Academic Detailing

Summary

Academic detailing is education outreach to prescribers by trained health care professionals or preventionists. The academic detailer contacts and schedules brief face-to-face information sharing sessions with health care providers usually during working hours and within the office setting. The outreach is designed to educate the health care provider on current and evidence-based substance misuse health initiatives. The initiatives can include resources for both the provider and patients as well as providing potential substance misuse treatment contacts for linkages to care. Academic detailing can be used to educate providers about any health initiative including opioid prescribing guidelines, substance use disorders and facilitating conversations with patients about treatment options.

The overarching goal of academic detailing is behavior change. Educating providers on evidenced-based practices leads to increased understanding, then adoption of improved healthcare system practices or polices, and ultimately leading to decreased rates of drug overdose morbidity and mortality. Based on the Centers for Disease Control and Prevention (CDC) Clinical Practice Guideline for Prescribing Opioids for Pain, the academic detailer will educate providers on the following practices:

1. The provider first recommends alternative non-opioid treatments for pain.
2. The provider has a policy/practice in place to check the Prescription Monitoring Program (PMP) prior to prescribing an opioid to ensure there are no risks including co-prescribing with benzodiazepines.
3. If an opioid is prescribed, the provider:
   1. starts with a low dose
   2. goes slow–prescribe for no more than 3 days
   3. schedules a follow-up appointment within one week
4. When prescribing an opioid, the patient is prescribed naloxone or is provided with information on where it can be secured for free. The provider always prescribes naloxone with an opioid prescription.
5. The provider conducts Screening, Brief Intervention and Referral to Treatment (SBIRT) with patients at-risk of substance misuse.
6. The provider champions the peer support referral model to provide patients a warm hand-off with linkages to care and support.
7. Providers offer to arrange treatment with evidence-based medications to treat patients with Medications for Opioid Use Disorder (MOUD).
8. Protocols or policies have been implemented/improved within the clinic or health system for evidence-based substance use disorder treatment or referrals.
9. The provider utilizes clinical decision support tools embedded in the EHR for universal screening, naloxone alerts, or other alerts to improve patient care for substance misuse.
10. The provider is aware of YourLifeIowa.org and its prevention, treatment.

The detailer will assess the provider’s current practice and determine the needs of the provider in relation to adapting these practices. Academic detailing is a conversational-style discussion with the provider, not a training presentation or a hard sales tactic.

Providers who work in hospice care, nursing homes, active cancer treatment, palliative care or end-of-life care should not be a focus of this program and should not be approached.

Core Components

Dosage/Frequency

At least 50% of the population of focus of health care prescribers who prescribe controlled substances should be impacted by behavior change by the end of the project period. Frequency is determined by considering the amount of health care providers that need to be contacted each contract year to achieve the dosage.

Required Key Steps

• All academic detailers must attend training through the National Resource Center for Academic Detailing (NaRCAD) prior to implementation.
• In collaboration with the coalition, discuss and complete the following:
  • Assess which health care providers will be of focus based on the behavior change needing to be implemented.
  • Discuss the key messages, features and benefits of the academic detailing strategy that are addressing the behavior change taking place in the service area such as:
    • Patient safety
    • Reduction in overdose potential
    • Providing holistic care and looking to treat underlying conditions rather than symptom manifestation of pain
    • Protection of provider license
    • Improvement in patient overall quality of life
    • Increased understanding of opioid dangers
    • Improvement in patient/provider relationship and rapport with clear understanding of goals, expectations, and outcomes.
  • To reduce duplicative efforts, determine whether communities have an academic detailing program in place, who the providers of focus are, and how they will be reached.
  • Determine how the program will be evaluated for effectiveness regarding behavior change and best practices.
  • Determine the level of frequency in reaching the providers and how visits and contact attempts will be monitored.

Capacity Building

It is expected to have healthcare provider representation in the coalition. Coalition members with a healthcare background will be able to provide valuable insight into the academic detailing program in the service area.

Implementation Resources

CDC Clinical Practice Guideline for Prescribing Opioids for Pain
CDC Training for Providers
Center for Innovation in Academic Detailing on Opioids (CIAO)
Drug Abuse Screening Tool (DAST)
National Resource Center for Academic Detailing (NaRCAD) Webinar Series
NaRCAD Opioid Safety Toolkit
Opioid Risk Tool (ORT)
SAMHSA Opioid Overdose Prevention and Response Toolkit
Screening, Brief Intervention, and Referral to Treatment (SBIRT)

References

Barth, K. S., Ball, S., Adams, R. S., Nikitin, R., Wooten, N. R., Qureshi, Z. P., & Larson, M. J. (2017). Development and feasibility of an academic detailing intervention to improve Prescription Drug Monitoring Program use among physicians. The Journal of Continuing Education in the Health Professions, 37(2), 98–105. https://doi.org/10.1097/CEH.0000000000000149

Midboe, A. M., Wu, J., Erhardt, T., Carmichael, J. M., Bounthavong, M., Christopher, M. L. D., Gale, R. C. (2018). Academic detailing to improve opioid safety: Implementation lessons from a qualitative evaluation. Pain Med, 19(1), S46-S53. https://doi.org/10.1093/pm/pny085

Zolekar, A., White, A., Fleming, M. L., Thornton, J.D., & Wang, Y. (2018). Outcomes related to opioid prescribing after academic detailing: A review of literature. Value in Health, 21(1), S265. https://doi.org/10.1016/j.jval.2018.04.1770