Download NaCRAD

National
Resource
Center for
Academic
Detailing
Supported by a grant from AHRQ
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NaRCAD
 Mission
 Team
 Background on academic detailing
 Elements of a successful program
 NaRCAD’s services
 Next Steps
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Mission
 To promote the use of evidence based medicine
by supporting the establishment and
improvement of academic detailing programs.
 NaRCAD provides training, materials, and
consultative support to health care organizations
to establish effective academic detailing
programs.
 NaRCAD aims to establish a network of programs
sharing best practices in academic detailing to
further the use of comparative effectiveness data
in medical practice.
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Team
 Michael Fischer, MD, MS, Program Director
 Jerry Avorn, MD, Co-Program Director
 Niteesh Choudhry, MD, PhD, Core Faculty
 Steve Farrell, MBA, Program Manager
 Lindsay Ritz, MPH, Program Coordinator
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The rationale for academic detailing
• FDA has limited data when treatments or tests
are first approved
– with limited relevance to many patients
• Physician data overload
– hundreds of important clinical papers published each month
• Imbalanced communication
– manufacturers provide much of the information
• Need for non-product-driven overviews
– delivered in a relevant, user-friendly way
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Two different worlds
Academia
Industry
MD comes to us
Goes to MD
Didactic
Interactive
Content ornate, not
clinically relevant
Content is simple,
straightforward, relevant
Visually boring
Excellent graphics
No idea of MD’s
Perspective
MD-specific data informs
discussion
Evaluation: minimal
Outcome evaluated, drives
salary
Goal = ????
Goal = behavior change
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Academic Detailing
Drug/Device
makers:
great
communicators
Government/Medical
School faculty:
Trusted sources of
Clinical information
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The goal of academic detailing
To close the gap between
the best available evidence
actual clinical practice
…so that clinical decisions are based
only on the most current and accurate evidence on:
efficacy
safety
cost-effectiveness
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Academic detailing
 Synthesizes up-to-date evidence about comparative
efficacy, safety, and cost-effectiveness of commonly used
therapies
 Content independently created by medical school faculty
and practitioners
 MDs, pharmacists and nurses provide information
interactively, in physicians’ own offices
 A time-efficient way to keep up with new findings
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The beginning of academic detailing
• Developed in early 1980’s
– “un-ads” for physicians with clinical background and
specific prescribing recommendations
– patient educational materials
• Effective from the start
– 92% MD acceptance rate from ‘cold calls’ to physicians
– Significant 14% reduction in inappropriate prescribing
 Avorn & Soumerai, NEJM 1983
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Where Academic detailing is now
(Partial Listing)
USA
 Initiatives in various states:
 California – Kaiser Permanente
 District of Columbia – DOH
 Idaho – Medicaid
 Maine – DHHS
 Massachusetts – DPH and CDC
 New York – Medicaid
 Oregon – OHSU
 Pennsylvania – Aged Care
 South Carolina – Medicaid
 Vermont – Medicaid
 National – new effort funded by AHRQ
World
 Australia
 Canada
 United Kingdom
 Sweden
 Netherlands
 New Zealand
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Current status of the evidence
• Evaluated extensively over the last 25 years
• Large evidence base confirms efficacy
• A large systematic review in 2007 combined 69 studies
and confirmed efficacy of AD
• O’Brien MA, Rogers S, et al. Cochrane, Database of Systematic
Reviews 2007
• However, quality of execution dramatically
impacts effectiveness
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Example: South Carolina - SCORxE
 South Carolina College of Pharmacy and South
Carolina DHHS
 Main Problem
 25% of Medicaid’s prescription medication spending was for mental
health drugs alone
 4/5 prescribed drugs from the state’s Medicaid program were for mental
health
 Funded in 2007 by a 5-year grant from DHHS
 Topics




Schizophrenia
Non-psychotic Major Depressive Disorder
Bipolar Disorder
Smoking Cessation
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Effectiveness – PACE Program
 Evaluated acid-suppression module in 2007
 Time-series analysis of PPI prescribing
 Following their first educational visit, intervention-group
doctors prescribed on average $124 less PPI per
physician per month than external controls (p = 0.09),
and $122 less PPI per physician per month than internal
controls (p = 0.05)
 For the first six months after the educational encounter
 intervention-group physicians reduced their use of PPIs by
about $286,000 within the PACE program alone
 If these changes persisted for a year, the savings would
have amounted to $572,000 for this one drug group
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Differing Scales of Academic Detailing
Programs
 Temporary programs: address a specific issue over
