just too good to be true”. So be patient, talk to people, and listen twice as much as you talk to build those relationships.” – Alisha Herrick, Center for Health Innovation (CHI)

 

• “When I’m detailing on one topic, I’m always thinking about future topics by gathering data from providers so that I can better understand their challenges. I ask providers their biggest concerns and I’ve been really surprised at how ready they are to share gaps in resources and information.” – Jacki Travers, Pharmacy Management Consultants (PMC)

 

• “There was [a recent visit I had where there was] no commitment to action or change and we didn’t build a connection. In order to bounce back from something like that, I think you need to acknowledge that it will happen sometimes and debrief with colleagues who have been in your shoes. Then just pick yourself up and try again.” – Jacqueline Meyers, RxFiles Academic Detailing

 

• Addressing the substance use crisis requires an “all-hands-on-deck” approach. Any setting where patients seek care are environments where detailing can improve patient access to support.” – Clement Chen, Rutgers New Jersey Medical School

Data Collection and Evaluation
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• “We found that practices were most successful when they chose an intervention, stuck with it, and set attainable goals. Some practices were at a 50% HPV vaccination rate and wanted to be at 80%. In those situations, we sat down with them and asked them to think about something more attainable, like a 5% increase in 6 months. Practices that committed to smaller increases not only met their goal, but slightly outperformed it.” - Lisa Gruss, Quality Insights

 

• “For anyone looking to intertwine AD with their state legislative process, you need to understand what your state’s priorities are. You can start by looking at state plans and guidelines for major health issues, just like the opioid crisis. You may need to do more research to understand where your program fits in and more importantly, who the movers and shakers in your governance are.” – Mary Moody, University of Illinois Chicago (UIC) College of Pharmacy

 

• “Be flexible in your approach – group detailing sessions or detailing sessions with non-clinicians can be extremely effective, and can lead to 1:1 clinician visits. Also, stay organized! Keep track of who you're reaching out to and who you're following up with. Having all that information tracked over time will help with your evaluation down the road.” - Kelsey Genovesse, Utah AIDS Education Center (ATEC)

We’re featuring a snapshot from an academic detailing visit with Corinne Puchalla, PharmD, BCPS, a clinical pharmacist and academic detailer at Illinois ADVANCE.
 
By Anna Morgan, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
Tags: Substance Use, Detailing Visit

Hi Corinne! Can you tell us about a recent academic detailing visit that you’re proud of?
 
Academic detailing does not come naturally to me—each visit starts with excitement, nervous energy, and the tingling anticipation of the unknown:
 
Will the prescriber be in a good mood and be receptive to the key messages?
Will I be able to express myself adequately?
Will I negotiate the right “ask”?
 
NaRCAD’s training elevated my confidence in making “the ask.” I’ve learned how to set small, quantifiable goals and give the prescriber a short timeframe for follow-up.
 
My first academic detailing visit after the NaRCAD training had the potential to be a doozy. The topic for discussion was the CDC guidelines for chronic pain management, and I was scheduled to meet with someone who only dealt with acute pain management in cardiothoracic surgery. 

​Adding to my sense of foreboding was the knowledge that the prescriber had been singled out by her employer for this AD visit based on the number of opioid prescriptions she’d written. Using the communication strategies I learned at NaRCAD, I researched and prepared more for this visit than I had for any other. I practiced with multiple colleagues. On the day of my visit, I felt ready—but uncertain.
 
My practice paid off. What began as a terse, somewhat tense conversation with the prescriber turned into an educational, productive, and collegial visit. I used my AD communication skills to dovetail from one question into another, ultimately discovering how my key messages resonated with the prescriber.

​I’m proud of the strides I made during that AD visit. I remained calm despite my anxiety, used my research on acute pain management to ask open-ended questions, translated what I know about chronic pain to support her in the acute pain setting, and laid the foundation for a strong, collaborative relationship. Best of all, I made a solid “ask.” I’m motivated to do it all over again with my next prescriber and take each learning opportunity as it comes.

