Transcript Academic detailing in November 2012: 'Where Do We Come

Academic detailing:
Where we are, and where we’re going
Jerry Avorn, M.D.
Professor of Medicine, Harvard Medical School
Chief, Division of Pharmacoepidemiology
and Pharmacoeconomics
Department of Medicine
Brigham and Women’s Hospital
The goal of academic detailing
To close the gap
between the best available science
and actual prescribing practice,
so that each prescription is based
only on the most current and accurate
evidence about efficacy, safety,
and cost-effectiveness.
The logic of academic detailing
• Medical (and pharmacy) school faculty have a
solid grasp of the evidence about drug benefits
and risks…
– but we’re often terrible communicators.
• Drug makers are superb communicators…
– but do so only to increase product sales.
• Can the content of the former be communicated
to prescribers through a ‘delivery system’ based
on the latter?
The content of academic detailing
• Experts in internal medicine and evidence
synthesis at Harvard Medical School review
the literature and formulate
recommendations.
• Well trained clinicians (pharm, RN, MD) offer a
service that provides non-commercial,
evidence-based information about the
comparative benefit, risk, and costeffectiveness of drugs used for common
clinical problems.
The method of academic detailing
• Educational outreach
– in the doctor’s own office
• Information is provided interactively, so the
educator can:
– understand where the MD is coming from in
terms of knowledge, attitudes, behavior
– modify the presentation appropriately
– keep the prescriber engaged
• The visit ends with specific practice-change
recommendations.
• Over time, the relationship becomes more
trusted and useful.
Essence of the approach
• Focus is on optimal management of a specific
clinical problem
– not just which drugs to use or avoid
• Learning about the practitioner’s perspective
and needs informs the discussion content
– prior focus group research is key in developing
modules
• Validated in ~100 randomized controlled trials
– practice change, savings, patient outcomes
Programs now in place
• The Independent Drug Information
Service
– several US states, the Veterans
Administration
– consultation on:
• drug use problems
• program development
• evaluation
• Other programs
Topics at www.RxFacts.org
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G.I. acid Sx
anti-platelet drugs
hypertension
cholesterol
diabetes
depression
osteoporosis
HIV for the PCP
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COPD
cognitive impairment
incontinence
gait impairment, falls
sleep meds
atrial fibrillation
chronic pain
anti-psychotics
Some useful links
Evidence-based clinical modules:
www. RxFacts.org
Research on medications from the BWH Division of
Pharmaco-epi and Pharmaco-eco (“DoPE”):
www. DrugEpi.org
Academic detailing resources:
www. NaRCAD.org
“Powerful Medicines: the Benefits, Risks, and Costs of
Prescription Drugs”
(Knopf):
www.PowerfulMedicines.org