canadian academic detailing collaboration - cadth.ca · pdf file4 canadian academic detailing...

Canadian Academic Detailing Collaboration

Michael Allen MDDalhousie University CME

CCOHTA Invitational SymposiumApril 3 – 4, 2006

Tuesday 1030-1200Session 10

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Outline

Definition

Development

Academic detailing programs

Projects

Next steps

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Definition

One-on-one educational intervention provided to physicians in their office by a trained health care professional

Evidence-based

Information for clinical decision-making

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Canadian Academic Detailing Collaboration - Development

British Columbia – 1993 Saskatchewan – 1997Nova Scotia and Alberta – 2001Facilitated poster session – 2002 Manitoba – 2003University of Victoria School of Health Information Science – 2003 Links with CADTH/COMPUS

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Canadian Academic Detailing Collaboration – Programs

British ColumbiaBC Community Drug Utilization Program50-60 family physicians in North/West Vancouver

AlbertaDrug Utilization Program of Alberta100 rural physicians - David Thompson Health Region 150 urban physicians – Calgary Health Region

SaskatchewanRx Files Academic Detailing Program400 physicians and other HCPs in SK

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Canadian Academic Detailing Collaboration – Programs

ManitobaPrescription Information Service of ManitobaGeneral practitioners – 1240Pharmacists – 1450

Nova ScotiaDalhousie CME Academic Detailing Service350 physicians and other HCPs in Nova Scotia

newsletter

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Process and Outcome Evaluation of Academic Detailing in 5 Provinces

Canadian Academic Detailing Collaboration - Projects

Best Practices Contribution Program

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1. Evaluation of ADing in North/West Vancouver – BC2. Effects of ADing on prescribing – U Victoria3. Canadian and international experiences with ADing 4. Evaluate printed educational materials – AB5. Time and motion study – SK6. Outcomes evaluation (READ study) – MB7. Physicians’ perceptions of ADing – NS

Canadian Academic Detailing Collaboration - Projects

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CADC Projects - British ColumbiaAssessment of Academic Detailing in North/West Vancouver

80 physicians randomized to get ADing session on CHF or another drug topic

After 6 months arms crossed over

Preliminary BC Pharmacare data show changes in prescribing of heart failure medications in group receiving academic detailing

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CADC Projects- British ColumbiaAssessment of Academic Detailing in North/West Vancouver

Now analyzing the following BC databases to determine effect of ADing

Drugs (PharmaNet)Physician billing (MSP)Hospitalization (DAD)

Methods in upcoming Basic and Clinical Pharmacology and ToxicologyWill refine this method to assess academic detailing in other provinces

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CADC Projects- British ColumbiaAssessment of Academic Detailing in North/West Vancouver

Anne Nguyen

[email protected]

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Randomize paired towns and practice

addresses Average Delay = 1-3 mo

Early visits

Delayed visits

CADC Projects - University Victoria Randomized delayed control trial

New patients

prescribed target drugs

TimeEarly visit

Delayed visit

Immediate Impact: Change in prescribing after visit to early physician, compared to matching delayed

physician, prior to the delayed visit

Window

Early

Delayed

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Malcolm Maclure

[email protected]

CADC Projects - University Victoria Randomized delayed control trial

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CADC ProjectsSynthesis of academic detailing best practices

5 Canadian programs and 10 international programs interviewed Best practices and innovative approaches to:

Selecting successful topics Physician incentives to participate and be influenced by prescribing recommendationsEffective printed educational materialsCharacteristics of a good academic detailer and a good visitComplementary strategiesEvaluation methods

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Programs similar goal to improve prescribing and medication use but differ in

Types of visitsEducational materials usedComplementary strategies.

Most AD activities are part of larger programs using a variety of initiatives and interventions Programs refine activities based on

Program objectivesPreferences of their target audienceHealth system, length of operation, and funding

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Rosemary Bacovsky

[email protected]

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CADC Projects – AlbertaEvaluation of printed educational materials

Collected PEMs from programs consulted during international synthesis Developed classification for PEMs

Key messages – post cardDecision aid – one page summaryDecision oriented evidence – 2 to 5 pagesOriginal reports – reprints of papers, CPGs

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CADC Projects – AlbertaEvaluation of printed educational materials

Involved information design specialists – U of AlbertaDeveloped performance specifications for PEMs – used COPD materialDeveloped design criteriaEvaluated PEMs from each program and made suggestions.

