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National State Attorney General Program At Columbia Law School New York, New York May 11, 2007

The Pennsylvania Academic Detailing Program. Pharmaceuticals Conference Evidence Based Medicine and Counter Detailing. Thomas M. Snedden, (tsnedden@state.pa.us) Director,

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National State Attorney General Program At Columbia Law School New York, New York May 11, 2007

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  1. The Pennsylvania Academic Detailing Program Pharmaceuticals Conference Evidence Based Medicine and Counter Detailing Thomas M. Snedden, (tsnedden@state.pa.us) Director, Pennsylvania PACE Program (www.aging.state.pa.us) National State Attorney General Program At Columbia Law School New York, New York May 11, 2007

  2. The Pennsylvania Academic Detailing Program Academic detailing is a supplement to PACE’s long-standing, comprehensive, concurrent and retrospective DUR processes.

  3. Program expectations The medication educator’s role

  4. Our goals • To provide evidence-based, non-commercial information about medications to physicians • To facilitate physicians’ use of that information in making the best prescription choices (efficacy, safety, and cost) for their patients

  5. Program strengths:Service, credibility, and integrity Service • Providing useful, practice-relevant information… • in a very time-efficient way… • that would be difficult to assemble oneself… • delivered in a professional, supportive manner. Credibility • Evidence-based materials, developed by experts • Non-commercial viewpoint Integrity • Only goal is to improve prescribing and patient care • No pharmaceutical company funding • Salary is not based on sales performance

  6. Goal 1: To provide physicians with current, evidence-based, non-commercial drug information HOW? • Offer the physician a flexible schedule for visits • Respond to questions knowledgeably, honestly, and with the weight of the evidence—or find someone who can! • Offer free CME credits to add value to the interaction • Present a professional appearance and pleasant demeanor • Practice the art of persistence

  7. Goal 2: To facilitate physicians’ use of that information in making the best prescription choices (efficacy, safety, and cost) for patients HOW? • Identify the physician’s needs, priorities, and concerns • Offer tools and resources to facilitate better choices (data summaries, patient education materials, etc.) • Refrain from excessive bashing of drug manufacturers

  8. Drug rep Serves: drug company Product: drug Goal: maximize use of a particular drug for profit$ Medication educator Serves: doctor Product: knowledge about drugs Goal: Share knowledge with doctor that will result in optimized prescription choices What makes a medication educator unique?

  9. Pharmaceutical company relationships • No affiliations with a pharmaceutical company (paid or unpaid) • Consulting • Employment • Speakers bureau/seminars/conferences

  10. Educational modules completed (whom to treat, which drugs to choose) • Cox-2’s / NSAIDs • Gastric acid: PPIs, H 2 blockers • Nexium, Prilosec, etc. • Anti-platelet drugs • Plavix, aspirin • Cholesterol-lowering drugs • Lipitor, Crestor, Zocor, other statins

  11. Drug Consultants • Clinical background in nursing, pharmacy • 10 individuals employed • 6 nurses, 4 pharmacists • 7.5 FTE total • Located in areas with highest density of PACE beneficiaries • Multi-day training sessions in Boston • regular followup teleconferences for updates, feedback • Quarterly one-on-one visits, ongoing relationships with prescribers

  12. The Harvard connection • Systematic review of current medical literature  evidence-based synthesis • Development of user-friendly materials • Follow-up, consultant support • Responses to MD questions • Fiscal management • Program evaluation • Web presence – www. RxFacts.org

  13. Detailer activity through mid-November

  14. The media have noticed • Wall Street Journal • Page One, March 13 • “The Daily Show” • May 4, www. TheDailyShow.com • The New York Times • op-ed, September 16 • Harvard Magazine, The Harvard Health Letter • November • The Boston Globe • February 26, 2007 • The Central Pennsylvania Business Journal • April 2007

  15. Effect on drug utilization:preliminary analysis The cox-2 / NSAID module

  16. Next steps • Additional analyses are ongoing • Additional drug topics to be covered: • Hypertension • Alzheimer’s disease • Diabetes • Broaden to other state programs? • state employees/retirees

  17. Questions

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