Implementation of clinical guidelines in Brazil: should academic detailing be used?

Abstract

Objective The Brazilian National Health System provides high cost medicines through the Specialized Component of Pharmaceutical Assistance in accordance with the adherence to agreed Clinical Guidelines. However, physician compliance to these Guidelines, as well as the barriers and facilitators related to them and the influence on the subsequent quality of care provided is unknown. Consequently, the objectives of this article are to undertake a review of international experiences and scientific publications of a strategy to disseminate and communicate guidelines to physicians through Academic Detailing. Subsequently, use the findings to develop and conduct a pilot Academic Detailing Programme in Brazil targeting specialists who prescribe medicines for patients with Alzheimer's disease, which are part of the Specialized Component of Pharmaceutical Assistance. Methods Review international experiences and scientific publications relating to academic detailing based on a thorough review of available literature including publications known to the coauthors. Develop and monitor physician acceptance of academic detailing for patients with Alzheimer's disease and the impact on future prescribing. Key findings Based on the lessons learnt from the international experience and review, coupled with the initial experiences in Brazil, we conclude that conducting academic detailing to enhance the implementation and dissemination of clinical protocols and therapeutic guidelines in Brazil is worthwhile. We will be closely monitoring the outcome of the pilot academic detailing programme as a basis for developing future programmes to further improve the quality of prescribing in Brazil. Conclusions Findings from the experiences are encouraging. This will be further explored to provide a basis for this approach in the future.

Mapping of Current Obstacles for Rationalizing Use of Medicines (CORUM) in Europe: Current Situation and Potential Solutions

“…Education refers to a wide range of educational activities ranging from simple distribution of printed material to more advanced strategies such as academic detailing and educational visits by trained facilitators. Academic detailing, sometimes called educational outreach visits, typically includes a visit of a trained health professional such as a physician or pharmacist to a general practitioner in their own setting on a one-on-one basis to provide information to help change behavior (Grimshaw et al, 2004;O'Brien et al, 2007;Jin et al, 2012;Chhina et al, 2013;Costa et al, 2016). Goals can include active dissemination and discussion on agreed national or regional treatment guidelines and improving the management of targeted health conditions (Chhina et al, 2013;Godman et al, 2014d;Costa et al, 2016).…”

“…Academic detailing, sometimes called educational outreach visits, typically includes a visit of a trained health professional such as a physician or pharmacist to a general practitioner in their own setting on a one-on-one basis to provide information to help change behavior (Grimshaw et al, 2004;O'Brien et al, 2007;Jin et al, 2012;Chhina et al, 2013;Costa et al, 2016). Goals can include active dissemination and discussion on agreed national or regional treatment guidelines and improving the management of targeted health conditions (Chhina et al, 2013;Godman et al, 2014d;Costa et al, 2016). Typically academic detailing is undertaken in one or more visits and often combined with other strategies to enhance its effectiveness including audits and other feedback approaches (O'Brien et al, 2007;Gustafsson et al, 2011;Costa et al, 2016).…”

“…Goals can include active dissemination and discussion on agreed national or regional treatment guidelines and improving the management of targeted health conditions (Chhina et al, 2013;Godman et al, 2014d;Costa et al, 2016). Typically academic detailing is undertaken in one or more visits and often combined with other strategies to enhance its effectiveness including audits and other feedback approaches (O'Brien et al, 2007;Gustafsson et al, 2011;Costa et al, 2016).…”

Comparative effectiveness of adalimumab and etanercept for rheumatoid arthritis in the Brazilian Public Health System

“…Adalimumab and etanercept were included from 2006 onwards [11,12]. Access to these expensive medicines in CEAF depends on compliance with the Clinical Protocols and Therapeutic Guidelines published by the Ministry of Health; otherFor reprint orders, please contact: reprints@futuremedicine.com wise 100% patient copayment for the medicines [13]. Requests for access to these high-cost medicines are checked by each State Department of Health or those contracted to them such as the SUS Collaborating Centre -Health Technology Assessment & Excellence at the College of Pharmacy, Federal University of Minas Gerais.…”

Access to high-cost medications for psoriatic arthritis in the National Health System in Brazil: the long path up to dispensation

“…An alternative allowing such integration would be the application of the academic detailing tool, which proposes the dissemination and communication to prescribers of the norms and operating conditions of health systems. Besides, it is possible to hear the unmet needs, doubts, and questionings from the physician directly attending the patient, respecting to difficulties found for the medication request [21].…”