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Contact Information

Harold Lopatka, Program DirectorEmail: [email protected]: 780-492-0110Website: www.uofaweb.ualberta.caAddress: Alberta Drug Utilization Program, University of Alberta, 305 Campus Tower, 8625 – 112 Street, Edmonton, AB, T6G 1K8

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CADC Projects - SaskatchewanTime and motion

Data collection to include:Time for research & material preparationTime for academic detailing

BookingDrivingWaitingDiscussing

Type of visit (individual vs group)Kilometres travelled

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Academic Detailing VisitsNumber of prescribers / visit: 1.2BC - 2.4 SK

Time discussing topic in MD office (minutes): BC: 21; AB: 32; SK: 39; NS: 33Individual sessions shorter: Ave 17min SK

Time traveling:24-59 min depending on region covered e.g. rural

Total time for visit: (includes booking visits, follow-up)varied from 60-94 min/visit

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Time for research & material preparation80 hrs – 975 hrs depending on topic and depth of analysis

Time for detailer trainingVaried from 49-58 hrs/detailer/topic

Total Cost - depends on …Type/depth of topic; controversial issues, etc.Number/type of detailers; geographical issuesRange: $278-389/visit; $115-316/prescriber

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Loren [email protected]

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CADC Projects – ManitobaOutcome evaluation

Rural Evaluation of Academic Detailing (READ) Study

Objectives:Determine cost-effectiveness and effect on prescribing of academic detailing and printed education material

Methodology:Cluster stratified RCT60 GP from 20 clinics in 2 rural health auth.

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READ study (continued)Two-arm intervention 30 FPs per arm

Printed material + academic detailing on CHFPrinted material on separate topic - control

OutcomesPrescribing of beta-blockers in CHF

Completed

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READ QuestionnaireBased on Theory of Planned Behaviour

Beta-blocker use in CHFStopping benzodiazepines in patients on long-term therapyManaging insomnia without prescribing benzodiazepines

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SubjectiveNorms

Attitudes

Intention Behaviour

Perceived Behavioural

Control

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Questionnaire information used to adapt intervention materials to behavioural targets

Prescribing Beta-Blockers in CHFdifficult - provide detailed titration information and case studies to make prescribing easierrisky - safety issues addressed; prevention, monitoring and resolution of side effects

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READ Study

Shawn Bugden

[email protected]

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CADC Projects – Nova ScotiaPhysicians’ perceptions of academic detailing

Questionnaire and interviews with doctors who have and have not used academic detailingQuestionnaire Mailed Received %

Not used 408 60 15Have used 481 219 46Total 879 288 33

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Encourage use Evidence-based approach

Topics useful to practice

Useful handout material

Discourage useSpending office time doing CME

Scheduling time to see detailer

CME provided by non-MD

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Michael Allen

[email protected]

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CADC Collaboration on developing content

Canadian and US updates on prevention of cardiovascular diseaseCritical appraisal of original literatureTeleconferences using voice over internet and and document sharing with Elluminate

Mowafa Househ - [email protected]

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CADC Collaboration on developing content

Each has taken responsibility for different aspects of the topic

MenWomenElderlyPeople with diabetes

Working on common messages and some common handout material

AtorvastatinCARDS

74(40-483)

Atorvastatin CARDS ASCOT-LLA**Diabetics

PravastatinPROSPERPravastatinPROSPERElderly (≥ 65 years old)

LovastatinAFCAPS/TexCAPSLovastatinAFCAPS/TexCAPSAtorvastatinASCOT

All women

PravastatinWOSCOPSLovastatinAFCAPS/TexCAPSAtorvastatinASCOT-LLA

45(35-64)

PravastatinWOSCOPSLovastatinAFCAPS/TexCAPS*AtorvastatinASCOT-LLA

All men

Primary Prevention

Simvastatin4S26(19-44)

PravastatinLIPID**SimvastatinHPS 4S

Diabetics

19(12-40)

Simvastatin4SPravastatinCARE

26(21-34)

PravastatinCARE, LIPID, PROSPERSimvastatin4S, HPS

Elderly (≥ 65 years old)

PravastatinLIPIDSimvastatin4S

33(24-55)

PravastatinCARE, LIPID**Simvastatin4S, HPS

All women

42(33-60)

PravastatinLIPID*Simvastatin4S, HPS*

27(22-33)

PravastatinLIPID, CARE*Simvastatin4S, HPS

All men

NNT for5 years(95% CIs)

Drugs and trialsNNT for5 years(95% CIs)

Drugs and trialsSecondary Prevention

All Cause MortalityMajor Cardiac EventsNon- fatal MI, deaths from CHD

Evidence for benefit

Insufficient evidence

Major cardiac events All cause mortality

Men

Men

Women

Women

Elderly

Elderly

Diabetes

Diabetes

Secondary

Primary

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Collaboration on Academic DetailingProcess evaluation of the CADC

Interviews with participantsSuccesses - the level of cooperation and implementation of several evaluation projectsChallenges - how to collaborate efficiently, how to reconcile local and national prioritiesBenefits of collaboration expected to grow over time. Requires effort and resources.\Developing partnership with COMPUS is a key priority.

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ActivitiesRegular communication

Education and training

Advocacy

Partnering

Research and evaluation

Outcomes

Quality improvement

Proposal developed

Expected to follow from report and partnering

Growing partnership with COMPUS, e.g., toolkit

Insights/ capacity-building from 2-yr program

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Richard Morrow

[email protected]

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Next steps

Life without AlbertaReview all projectsDetermine relevance for our programsDevelop strategic planContinue to build relationship with COMPUS/CADTH

canadian academic detailing collaboration - cadth.ca · pdf file4 canadian academic detailing...

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