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Nazari JL, Kulbokas V, Smart MH, Hensle TR, Lee TA, Pickard AS. Implementation of virtual academic detailing in North America: A qualitative study. J Eval Clin Pract 2024; 30:693-702. [PMID: 38652541 DOI: 10.1111/jep.13997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024]
Abstract
RATIONALE The shift toward virtual academic detailing (AD) was accelerated by the COVID-19 pandemic. AIMS AND OBJECTIVES We aimed to examine the role of external, contextual, and intrinsic programme-specific factors in virtual engagement of healthcare providers (HCPs) and delivery of AD. METHODS AD groups throughout North America were contacted to participate in semistructured interviews. An interview guide was constructed by adapting the Consolidated Framework for Implementation Research (CFIR). A point of emphasis included strategies AD groups employed for provider engagement while implementing virtual AD programmes. Independent coders conducted qualitative analysis using the framework method. RESULTS Fifteen AD groups from Canada (n = 3) and the United States (n = 12) participated. Technological issues and training detailers and HCPs were challenges during the transition to virtual AD visits. Restrictions on in-person activities during the pandemic created difficulties engaging HCPs and fewer AD visits. Continuing education was one strategy to incentivize participation, but credits were often not claimed by HCPs. Groups with established networks and prior experience with virtual AD leveraged connections to mitigate disruptions and continue AD visits. Other facilitators included emphasizing contemporary topics, including opioid education beyond fundamental guidelines. Virtual AD had the additional benefit of expanding geographic reach and flexible scheduling with providers. CONCLUSIONS AD groups across North America have shifted to virtual outreach and delivery strategies. This trend toward virtual AD may aid outreach to vulnerable rural communities, improving health equity. More research is needed on the effectiveness of virtual AD and its future implications.
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Affiliation(s)
- Jonathan L Nazari
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Victoria Kulbokas
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Mary H Smart
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Tara R Hensle
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes, and Policy, University of Illinois Chicago, Chicago, Illinois, USA
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Luetsch K, Wong G, Rowett D. A realist synthesis of educational outreach visiting and integrated academic detailing to influence prescribing in ambulatory care: why relationships and dialogue matter. BMJ Qual Saf 2023; 33:43-54. [PMID: 37142414 PMCID: PMC10804006 DOI: 10.1136/bmjqs-2022-015498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 04/19/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Many quality improvement initiatives in healthcare employ educational outreach visits, integrating academic detailing to bridge evidence-practice gaps and accelerate knowledge translation. Replicability of their outcomes in different contexts varies, and what makes some visiting programmes more successful than others is unclear. OBJECTIVE We conducted a realist synthesis to develop theories of what makes educational outreach visiting integrating academic detailing work, for whom, under which circumstances and why, focusing on the clinician-visitor interaction when influencing prescribing of medicines in ambulatory care settings. METHODS The realist review was performed in accordance with RAMESES standards. An initial programme theory was generated, academic databases and grey literature were screened for documents with detail on contexts, intervention and outcomes. Using realist logic of analysis, data from 43 documents were synthesised in the generation of a refined programme theory, supported by additional theoretical frameworks of learning and communication. RESULTS Twenty-seven interdependent context-mechanism-outcome configurations explain how clinicians engage with educational outreach visits integrating academic detailing through programme design, what matters in programme design and the educational visitor-clinician interaction and how influence extends beyond the visit. They suggest that in addition to relevance, credibility and trustworthiness of a visit's contents, communication and clinical skills of educational visitors, the relationship between the educational visitor and clinician, built on a dialogue of learning from and sense-making with each other, creates conditions of critical thinking which are conducive to facilitating prescribing practice change when necessary. CONCLUSION This realist synthesis elucidates that the quality of clinician-educational visitor interactions is pivotal to educational outreach visiting programmes. Building and sustaining relationships, and establishing an open dialogue are important; neglecting these undermines the impact of visits. Educational visitors can facilitate clinicians' reflection on practice and influence their prescribing. Clinicians value the discussion of individualised, tailored information and advice they can translate into their practice. PROSPERO REGISTRATION NUMBER CRD42021258199.
