Academic detailers’ and general practitioners’ views and experiences of their academic detailing visits to improve the quality of analgesic use: process evaluation alongside a pragmatic cluster randomized controlled trial

Abstract

BackgroundContinuous medical education strategies, including academic detailing (AD), have mixed effects on the quality of prescribing in general practice. Alongside a cluster-randomized controlled trial (cRCT) to assess the effectiveness of AD visits (on appropriate prescribing of analgesics for chronic pain in osteoarthritis) by Farmaka, an independent drug information center, we performed a process evaluation to identify possible barriers and success factors to improve these AD visits, both from the perspective of the academic detailers delivering the visits and the general practitioners (GPs) receiving them.MethodsWe performed semi-structured interviews with 20 GPs who participated in the cRCT and 13 academic detailers. The interviews were transcribed verbatim and analysed using thematic analysis.ResultsGPs viewed AD visits as a practical and useful CME strategy, that is less time consuming than other CME activities, and the visitors as providers of objective and independent information relevant to their daily practice with whom they can have meaningful discussion. Academic detailers saw themselves as content experts, mainly informing GPs about the topic and not emphasizing on behavior change. Both GPs and academic detailers believed that the AD visits could have better interaction and discussion if performed in small groups. According to the GPs, the visits on analgesic use provided some new and relevant information as well as clarifying some misconceptions. They increased awareness of the disadvantages of particular non-steroidal anti-inflammatory drugs and of the lower doses of paracetamol that should be prescribed for chronic use, which may have changed their beliefs and/or attitudes towards more appropriate prescribing for osteoarthritis. However, the transfer of knowledge into practice was seen as not so straightforward.ConclusionsGPs view AD visits as a credible and interesting way of CME that enhances their knowledge and increases reflection on their prescribing behavior.

<p>Academic detailing as a method of continuing medical education</p>

“…Others have also shown that users of AD highly appreciate its educational value and, due to their positive experience with AD, tend to view information from other sources and other forms of continuing medical education more critically 29. In a study from Belgium, the GPs concluded that the visits were a credible and interesting way of receiving continuing medical education and that they both enhanced their knowledge and increased their reflections on their own prescribing behaviour 30. That the service is free for the GP and that the GP does not have to leave the office eliminates the need for travel and minimizes any loss of income for the GP.…”

Converting habits of antibiotic use for respiratory tract infections in German primary care (CHANGE-3) - process evaluation of a complex intervention

“…A central component of the practice-team intervention was an outreach visit by experienced outreach visitors (OVs) who presented general information on antibiotic prescribing and the CHANGE-3 project. Outreach visits are considered to be a credible instrument in continuous medical education [ 20 ] and might be chosen for changes which are considered to be difficult to achieve [ 21 ]. They can improve the care delivered to patients and provide small to moderate changes in prescribing patterns [ 22 ].…”

Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care (Change-3) - Process evaluation of a complex intervention

“…A central component of the practice-team intervention was an outreach visit by experienced outreach visitors (OVs) who presented general information on antibiotic prescribing and the CHANGE-3 project. Outreach visits are considered to be a credible instrument in continuous medical education [18] and might be chosen for changes which are considered to be di cult to achieve [19]. They can improve the care delivered to patients and provide small to moderate changes in prescribing patterns [20].…”