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography. Corinne is a clinical pharmacist at the University of Illinois at Chicago (UIC) College of Pharmacy. She uses her passion for drug information and advancing patient care in her role as a clinical instructor and academic detailer. Her areas of interest include hepatitis C, migraine, and diabetes pharmacotherapy, and new drug approvals. Corinne is a proud graduate of the UIC College of Pharmacy, Class of 2016. Her enthusiasm for science, health, and helping others prompted her to pursue a career in pharmacy. Before beginning her career in pharmacy, Corinne was a symphonic bassoonist and also worked as personnel manager for The Florida Orchestra. She graduated from the University of Iowa with a Bachelor of Music in 2001 and from Indiana University with a Masters in Music in 2006.

An interview with Clement Chen, PharmD, BCPS, Clinical Pharmacist Specialist, Rutgers New Jersey Medical School.
 
by Anna Morgan, MPH, RN, PMP, Senior Manager, Training & Education, NaRCAD
 
Tags: Substance Use, Detailing Visits, Evidence Based Medicine

Anna: Hi Clement! We can’t wait to hear about all the impactful work you’ve been doing in New Jersey. Tell us a little about your academic detailing program.
 
Clement: The Northern New Jersey Medication-Assisted Treatment Center of Excellence was established in 2019 and is funded by the New Jersey Department of Human Services. Our goal is to not only increase access to medications for opioid use disorder (MOUD) in office-based addiction treatment practices, but also to ensure that providers treat this chronic disease with evidence-based practices. Our vision is to end the stigma of addiction and ensure that all people with substance use disorders have access to high quality care so they may live full and satisfied lives. I was hired as the academic detailer to provide education and identify the needs of providers in these practices.

Anna: Tell me more about the types of providers you visit.

Clement: I’ve been working with providers from all areas of care. In addition to office-based providers, they also include those from hospital settings, psychiatric hospitals, community health centers, substance use licensed facilities, and prison settings.

Addressing the substance use crisis requires an “all-hands-on-deck” approach. Any setting where patients seek care are environments where detailing can improve patient access to support.

Anna: It’s so important to approach academic detailing with a wider lens and consider where it can fit in with other community initiatives. Can you walk us through some of the work you’ve done so far, or are planning to do, in each of these settings?

Clement: I’d be happy to!

Hospital Setting: One of the inner-city hospitals that we are working with is looking to establish an addiction medicine service within their hospital system. The goal is to provide trainings and consultations on best practices for addiction medicine, in addition to technical assistance in setting up a program. I’ll be working with their attending physicians and residents to provide evidence-based practice trainings. 

Another one of our partners, an addiction medicine provider, has been pushing for greater initiation of MOUD in her own hospital system. The main issue is to ensure that providers use MOUD in an evidence-based manner and adhere to the latest findings. For example, the provider has been receiving pushback from other providers due to the lack of referral sources. These providers have shared that they believe MOUD should not be initiated without a “warm handoff.”

Furthermore, buprenorphine has been discontinued during the pre and peri-operative settings and only resumed post-operatively despite growing evidence for continuing buprenorphine in these settings. I plan to detail these providers in-person to provide literature supporting the use of MOUD, even when warm handoffs are unavailable. I’ve provided supporting literature and a summary to the addiction medicine provider to assist with her case to expand this initiative, which helped her to develop an information sheet to justify the expansion of MOUD in her hospital.

Psychiatric Hospital Setting: We’ve also partnered with physician champions at some of the psychiatric hospitals in New Jersey. Stigma and the inaccurate idea that patients do not experience acute withdrawal for opioid use has made many providers hesitant to start therapy with buprenorphine. Psychiatric hospitals have been fervently looking to provide treatment for opioid use disorders.

