The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Mark Bounthavong - One of the best experts on this subject based on the ideXlab platform.
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impact of implementing an Academic Detailing program on opioid benzodiazepine co prescribing trends at the u s department of veterans affairs
Pain Medicine, 2021Co-Authors: Mark Bounthavong, Sarah J Popish, Daina L Wells, Chad L Kay, Julianne E Himstreet, Marcos K Lau, Michael A Harvey, Andrea Grana, Blake A Freeman, Christina M MorilloAbstract:OBJECTIVES To assess the process and outcomes of Academic Detailing to enhance the Opioid Safety Initiative and the Psychotropic Drug Safety Initiative to reduce co-prescribing of opioid-benzodiazepine combinations in veterans. METHODS A retrospective cohort design was conducted to evaluate the impact of implementing an Academic Detailing program on opioid-benzodiazepine co-prescribing between October 2014 through March 2019 at the U.S. Department of Veterans Affairs (VA). The primary outcome was the monthly prevalence of veterans (number per 1,000 population) who were co-prescribed opioid-benzodiazepine combination. Process measure was evaluated using implementation reach (proportion of providers who received Academic Detailing). Station-level analysis was performed using a linear fixed effects regression model to evaluate the rate of change in the prevalence of veterans co-prescribed opioid-benzodiazepine. RESULTS Altogether 130 VA stations was included for analysis; 119 stations implemented opioid-related or benzodiazepine-related Academic Detailing, and 11 stations did not. Stations that had implemented Academic Detailing had a 33% greater monthly reduction on the opioid-benzodiazepine co-prescribing prevalence compared to stations that did not implement Academic Detailing (P = .036). In the linear fixed effects regression model, stations that were expected to have 100% of providers exposed to Academic Detailing were statistically associated with a greater decrease in the monthly prevalence of Veterans co-prescribed opioid-benzodiazepine by 4.9 veterans per 1,000 population (P < .001) compared to stations with 0% of providers exposed to Academic Detailing. CONCLUSIONS Stations that implemented Academic Detailing and had a higher proportion of providers who were exposed to opioid- or benzodiazepine-related Academic Detailing had a significant decrease in the monthly prevalence of Veterans co-prescribed opioid-benzodiazepine combinations.
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providers perceptions on barriers and facilitators to prescribing naloxone for patients at risk for opioid overdose after implementation of a national Academic Detailing program a qualitative assessment
Research in Social & Administrative Pharmacy, 2020Co-Authors: Mark Bounthavong, Melissa L D Christopher, David L Veenstra, Anirban Basu, Kangho Suh, Emily Beth DevineAbstract:Abstract Background Academic Detailing is an educational outreach program that aligns providers' prescribing with evidence-based practice. The U.S. Department of Veterans Affairs (VA) Opioid Overdose Education and Naloxone Distribution (OEND) Program partnered with the VA Pharmacy Benefits Management National Academic Detailing Service to deliver naloxone education to providers who cared for patients at risk of opioid overdose. In this pilot study, we interviewed providers’ who received Academic Detailing to capture their perceptions of facilitators and barriers to prescribing naloxone. Objective To identify providers’ perceptions of facilitators and barriers to prescribing naloxone for patients at risk for opioid overdose after implementation of a national Academic Detailing program. Methods This was a hybrid inductive-deductive qualitative pilot using semi-structured interviews with VA providers to explore constructs associated with facilitators and barriers to prescribing take-home naloxone to patients at risk for opioid overdose from August 2017 to April 2018. Results Eleven participants were interviewed, six physicians, three clinical psychiatric pharmacists, and two nurse practitioners. Participants identified patient-level barriers (social stigma and lack of homeless patient support), poor data integration, and burden of data validation as barriers to prescribing naloxone. However, they also identified patient lists, repeat visits, and face-to-face/one-on-one video conferencing visits as important facilitators for naloxone prescribing. Conclusions/importance Academic Detailing will need to address issues of social stigma regarding naloxone, educate providers about existing support systems for homeless veterans, and develop tools for data integration to improve naloxone access for veterans at risk for an opioid overdose.
