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Academic detailing: Where we are, and where we’re going

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

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Academic detailing: Where we are, and where we’re going

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  1. 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

  2. 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.

  3. 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?

  4. 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 comparativebenefit, risk, and cost-effectiveness of drugs used for common clinical problems.

  5. 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.

  6. 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

  7. 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

  8. Topics at www.RxFacts.org • G.I. acid Sx • anti-platelet drugs • hypertension • cholesterol • diabetes • depression • osteoporosis • HIV for the PCP • COPD • cognitive impairment • incontinence • gait impairment, falls • sleep meds • atrial fibrillation • chronic pain • anti-psychotics

  9. 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

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