Joy Leotsakos, Senior Clinical Pharmacist, Atrius Health
Academic detailing, described as “university or non-commercial-based educational outreach,” is crucial for enhancing patient care and reducing health care costs in 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 ensure that prescribing is consistent with medical evidence from randomized controlled trials. A key component of non-commercial or university-based detailing programs is that they (academic detailers/ clinical educators, management, staff, program developers, etc.) do not have any financial links to the pharmaceutical industry. Academic detailing has been studied for over 25 years and has proven effective at improving prescribing of targeted medications about 5 percentage from baseline. Though it is primarily used to affect prescribing, it is also used to educate providers regarding other non-drug interventions, such as health care screening guidelines.
As organizations develop and refine their academic detailing programs to improve patient care, our experiences at Atrius Health have showed us that academic detailing must be a continuous 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 evolved over the past several years through the evaluation of its impact, solicitation of internal feedback, and by working with others in the field, including the National Resource Center for Academic Detailing (NaRCAD).
When we began the clinical pharmacy ADS program in 2011, our clinical pharmacists detailed clinicians in individual scheduled appointments or in larger groups during department meetings.
Our objective was to meet with all internal medicine and family medicine prescribers once per fiscal quarter to discuss cost-effective prescribing and clinical quality. Documentation of our ADS meetings consisted of checking off a list of the clinicians we detailed each quarter.
At that time, there was no formal training for our clinical pharmacists on how to conduct a detailing meeting. Our method of creating content for visits soon resulted in a large menu of topics so varied that each quarter’s detailing became unwieldy and too broadly focused. While our documentation gave us a general sense of the number of clinicians detailed, it did not tell us anything about the quality of our interactions.
In 2013, after attending one of NaRCAD’s training sessions, we implemented changes to improve our service and hone the skills of our detailers. As a result, we choose to detail clinicians in an individual or small group setting of less than four. We also selected a goal of 90 percent of internal/family medicine clinicians receiving detailing at least once every quarter.
We put our new ADS program into practice to help our patients following newFood 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 did not improve detection or prevention of liver injury for patients using ‘statin’ cholesterol-lowering medications. Using our newly revised ADS workflow to educate our internal and family medicine clinicians about the new guidelines, we influenceda61 percent reduction in ordering ALT tests in patients on ’statin’ medications, resulting in $100,000 in savings the following year.
We further refined our program in 2014 based upon our findings from an internal 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 understand that the continuous 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 a single specific prescribing initiative. We implemented this new workflow with a goal to improve the use of evidence-based beta-blockers in patients with heart failure, a quality measure for the national Medicare Pioneer Accountable Care Organization (ACO) model in which Atrius Health participated. Using this new approach, clinical pharmacists were able to deliver a fresh and meaningful message to the right prescribers, resulting in a change from 74 percent to 86 percent prescribing of evidence-based beta-blockers in this patient population.
The following year, several new anticoagulants used to prevent strokes in patients with atrial fibrillation were introduced to the market, and our group responded by reviewing the entire class of drugs and providing guidance to internal and familymedicine clinicians on appropriate drug therapy selection and monitoring. 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.
2016 brought to the market new cholesterol-lowering medications, the PCSK9 inhibitors, and we provided education regarding the evidence base and renewed efforts in maximizing statin medications in the right patients. Over the past year, the ADS was further refined to capture allprepared educational presentations by clinical pharmacists to Atrius Health clinicians and staff. We continue to focus on several major educational initiatives per year with our goal of 90 percent detailing.
By continuously evaluating our program, and soliciting honest feedback from academic detailers themselves and from the customers they serve,organizations can hone their efficiency, respond to the current healthcare environment, and provide clear messaging in many therapeutic areas of internal and family medicine. Enhancing drug therapy decision-making in 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 continue to improve patient care and reduce costs for the benefit of the communities they serve.