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Affiliation(s)
- Karen Luetsch
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Geoff Wong
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Debra Rowett
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Ling-I Tseng O, Lakzadeh P, Conte T, Naumann T, Kuo IF, Mitton C. Barriers and facilitators influencing the management of academic detailing programs: A descriptive analysis of four programs. J Am Pharm Assoc (2003) 2023; 63:1017-1025.e3. [PMID: 37121511 DOI: 10.1016/j.japh.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 04/23/2023] [Accepted: 04/23/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Educating prescribers is a key strategy to reduce inappropriate prescribing in selection, dose, type, timing, and duration. Academic detailing (AD) is a form of continuing medical education to educate prescribers. AD programs have been established in Canada, Australia, the United States, and other countries. Each program operates uniquely to reflect its local context and resources. It remains unclear how AD programs in universal health care systems differ from each other in their program components and experiences. OBJECTIVES To compare AD programs focusing on components of resources, activities, and services and to identify factors influencing program efficiency during the processes of program management, topic development, and service delivery among the selected Canadian and international AD programs. METHODS We adopted a process evaluation methodology with semistructured interviews and documents. We selected 4 well-established AD programs through an iterative discussion with the BC Ministry of Health: three provincial AD programs in the Canadian provinces of British Columbia, Ontario, and Saskatchewan, and an Australian program based in the State of South Australia. We invited one leader from each program to attend a 1-hour teleconferencing interview. RESULTS The 4 programs shared similarities of public government funding while differed in their operation models (centralized vs. decentralized), employment of detailers (part-time vs. full-time; hired by AD programs vs. hired by partnered multidisciplinary primary care teams) and staff who developed topics (detailers vs. nondetailers). The most common barriers were funding and reaching new participants, followed by team connection, detailer training resources, summarizing skills, and AD session scheduling. The most common facilitators were participant retention, participant recruitment through partnership, and easy access sessions. CONCLUSION AD programs can potentially guide a prescriber's choice of drug. A program's operation can be impacted by its access to resources and participants, activities, and service design.
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Hoffman JD, Shayegani R, Spoutz PM, Hillman AD, Smith JP, Wells DL, Popish SJ, Himstreet JE, Manning JM, Bounthavong M, Christopher MLD. Virtual academic detailing (e-Detailing): A vital tool during the COVID-19 pandemic. J Am Pharm Assoc (2003) 2020; 60:e95-e99. [PMID: 32747164 PMCID: PMC7833607 DOI: 10.1016/j.japh.2020.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/19/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022]
Abstract
As the coronavirus disease (COVID-19) pandemic continues its course in 2020, telehealth technology provides opportunities to connect patients and providers. Health policies have been amended to allow easy access to virtual health care, highlighting the field's dynamic ability to adapt to a public health crisis. Academic detailing, a peer-to-peer collaborative outreach designed to improve clinical decision-making, has traditionally relied on in-person encounters for effectiveness. A growth in the adoption of telehealth technology translates to increases in academic detailing reach for providers unable to meet with academic detailers in person. The U.S. Department of Veterans Affairs (VA) has used academic detailing to promote and reinforce evidence-based practices and has encouraged more virtual academic detailing (e-Detailing). Moreover, VA academic detailers are primarily clinical pharmacy specialists who provide clinical services and education and have made meaningful contributions to improving health care at VA. Amid the COVID-19 pandemic and physical isolation orders, VA academic detailers have continued to meet with providers to disseminate critical health care information in a timely fashion by using video-based telehealth. When working through the adoption of virtual technology for the delivery of medical care, providers may need time and nontraditional delivery of "evidence" before eliciting signals for change. Academic detailers are well suited for this role and can develop plans to help address provider discomfort surrounding the use of telehealth technology. By using e-Detailing as a method for both familiarizing and normalizing health professionals with video-based telehealth technology, pharmacists are uniquely poised to deliver consultation and direct-care services. Moreover, academic detailing pharmacists are ambassadors of change, serving an important role navigating the evolution of health care in response to emergent public health crises and helping define the norms of care delivery to follow.
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Vasudev K, Lamoure J, Beyaert M, Dua V, Dixon D, Eadie J, Husarewych L, Dhir R, Takhar J. Academic detailing among psychiatrists - feasibility and acceptability. Int J Health Care Qual Assur 2017; 30:79-88. [PMID: 28105877 DOI: 10.1108/ijhcqa-04-2016-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Research has shown that academic detailing (AD), which includes repeated in-person educational messages in an interactive format in a physician's office, is among the most effective continuing medical education (CME) forms for improving prescribing practices and reducing drug costs. The purpose of this paper is to investigate AD's feasibility and acceptability as an educational tool among psychiatrists and its ability to facilitate positive changes in antipsychotic prescribing. Design/methodology/approach All psychiatrists practicing in Southwestern Ontario, Canada were invited to participate. Participants (32/299(10.7 percent)) were provided with two educational sessions by a healthcare professional. Participants evaluated their AD visits and completed a pre- and post-AD questionnaire measuring various prescribing practice aspects. Findings A total of 26 out of 32 (81.3 percent) participants completed the post-AD evaluation; most of them (61.5 percent, n=16) felt that AD gave noteworthy information on tools for monitoring side-effects and 50.0 percent ( n=13) endorsed using these in practice. In total, 13 participants (50.0 percent) felt that the AD sessions gave them helpful information on tools for documenting polypharmacy use, which 46.2 percent ( n=12) indicated they would implement in their practice. No significant differences were found between participants' pre- and post-assessment prescribing behaviors. Practical implications There is great need for raising AD program's awareness and improving physician engagement in this process locally, provincially and nationally. Originality/value To the authors' knowledge, this is the first AD program in Canada to target specialists solely. Participant psychiatrists accepted the AD intervention and perceived it as a feasible CME method.