a defined time period
 Redeployment of current resources
 Often complimentary to other efforts
 Limited scale, longer term programs: cover a
wider range of issues
 Redeployment of current resources
 Augmentation of resources
 Cut across multiple disease areas
 Larger scale, longer term programs
 Dedicated resources
 Multiple topics
 Broad range of medical areas
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Flexible Uses of Academic Detailing
 Improve knowledge
 New guidelines
 Health threats
 Change in treatment
 More effective/cost effective or safer
 Decrease overuse
 Improve patient education
 Use of materials
 Communication of vital information
 Increase diagnosis/screening
 What to look for
 What to do when found
 Increase utilization of complimentary resources
 Public health programs
 Referral resources
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Basis for AD Programs
(partial listing)
State
Year
Started
Funding
Annual Budget
Idaho
2009
Grant funding by Pew
Charitable Trust and
Medicaid Match
$50,000
Maine
2009
Manufacturer fees,
funding from
settlements
$150,000
Pennsylvania
(PACE)
2005
Funds from PA state
lottery
$1,000,000
Vermont
1999
General funds and
manufacturer fees
$100,000
Washington, DC
2007
Industry detailer
licensing fees
$450,000
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Possible Future Funding
 Medicaid Match
 Program eligible for federal funds
 Matched at a certain percentage from the government
 CDC Block Grants
 Leverage NaRCAD’s resources
 Other government sources
 Mandate for dissemination of PCORI findings
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Elements of a Successful Academic
Detailing Program
Identifying
Program
Needs
Developing
and
Producing
Materials
Hiring and
Management
of Academic
Detailers
Training
of
Detailers
Measuring
Program
Effectiveness
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Identifying Program Needs
 Goals
 Organizational capabilities and experience
 Health needs in target population
 Gaps in target population
 Current practice
 Best practices
 Evaluate existing data
 Prescription data, other health records
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Developing and Producing Detailing
Materials
 Compilation of evidence base (AHRQ Comparative
Effectiveness Reviews)
 Analysis and summary by relevant experts
 Identifying key messages
 Synthesized into communication materials
 Relevant, useful information for:
physician
patient
 Clearly and effectively communicated
 Retained for future reference
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Detailing Material Topics
 Based on AHRQ Comparative Effectiveness
Reviews
 oral diabetes medications and insulin for adults with
type 2 diabetes
 off-label use of atypical anti-psychotics for agitation in
dementia
 analgesics for osteoarthritis
 Updated for the latest evidence
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Hiring and Management of Detailers
 Job description
 Successful detailer profiles
 Full time hires vs. consultants
 Establishing goals
 Monitoring performance
 Team building
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Training of Detailers – How to Detail
 Principles of social marketing
 Structuring visit
 Communicating messages effectively
 Actively listening and engaging clinician in conversation
 Message delivery under a variety of circumstances
 Gaining commitment to action
 NaRCAD will have two training sessions a year through
2013
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Training of Detailers – Clinical Background
 Grounding in clinical areas and treatments
 Diabetes
 Agitation in Dementia
 Osteoarthritis
 NaRCAD will have two clinical training sessions a
year beginning Fall 2011 through summer 2013
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Measuring Program Effectiveness
 Change in patterns of care
 Prescribing data, other sources
 Cost-effectiveness of detailing effort
 Potential impact of modifications to program
 Impact on expenses outside of network
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Elements of a Successful Academic
Detailing Program
NaRCAD
performs
Identifying
Program
Needs
NaRCAD
performs
Developing
and
Producing
Materials
NaRCAD
advises
NaRCAD
performs
Hiring and
Management
of Academic
Detailers
Training
of
Detailers
NaRCAD
supports
Measuring
Program
Effectiveness
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NaRCAD Experience
 Collectively over 40 years in academic detailing
 Established or assisted programs in 6 states
 Expertise in:
 Evidence based prescribing
 Training and materials development
 Pharmaco analytics
 Public and private partnerships
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NaRCAD Partners
 Groups wishing to know more about academic
detailing
 Groups seeking to establish new academic detailing
programs
 Groups seeking assistance to measure current
program effectiveness
 Groups seeking to improve or expand current
programs
 Experienced groups seeking to share best practices
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Next Steps
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Contact
 Stephen Farrell, MBA, Program
Director, [email protected] or Lindsay Ritz,
[email protected]
 www.narcad.org
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