The goal is to implement a clinic designed for initiating and maintaining those on buprenorphine and naltrexone extended release. We’ll be assisting with the implementation of the clinic and provide individual in-person detailing visits for the providers at the hospital. To prepare for this, we’ve developed several informational sheets on MOUD and other related information to give to the providers.  

Community Health Center Setting: One of the community health centers that we’ve partnered with wants to begin providing MOUD for those already on the therapy. There are several advanced nurse practitioners and physicians at the health centers looking for more guidance and support on the appropriate prescribing of buprenorphine. I’ll be working with their team to provide them with evidence-based practices and help them with buprenorphine induction strategies. 

Substance Use Licensed Facility Setting: One of the substance use licensed facilities I’ve consulted with mentioned that fentanyl has made initiation of buprenorphine very difficult due to the increase in the number of cases with precipitated withdrawal. As a detailer, I’ve worked closely with their lead providers, providing them with available literature on alternative buprenorphine induction strategies. They're in the process of updating their protocols for the induction of buprenorphine. Another facility is working with us to start prescribing MOUD within their residential settings.
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Prison Setting: I regularly consult with the Department of Corrections providers since access to MOUD have traditionally been low in the prison system. Their patients also have unique needs compared to those in the community setting. I meet with them on a monthly basis via a case conference and discuss clinical solutions in order to help them provide the best care to their patients. ​

Anna: Your work is incredibly comprehensive and thoughtful. It’s truly amazing to see how your team has incorporated academic detailing into so many initiatives and clinical settings within your community.

Clement: We believe that to overcome this crisis, all patients with opioid use disorder need equitable and timely access to care. With the record number of overdose deaths reaching over 100,000 in one year, this is our greatest focus. We’re confident that our academic detailing work will help us achieve this goal.

Have thoughts on our DETAILS Blog posts?
You can head on over to our Discussion Forum to continue the conversation!

Biography.  Dr. Clement Chen graduated from the Ernest Mario School of Pharmacy at Rutgers University in 2013 with his Pharm.D. He then completed a one-year residency at the Hudson Valley Veterans Affairs Ambulatory Care Clinic. Thereafter, he has worked as a staff pharmacist at St. Michael’s Medical Center in Newark and as a cardiology heart failure clinical pharmacist specialist at University Hospital in Newark. In addition to working as a clinical pharmacist specialist, he was a Transitions of Care pharmacist at Hunterdon Medical Center from 2016-2020. This has helped him to balance his inpatient and outpatient roles as a pharmacist. To further demonstrate proficiency in clinical pharmacy care, he received his Board Certification in Pharmacotherapy in July of 2016.  His current role is as the academic detailer in the Northern NJ Center of Excellence, with the goal of providing education and support to increase statewide capacity to provide medications for addictions treatment (MAT) for patients with substance use disorders with a focus on opioid use disorder.

Aanchal Gupta,  NaRCAD Program Coordinator

Tags: Conference, Detailing Visits, Stigma, ​E Detailing, ​Opioid Safety
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​Take a peek at the NaRCAD2021 conference materials on our Conference Hub.

Bevin Shagoury
NaRCAD Deputy Director

Tags: Conference, COVID 19, ​Detailing Visits

Unless you’re delightfully old school, I’m going to guess that you’re not holding the page you’re reading in your hands. That’s been a tough adjustment for those of us who prefer a paperback to a Kindle, or for those of us who miss unfolding an inky newspaper in the morning.

In either case, this trend toward the intangible has been in motion for a long time, even pre-pandemic (if you can still imagine a world without COVID). We’ve been forced to step up the transition from tangible to virtual, seemingly at warp speed. And yet, as always, we’ve found ways to adapt.

In a field like ours, where our work relies so heavily on the intricacies of human interaction, the inability to see nonverbal cues (at least, none below a clinician’s shoulders) during an e-detailing session could have easily thrown us off. If AD was the focus of a Netflix series, we could have entire episodes that depict the harsh reality of being “ghosted” after setting up a virtual visit, or trying to engage with a clinician who’s typing in chart notes while eating a sandwich.