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Affiliation(s)
- Kamini Vasudev
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Canada
| | - Joel Lamoure
- Department of Continuing Professional Development, Schulich School of Medicine and Dentistry, London, Canada
| | - Michael Beyaert
- Department of Continuing Professional Development, Schulich School of Medicine and Dentistry, London, Canada
| | - Varinder Dua
- Department of Psychiatry, Schulich School of Medicine and Dentistry, London, Canada
| | - David Dixon
- Department of Continuing Professional Development, Schulich School of Medicine and Dentistry, London, Canada
| | - Jason Eadie
- Department of Continuing Professional Development, Schulich School of Medicine and Dentistry, London, Canada
| | - Larissa Husarewych
- Department of Continuing Professional Development, Schulich School of Medicine and Dentistry, London, Canada
| | - Ragu Dhir
- Department of Continuing Professional Development, Schulich School of Medicine and Dentistry, London, Canada
| | - Jatinder Takhar
- Department of Continuing Professional Development, Schulich School of Medicine and Dentistry, London, Canada
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Due TD, Thorsen T, Kousgaard MB, Siersma VD, Waldorff FB. The effectiveness of a semi-tailored facilitator-based intervention to optimise chronic care management in general practice: a stepped-wedge randomised controlled trial. BMC FAMILY PRACTICE 2014; 15:65. [PMID: 24716545 PMCID: PMC4234362 DOI: 10.1186/1471-2296-15-65] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 04/03/2014] [Indexed: 11/11/2022]
Abstract
Background The Danish health care sector is reorganising based on disease management programmes designed to secure integrated and high quality chronic care across hospitals, general practitioners and municipalities. The disease management programmes assign a central role to general practice; and in the Capital Region of Denmark a facilitator-based intervention was undertaken to support the implementation of the programmes in general practice. The purpose of the study was to assess the effectiveness of this semi-tailored facilitator-based intervention. Method The study was a stepped-wedge, randomised, controlled trial among general practices in the Capital Region of Denmark. The intervention group was offered three one-hour visits by a facilitator. The intervention was semi-tailored to the perceived needs as defined by each general practice, and the practices could choose from a list of possible topics. The control group was a delayed intervention group. The primary outcome was change in the number of annual chronic disease check-ups. Secondary outcomes were: changes in the number of annual check-ups for type 2 diabetes (DM2) and chronic obstructive pulmonary disease (COPD); changes in the number of spirometry tests, changes in the use of ICPC diagnosis coding and patient stratification; sign-up for a software program for patient overview; and reduction in number of practices with few annual chronic disease check-ups. Results We randomised 189 general practices: 96 practices were allocated to the intervention group and 93 to the delayed intervention group. For the primary outcome, 94 and 89 practices were analysed. Almost every outcome improved from baseline to follow-up in both allocation groups. At follow-up there was no difference between allocation groups for the primary outcome (p = 0.1639). However, some secondary outcomes favoured the intervention: a higher reported use of ICPC diagnosis coding for DM2 and COPD (p = 0.0050, p = 0.0243 respectively), stratification for COPD (p = 0.0185) and a faster initial sign-up rate for the software program. Conclusion The mixed results from this study indicate that a semi-tailored facilitator-based intervention of relatively low intensity is unlikely to add substantially to the implementation of disease management programmes for DM2 and COPD in a context marked by important concurrent initiatives (including financial incentives and mandatory registry participation) aimed at moving all practices towards changes in chronic care. Trial registration ClinicalTrials.gov: NCT01297075
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Affiliation(s)
- Tina Drud Due
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Jin M, Naumann T, Regier L, Bugden S, Allen M, Salach L, Chelak K, Blythe N, Gagnon A, Dolovich L. A brief overview of academic detailing in Canada: Another role for pharmacists. Can Pharm J (Ott) 2013; 145:142-146.e2. [PMID: 23509530 DOI: 10.3821/145.3.cpj142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Meehan TP, Van Hoof TJ, Giannotti TE, Tate JP, Elwell A, Curry M, Petrillo MK. A Descriptive Study of Educational Outreach to Promote Use of Quality Improvement Tools in Primary Care Private Practice. Am J Med Qual 2008; 24:90-8. [DOI: 10.1177/1062860608329797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Thomas J. Van Hoof
- University of Connecticut School of Nursing, Farmington; University of Connecticut School of Medicine, Farmington
