Keeping Pace with a Changing Healthcare Environment through Academic Detailing

Keeping Pace with a Changing Healthcare Environment through Academic Detailing

Academic detailing, described as “university or non-commercial-based educational outreach”, is crucial for enhancing patient care and reducing health care costs within the realm of medication therapy. With a goal of improving the prescribing of targeted drugs, academic detailing typically involves face-to-face education of prescribers by trained health care professionals (typically pharmacists, physicians, or nurses) who work to make sure that prescribing is according to medical evidence from randomized controlled trials. One of the main elements of non-commercial or university-based detailing programs is that they don't have any financial links to the pharmaceutical industry. Academic analysis has been studied for over 25 years and has confirmed compelling at developing the prescription of targeted medications about 5% from baseline. Though it's primarily wont to affect prescribing, it's also wont to educate providers regarding other non-drug interventions, like health care screening guidelines.

As organizations develop and refine their academic detailing programs to enhance patient care, our experiences at Atrius Health have shown us that academic detailing must be an endless process of evaluation and collaboration for adapting to changes in today’s healthcare environment. Our Academic Detailing Service (ADS) for the Atrius Health Clinical Pharmacy program has emerged over the past several years through the appraisal of its impact, encouragement of internal feedback, and by working with others within the field, including the National Resource Center for tutorial Detailing (NaRCAD).

When we began the clinical pharmacy ADS program in 2011, our clinical pharmacists detailed clinicians in individually scheduled appointments or in larger groups during department meetings. Our objective was to satisfy all general medicine and family practice prescribers once per fiscal quarter to debate cost-effective prescribing and clinical quality. Documentation of our ADS meetings consisted of checking off an inventory of the clinicians we detailed each quarter.

At that point, there was no formal training for our clinical pharmacists on the way to conduct a detailing meeting. Our method of making content for visits soon resulted during a large menu of topics so varied that every quarter detailing became unwieldy and too broadly focused. While our documentation gave us a general sense of the number of clinicians detailed, it didn't tell us anything about the standard of our interactions.

Clinical pharmacists used our ADS workflow to provide an educational presentation on the new anticoagulants, the evidence base for their place in therapy, supporting documents and prescribing tools for appropriate use

In 2013, after attending one among NaRCAD’s training sessions, we implemented changes to enhance our service and hone the talents of our detailers. As a result, we elect to detail clinicians in a private or small group setting of but four. We also selected a goal of 90% of internal/family medicine clinicians receiving detailing a minimum of once quarterly.

We put our new ADS program into practice to assist our patients following new Food and Drug Administration (FDA) guidelines regarding the monitoring of liver enzymes. The 2012 FDA decision concluded that routine liver enzyme monitoring with the alanine transaminase (ALT) test didn't improve the detection or prevention of liver injury for patients using ‘statin’ cholesterol-lowering medications. Using our newly revised ADS workflow to teach our internal and family practice clinicians about the new guidelines, we influenced a 61 percent reduction in ordering ALT tests in patients on ’statin’ medications, leading to $100,000 in savings the subsequent year.

We further refined our program in 2014 based upon our findings from an indoor focus group. By soliciting honest feedback from our clinical pharmacists, we noted considerable variation in how they approached the medication therapy topics discussed each quarter and came to know that the continual process of visiting with each clinician at their sites often felt stale and repetitive. We continued revising the ADS with a more targeted technique of tying each round of clinician appointments to one specific prescribing initiative. We implemented this new workflow with a goal to enhance the utilization of evidence-based beta-blockers in patients with coronary failure, a top-quality measure for the national Medicare Pioneer Accountable Care Organization (ACO) model during which Atrius Health participated. Using this new approach, clinical pharmacists were ready to deliver a fresh and meaningful message to the proper prescribers, leading to a change from 74 to 86 percent prescribing of evidence-based beta-blockers during this patient population.

The following year, several new anticoagulants wont to prevent strokes in patients with fibrillation were introduced to the market, and our group responded by reviewing the whole class of medicine and providing guidance to internal and family practice clinicians on appropriate drug therapy selection and monitoring. Clinical pharmacists used our ADS workflow to supply an academic presentation on the new anti-coagulants, the evidence base for his or her place in therapy, supporting documents and prescribing tools for appropriate use.

2016 delivered to the market new cholesterol-lowering medications, the PCSK9 inhibitors, and that we provided education regarding the evidence base and renewed efforts in maximizing statin medications within the right patients. Over the past year, the ADS were more refined to apprehend all prepared educational presentations by clinical pharmacists to Atrius Health clinicians and staff. We still specialize in several major educational initiatives per annum with our goal of 90% detail.

By continuously evaluating our program, and soliciting honest feedback from academic detailers themselves and from the purchasers they serve, organizations can hone their efficiency, answer the present healthcare environment, and supply clear messaging in many therapeutic areas of internal and family practice. Enhancing drug therapy decision-making during a streamlined and single-topic manner helps clinical pharmacists build and sustain relationships with their clinicians by providing timely, useful and practical medication education to clinicians and staff. In doing so, organizations can still improve patient care and reduce costs for the advantage of the communities they serve.

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