Implementation of a pharmacy-led virtual academic detailing program at the US Veterans Health Administration

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PURPOSE

To provide a summary of the implementation of a virtual academic detailing pilot program at the US Department of Veterans Affairs (VA).

SUMMARY

In September 2018, VA Pharmacy Benefits Management implemented a virtual academic detailing ("e-Detailing") pilot program across three regional networks. Academic detailing involves multifaceted collaborative outreach delivered by trained healthcare clinicians to other clinicians using targeted educational interventions that improve clinical decision-making. Across VA, academic detailing programs are primarily staffed by specially trained clinical pharmacist specialists. Implementation began with an in-person meeting to train academic detailers on using the virtual academic detailing platform (VA Video Connect) and virtual soft skills, which was followed by regular facilitation meetings to address issues and share experiences. During e-Detailing program implementation, the coronavirus disease 2019 (COVID-19) emerged, prompting the US Department of Health and Human Services to declare a public health emergency. VA followed with restrictions on nonessential travel for all employees, thus hampering in-person academic detailing activities. Fortunately, e-Detailing provided an alternative channel for academic detailers across VA to continue delivering critical outreach to providers during the pandemic. Qualitative assessment of academic detailers' and providers' perceptions on e-Detailing highlighted the need for local leadership support for e-Detailing and telehealth, the efficiency of virtual compared to in-person visits, and potential time savings resulting from avoidance of long commutes.

CONCLUSION

The timing of e-Detailing implementation during the COVID-19 pandemic illustrates the need and potential for a virtual platform to deliver timely provider outreach.

Virtual academic detailing (e-Detailing): A vital tool during the COVID-19 pandemic

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.

Reducing coprescriptions of benzodiazepines and opioids in a veteran population

OBJECTIVES

Combination opioid and benzodiazepine (BZD) therapy is associated with poor treatment outcomes and increased risk of overdose death. There is currently limited literature detailing well-implemented strategies to minimize dual prescribing of these agents. The following describes the implementation processes and outcomes of a health system quality improvement project that aimed to reduce combination BZD and opioid therapy.

STUDY DESIGN

A retrospective chart review-based quality improvement project.

METHODS

All patients within a single healthcare system of the Department of Veterans Affairs treated with long-term (>90 days) combination therapy were identified. A psychiatric pharmacist submitted a 1-time chart review note for each patient, which briefly outlined patient-specific considerations and recommendations for alternatives to BZD treatment. After a 30-day period following entry of the chart review notes, data were collected regarding the number of providers who (1) acknowledged the chart review notes by providing their additional signature and (2) committed to the recommended interventions by initiating taper schedules.

RESULTS

During the 30-day follow-up period, 47.5% (n = 29) of chart review notes were acknowledged and 11.5% (n = 7) of prescriptions were tapered by providers. Mental health providers were less likely to provide their additional signature to the chart review notes (χ2 = 4.62, df = 1, P = .0316; Fisher exact test, P = .0215) and to initiate taper schedules (χ2 = 5.51, df = 1, P = .0189; Fisher exact test, P = .0410) compared with primary care providers.

CONCLUSIONS

Chart review note recommendations were frequently disregarded by providers and are likely insufficient as a primary intervention tool for reducing long-term combination BZD and opioid therapy.