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Graham SD, Hartzema AG, Sketris IS, Winterstein AG. Effect of an academic detailing intervention on the utilization rate of cyclooxygenase-2 inhibitors in the elderly. Ann Pharmacother 2008; 42:749-56. [PMID: 18430793 DOI: 10.1345/aph.1k537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Osteoarthritis is prevalent in the elderly. Nova Scotia general practitioners (GPs) identified the need for an academic detailing (AD) intervention aimed at optimizing the management of osteoarthritis. AD was provided by Dalhousie University Continuing Medical Education in a face-to-face encounter employing evidence-based information. GP participation was voluntary. OBJECTIVE To evaluate the effect of a GP-targeted osteoarthritis AD intervention on a reduction in the prescribing of cyclooxygenase-2 (COX-2) inhibitors, as well as examine the intervention effect on the utilization rates of gastroprotective agents and medical services. METHODS A retrospective cohort study design employing administrative data was used. Differences in utilization rates between intervention and control groups were evaluated using generalized estimating equations analysis for longitudinal data over four 90-day postintervention periods. Confounding was addressed using propensity scores to adjust for between-group bias on the measured covariates. RESULTS The between-group difference for change in COX-2 utilization rates was 0.76 defined daily doses/patient (p = 0.040; 95% CI 0.037 to 1.48) for the 3-month period following the intervention, with lower COX-2 utilization in the AD intervention group than in the control group. The intervention group showed a significant decrease in the within-group utilization rate between the pre- and postintervention periods (z =-2.34; p = 0.019). The between-group difference for change in GP office visit rates was 0.40 visits/patient (p = 0.028; 95% CI 0.046 to 0.79) with the intervention group, showing higher visit rates compared with the control group. CONCLUSIONS The osteoarthritis AD intervention was associated with a significant decrease (23%) in COX-2 utilization rates in the 3-month period immediately following the intervention. The only secondary outcome to show a significant between-group effect was the GP office visit rate, which was higher for the intervention group in the second 3-month postintervention period.
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Affiliation(s)
- Stephen D Graham
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Allen M, Ferrier S, O'Connor N, Fleming I. Family physicians' perceptions of academic detailing: a quantitative and qualitative study. BMC MEDICAL EDUCATION 2007; 7:36. [PMID: 17935614 PMCID: PMC2099423 DOI: 10.1186/1472-6920-7-36] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 10/12/2007] [Indexed: 05/22/2023]
Abstract
BACKGROUND The efficacy of academic detailing in changing physicians' knowledge and practice has been the subject of many primary research publications and systematic reviews. However, there is little written about the features of academic detailing that physicians find valuable or that affect their use of it. The goal of our project was to explore family physicians' (FPs) perceptions of academic detailing and the factors that affect their use of it. METHODS We used 2 methods to collect data, a questionnaire and semi-structured telephone interviews. We mailed questionnaires to all FPs in the Dalhousie Office of Continuing Medical Education database and analyzed responses of non-users and users of academic detailing. After a preliminary analysis of questionnaire data, we conducted semi-structured interviews with 7 FPs who did not use academic detailing and 17 who did use it. RESULTS Overall response rate to the questionnaire was 33% (289/869). Response rate of non-users of academic detailing was 15% (60/393), of users was 48% (229/476). The 3 factors that most encouraged use of academic detailing were the topics selected, the evidence-based approach adopted, and the handout material. The 3 factors that most discouraged the use of academic detailing were spending office time doing CME, scheduling time to see the academic detailer, and having CME provided by a non-physician. Users of academic detailing rated it as being more valuable than other forms of CME. Generally, interview data confirmed questionnaire data with the exception that interview informants did not view having CME provided by a non-physician as a barrier. Interview informants mentioned that the evidence-based approach adopted by academic detailing had led them to more critically evaluate information from other CME programs, pharmaceutical representatives, and journal articles, but not advice from specialists. CONCLUSION Users of academic detailing highly value its educational value and tend to view information from other sources more critically because of its evidence-based approach. Non-users are unlikely to adopt academic detailing despite its high educational value because they find using office time for CME too much of a barrier. To reach these physicians with academic detailing messages, we will have to find other CME formats.
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Affiliation(s)
- Michael Allen
- Continuing Medical Education, Dalhousie University, Clinical Research Centre, 5849 University Avenue, Halifax, Nova Scotia, B3H 4H7, Canada
| | - Suzanne Ferrier
- Continuing Medical Education, Dalhousie University, Clinical Research Centre, 5849 University Avenue, Halifax, Nova Scotia, B3H 4H7, Canada
| | - Nicolette O'Connor
- Department of Political Science, Carleton University, B640 Loeb Building, 1125 Colonel By Drive, Ottawa, Ontario, K1S 5B6, Canada
| | - Isobel Fleming
- Continuing Medical Education, Dalhousie University, Clinical Research Centre, 5849 University Avenue, Halifax, Nova Scotia, B3H 4H7, Canada
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