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virtual Academic Detailing e Detailing a vital tool during the covid 19 pandemic
Journal of The American Pharmacists Association, 2020Co-Authors: Jonathan D Hoffman, Sarah J Popish, Daina L Wells, Ramona Shayegani, Patrick M Spoutz, Ashley D Hillman, Jason P Smith, Julianne E Himstreet, Jane M Manning, Mark BounthavongAbstract:As the coronavirus disease (COVID-19) pandemic continues its course in 2020, telehealth technology provides opportunities to connect patients and providers. Health policies have been amended to allow easy access to virtual health care, highlighting the field's dynamic ability to adapt to a public health crisis. Academic Detailing, a peer-to-peer collaborative outreach designed to improve clinical decision-making, has traditionally relied on in-person encounters for effectiveness. A growth in the adoption of telehealth technology translates to increases in Academic Detailing reach for providers unable to meet with Academic detailers in person. The U.S. Department of Veterans Affairs (VA) has used Academic Detailing to promote and reinforce evidence-based practices and has encouraged more virtual Academic Detailing (e-Detailing). Moreover, VA Academic detailers are primarily clinical pharmacy specialists who provide clinical services and education and have made meaningful contributions to improving health care at VA. Amid the COVID-19 pandemic and physical isolation orders, VA Academic detailers have continued to meet with providers to disseminate critical health care information in a timely fashion by using video-based telehealth. When working through the adoption of virtual technology for the delivery of medical care, providers may need time and nontraditional delivery of "evidence" before eliciting signals for change. Academic detailers are well suited for this role and can develop plans to help address provider discomfort surrounding the use of telehealth technology. By using e-Detailing as a method for both familiarizing and normalizing health professionals with video-based telehealth technology, pharmacists are uniquely poised to deliver consultation and direct-care services. Moreover, Academic Detailing pharmacists are ambassadors of change, serving an important role navigating the evolution of health care in response to emergent public health crises and helping define the norms of care delivery to follow.
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implementation evaluation of Academic Detailing on naloxone prescribing trends at the united states veterans health administration
Health Services Research, 2019Co-Authors: Mark Bounthavong, Melissa L D Christopher, Michael A Harvey, Emily Beth Devine, David L Veenstra, Anirban BasuAbstract:OBJECTIVE Academic Detailing in partnership with the Opioid Overdose Education and Naloxone Distribution (OEND) program was implemented to increase naloxone access for the prevention of opioid overdose mortality in veterans at the U.S. Department of Veterans Affairs (VA). However, implementation was not uniform leading to varying levels of intervention exposure potentially impacting naloxone prescribing. We examined the impact of implementation strength (proportion of providers exposed to Academic Detailing) at each station on naloxone prescribing from September 2014 to December 2017. STUDY DESIGN AND SETTING Retrospective cohort design with fixed effects models at the VA. DATA COLLECTION/EXTRACTION METHODS We used VA Corporate Data Warehouse for data on pharmacy dispensing, station-, provider- and patient-level characteristics. OEND-specific Academic Detailing activities came from data recorded by Academic detailers using Salesforce.com. PRINCIPAL FINDINGS VA stations wherein 100 percent of providers exposed to an OEND-related Academic Detailing educational outreach visit experienced an increased incident rate of naloxone prescribing that was 5.52 times the incident rate of stations where no providers were exposed; alternatively, this is equivalent to an average monthly increase of 2.60 naloxone prescriptions per 1000 population at risk for opioid overdose. CONCLUSIONS Our findings highlight the importance of Academic Detailing's implementation strength on naloxone prescribing. Decision makers must carefully consider the implementation process to achieve the greatest effectiveness from the intervention.
