the pennsylvania academic detailing program pharmaceuticals conference evidence based medicine and...
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The Pennsylvania Academic Detailing Program
Pharmaceuticals Conference
Evidence Based Medicine and Counter Detailing
National State Attorney General ProgramAt Columbia Law School
New York, New YorkMay 11, 2007
Thomas M. Snedden, ([email protected])
Director,Pennsylvania PACE Program
(www.aging.state.pa.us)
The Pennsylvania Academic Detailing Program
Academic detailing is a supplement to PACE’s long-standing, comprehensive, concurrent and retrospective DUR processes.
Program expectations
The medication educator’s role
Our goals To provide evidence-based, non-
commercial information about medications to physicians
To facilitate physicians’ use of that information in making the best prescription choices (efficacy, safety, and cost) for their patients
Program strengths:Service, credibility, and integrity
Service Providing useful, practice-relevant information… in a very time-efficient way… that would be difficult to assemble oneself… delivered in a professional, supportive manner.
Credibility Evidence-based materials, developed by experts Non-commercial viewpoint
Integrity Only goal is to improve prescribing and patient
care No pharmaceutical company funding Salary is not based on sales performance
Goal 1: To provide physicians with current, evidence-based, non-commercial drug information
HOW? Offer the physician a flexible schedule for visits
Respond to questions knowledgeably, honestly, and with the weight of the evidence—or find someone who can!
Offer free CME credits to add value to the interaction
Present a professional appearance and pleasant demeanor
Practice the art of persistence
Goal 2: To facilitate physicians’ use of that information in making the best prescription choices (efficacy, safety, and cost) for patients
HOW? Identify the physician’s needs, priorities, and
concerns
Offer tools and resources to facilitate better choices (data summaries, patient education materials, etc.)
Refrain from excessive bashing of drug manufacturers
What makes a medication educator unique?Drug rep
Serves: drug company
Product: drug
Goal: maximize use of a particular drug for profit$
Medication educator Serves: doctor
Product: knowledge about drugs
Goal: Share knowledge with doctor that will result in optimized prescription choices
Pharmaceutical company relationships No affiliations with a
pharmaceutical company (paid or unpaid) Consulting Employment Speakers
bureau/seminars/conferences
Educational modules completed (whom to treat, which drugs to choose)
Cox-2’s / NSAIDs Gastric acid: PPIs, H 2 blockers
Nexium, Prilosec, etc. Anti-platelet drugs
Plavix, aspirin Cholesterol-lowering drugs
Lipitor, Crestor, Zocor, other statins
Drug Consultants Clinical background in nursing, pharmacy
10 individuals employed 6 nurses, 4 pharmacists
7.5 FTE total Located in areas with highest density of
PACE beneficiaries Multi-day training sessions in Boston
regular followup teleconferences for updates, feedback
Quarterly one-on-one visits, ongoing relationships with prescribers
The Harvard connection Systematic review of current medical
literature evidence-based synthesis Development of user-friendly materials Follow-up, consultant support Responses to MD questions Fiscal management Program evaluation Web presence – www. RxFacts.org
Detailer activity through mid-November
N
Completed educational encounters 974
Unique providers who have had educational encounters
450
Educational encounters by topic*
iDiS introduction 175
coxibs/NSAIDs 362
PPIs, acid-suppressing therapy 340
anti-platelet therapy 240
statins, lipid-lowering therapy 2
Survey item:Mean ± SD
1=Strongly disagree 2=Disagree 3=Neutral 4=Agree 5=Strongly Agree
The program provides me with useful information about commonly used medications
4.6 ± .5
The content represents unbiased and balanced information about drugs
4.6 ± .5
The program provides a perspective on prescribing that is different form what I get from other sources
4.4 ± .6
My Drug Information Consultant is a well-informed source of evidence-based information about drugs I prescribe
4.6 ± .5
I find the patient materials useful in my practice 4.3 ± .8
Being able to get Continuing Medical Education credits from Harvard is a valuable component of the service
4.0 ± 1.2
It makes sense for the Commonwealth of Pennsylvania to devote resources to this activity
4.5 ± .6
I would like to see this program continue 4.6 ± .6
The media have noticed Wall Street Journal
Page One, March 13 “The Daily Show”
May 4, www. TheDailyShow.com The New York Times
op-ed, September 16 Harvard Magazine, The Harvard Health Letter
November The Boston Globe
February 26, 2007 The Central Pennsylvania Business Journal
April 2007
Effect on drug utilization:preliminary analysis
The cox-2 / NSAID module
0
200
400
600
800
1000
-18
-17
-16
-15
-14
-13
-12
-11
-10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 7
Months before and after intervention month
Cox
ib s
pend
ing
per p
hysi
cian
Internal control cohort
Intervention cohort
IDIS intervention month
Next steps Additional analyses are ongoing Additional drug topics to be covered:
–Hypertension–Alzheimer’s disease –Diabetes
Broaden to other state programs?–state employees/retirees
Questions