Evaluation of Academic Detailing Within a Coordinated Care Trial

Abstract

Background: Academic detailing has been identified as an intervention that modifies health professionals' practice, particularly prescribing. Aim: To assess the impact of academic detailing on general practitioners' (GPs) prescribing for heart failure, and chronic pain associated with osteoarthritis, in an elderly population. Method: This was a quasi-experimental study embedded within a coordinated care trial, with a 12-month follow-up. 1151120 (96%) of GPs invited to participate received academic detailing visits by experienced teaching-hospital clinical pharmacists between July 1998 and July 1999. The pharmacological management of two conditions was addressed: heart failure in Phase 1, and chronic pain associated with osteoarthritis in Phase 2. Data from the Pharmaceutical Benefits Scheme (PBS) were analysed for changes in prescribing. The perceptions of the GP and pharmacist were also assessed. Results: Consistent with key messages, non-steroidal antiinflammatory drug (NSAID) use decreased in Phase I, and in Phase 2long-acting NSAID use decreased and low-dose tricyclic antidepressant use increased. Inconsistent with key messages of Phase 1, angiotensin converting enzyme inhibitor prescribing for heart failure did not change. GPs and pharmacists were highly satisfied with the project. Conclusion: Academic detailing visits to GPs were partly successful in changing prescribing practices for heart failure, and pain management of osteoarthritis. Initiatives such as this may strengthen professional links between pharmacists and GPs and benefit patients through enhanced quality use of medicines.

A realist synthesis of educational outreach visiting and integrated academic detailing to influence prescribing in ambulatory care: why relationships and dialogue matter

“…Transparent evidence-based synthesis and presentation of a topic influences their views of the credibility and usefulness of an EV which can be tainted by perceptions of cost cutting 11 12 16 51 55–57. Programme designers should develop topic content and materials based on critical appraisal and systematic synthesis of evidence by clinicians (peers or experts), use of (local) data and identification of evidence-practice gaps,11 12 39 40 42 43 52 58–63 which also inform the design of support materials and preparation of the visitor 45 60. Providing clinicians with balanced information, acknowledgement of controversies and uncertainties in evidence contributes to transparency and conveys an understanding of greyness and complexity in clinical practice 2 12 38 48 52 53 56.…”

“…Rapport and relationships have to be built throughout a visit and over time with regular repeat visits and continuity of the visitor 12 40 44 52 55 63. Visitors and clinicians find that building or established relationships enhance the interaction and educational exchange and increase the trust between them 55 62 75…”

“…A commitment or intention to change practice is a precursor to actual change in prescribing,16 41 59 in line with Theory of Planned Behaviour 32. Both were mainly self-reported via surveys of clinicians’ or visitors’ perceptions55 61 62 64 76 and often described in non-specific terms (general intention to change practice), not explicitly related to actual programme messages and intentions, or specified as a commitment to review patients, change prescribing, implement agreed actions 16 38 40 47 51 68. Repetition of key messages and follow-up on previous topics is supposed to reinforce messages, deepen learning and support change and reminds of (previous) discussions and commitments 48 59…”

Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

“…The literature shows that educational outreach has been used in a variety of healthcare settings to change professional practice. [11][12][13][14][15][16] An updated Cochrane review, which included 69 studies involving more than 15 000 health professionals, assessed the effect of educational outreach on health professional practice or patient outcomes. The authors concluded that educational outreach alone, or when combined with other interventions, had a relatively small but consistent positive effect on prescribing behaviour, but for other types of professional practice, such as providing screening tests, educational outreach provided small to moderate changes in practice, although the effects were varied.…”

“…The literature shows that educational outreach has been used in a variety of healthcare settings to change professional practice . An updated Cochrane review, which included 69 studies involving more than 15 000 health professionals, assessed the effect of educational outreach on health professional practice or patient outcomes.…”