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clinical dashboard development and use for Academic Detailing in the u s department of veterans affairs
Journal of The American Pharmacists Association, 2019Co-Authors: Marcos K Lau, Chad L Kay, Mark Bounthavong, Michael A Harvey, Melissa L D ChristopherAbstract:Abstract Objective To describe the U.S. Department of Veterans Affairs (VA) Academic Detailing Service's (ADS) experience with the development and use of clinical dashboards across the VA's national clinical campaigns. We focused only on dashboards developed by the VA ADS national clinical program managers. Setting U.S. Department of Veterans Affairs Pharmacy Benefits Management National Academic Detailing Service. Practice description Academic Detailing is a multifaceted, educational outreach intervention that services providers through interactions with Academic detailers (at the VA, these are specially trained clinical pharmacy specialists) using evidence-based research, educational brochures, and clinical dashboards to align prescribing behavior with best practices. The VA ADS developed clinical dashboards to benchmark and monitor Academic Detailing activities and performance and to identify opportunities for redistributing resources. We used the opioid crisis as an example to highlight key steps in the development of a clinical dashboard. Evaluation Testing is an important part of clinical dashboard development. Evaluations of the users perceptions contributed to lessons learned. Results Data validation, missing data, data availability, standardization, user engagement, and technical limitations were among several challenges the VA ADS encountered during dashboard development. Stakeholder engagement, communication, and flexibility with development time allowed us to develop efficient dashboards. Conclusions Health care data and health analytics have transformed the type of clinical care that can be practiced by creating the ability to implement system-wide processes for both population management and quality improvement processes. End users of these VA ADS clinical dashboards can generate priority panel reports and data visualization of key performance indicators to identify areas for improvement or action.
Melissa L D Christopher - One of the best experts on this subject based on the ideXlab platform.
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providers perceptions on barriers and facilitators to prescribing naloxone for patients at risk for opioid overdose after implementation of a national Academic Detailing program a qualitative assessment
Research in Social & Administrative Pharmacy, 2020Co-Authors: Mark Bounthavong, Melissa L D Christopher, David L Veenstra, Anirban Basu, Kangho Suh, Emily Beth DevineAbstract:Abstract Background Academic Detailing is an educational outreach program that aligns providers' prescribing with evidence-based practice. The U.S. Department of Veterans Affairs (VA) Opioid Overdose Education and Naloxone Distribution (OEND) Program partnered with the VA Pharmacy Benefits Management National Academic Detailing Service to deliver naloxone education to providers who cared for patients at risk of opioid overdose. In this pilot study, we interviewed providers’ who received Academic Detailing to capture their perceptions of facilitators and barriers to prescribing naloxone. Objective To identify providers’ perceptions of facilitators and barriers to prescribing naloxone for patients at risk for opioid overdose after implementation of a national Academic Detailing program. Methods This was a hybrid inductive-deductive qualitative pilot using semi-structured interviews with VA providers to explore constructs associated with facilitators and barriers to prescribing take-home naloxone to patients at risk for opioid overdose from August 2017 to April 2018. Results Eleven participants were interviewed, six physicians, three clinical psychiatric pharmacists, and two nurse practitioners. Participants identified patient-level barriers (social stigma and lack of homeless patient support), poor data integration, and burden of data validation as barriers to prescribing naloxone. However, they also identified patient lists, repeat visits, and face-to-face/one-on-one video conferencing visits as important facilitators for naloxone prescribing. Conclusions/importance Academic Detailing will need to address issues of social stigma regarding naloxone, educate providers about existing support systems for homeless veterans, and develop tools for data integration to improve naloxone access for veterans at risk for an opioid overdose.
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implementation evaluation of Academic Detailing on naloxone prescribing trends at the united states veterans health administration
Health Services Research, 2019Co-Authors: Mark Bounthavong, Melissa L D Christopher, Michael A Harvey, Emily Beth Devine, David L Veenstra, Anirban BasuAbstract:OBJECTIVE Academic Detailing in partnership with the Opioid Overdose Education and Naloxone Distribution (OEND) program was implemented to increase naloxone access for the prevention of opioid overdose mortality in veterans at the U.S. Department of Veterans Affairs (VA). However, implementation was not uniform leading to varying levels of intervention exposure potentially impacting naloxone prescribing. We examined the impact of implementation strength (proportion of providers exposed to Academic Detailing) at each station on naloxone prescribing from September 2014 to December 2017. STUDY DESIGN AND SETTING Retrospective cohort design with fixed effects models at the VA. DATA COLLECTION/EXTRACTION METHODS We used VA Corporate Data Warehouse for data on pharmacy dispensing, station-, provider- and patient-level characteristics. OEND-specific Academic Detailing activities came from data recorded by Academic detailers using Salesforce.com. PRINCIPAL FINDINGS VA stations wherein 100 percent of providers exposed to an OEND-related Academic Detailing educational outreach visit experienced an increased incident rate of naloxone prescribing that was 5.52 times the incident rate of stations where no providers were exposed; alternatively, this is equivalent to an average monthly increase of 2.60 naloxone prescriptions per 1000 population at risk for opioid overdose. CONCLUSIONS Our findings highlight the importance of Academic Detailing's implementation strength on naloxone prescribing. Decision makers must carefully consider the implementation process to achieve the greatest effectiveness from the intervention.
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clinical dashboard development and use for Academic Detailing in the u s department of veterans affairs
Journal of The American Pharmacists Association, 2019Co-Authors: Marcos K Lau, Chad L Kay, Mark Bounthavong, Michael A Harvey, Melissa L D ChristopherAbstract:Abstract Objective To describe the U.S. Department of Veterans Affairs (VA) Academic Detailing Service's (ADS) experience with the development and use of clinical dashboards across the VA's national clinical campaigns. We focused only on dashboards developed by the VA ADS national clinical program managers. Setting U.S. Department of Veterans Affairs Pharmacy Benefits Management National Academic Detailing Service. Practice description Academic Detailing is a multifaceted, educational outreach intervention that services providers through interactions with Academic detailers (at the VA, these are specially trained clinical pharmacy specialists) using evidence-based research, educational brochures, and clinical dashboards to align prescribing behavior with best practices. The VA ADS developed clinical dashboards to benchmark and monitor Academic Detailing activities and performance and to identify opportunities for redistributing resources. We used the opioid crisis as an example to highlight key steps in the development of a clinical dashboard. Evaluation Testing is an important part of clinical dashboard development. Evaluations of the users perceptions contributed to lessons learned. Results Data validation, missing data, data availability, standardization, user engagement, and technical limitations were among several challenges the VA ADS encountered during dashboard development. Stakeholder engagement, communication, and flexibility with development time allowed us to develop efficient dashboards. Conclusions Health care data and health analytics have transformed the type of clinical care that can be practiced by creating the ability to implement system-wide processes for both population management and quality improvement processes. End users of these VA ADS clinical dashboards can generate priority panel reports and data visualization of key performance indicators to identify areas for improvement or action.
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Academic Detailing to improve opioid safety implementation lessons from a qualitative evaluation
Pain Medicine, 2018Co-Authors: Amanda M Midboe, Melissa L D Christopher, Mark Bounthavong, Taryn Erhardt, Jannet M Carmichael, Randall C GaleAbstract:Objective Academic Detailing (AD) is a promising intervention to address the growing morbidity and mortality associated with opioids. While AD has been shown to be effective in improving provider prescribing practices across a range of conditions, it is unclear how best to implement AD. The present study was designed to identify key lessons for implementation based on a model AD program in the Veterans Health Administration (VA). Design Qualitative process evaluation using semistructured interviews. Setting Seven VA health care systems in the Sierra Pacific region. Subjects Current and former Academic detailers (N = 10) and VA providers with varying exposure to AD (high, low, or no; N = 20). Methods Semistructured interviews were audio-recorded and transcribed. We used a team-based, mixed inductive and deductive approach guided by the Consolidated Framework for Implementation Research. Results Key lessons identified by Academic detailers and providers coalesced around key themes: 1) one-on-one sessions customized to the provider's patient population are most useful; 2) leadership plays a critical role in supporting providers' participation in AD programs; 3) tracking Academic detailer and provider performance is important for improving performance for both groups; 4) Academic detailers play a key role in motivating provider behavior change and thus training in Motivational Interviewing is highly valuable; and 5) Academic detailers noted that networking is important for sharing implementation strategies and resources. Conclusions Identifying and incorporating these key lessons into the implementation of complex interventions like AD are critical to facilitating uptake of evidence-based interventions addressing the opioid epidemic.
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multifaceted Academic Detailing program to increase pharmacotherapy for alcohol use disorder interrupted time series evaluation of effectiveness
Addiction Science & Clinical Practice, 2016Co-Authors: Alex H S Harris, Thomas Bowe, Hildi J Hagedorn, Andrea Nevedal, Andrea K Finlay, Risha Gidwani, Craig S Rosen, Melissa L D ChristopherAbstract:Background Active consideration of effective medications to treat alcohol use disorder (AUD) is a consensus standard of care, yet knowledge and use of these medications are very low across diverse settings. This study evaluated the overall effectiveness a multifaceted Academic Detailing program to address this persistent quality problem in the US Veterans Health Administration (VHA), as well as the context and process factors that explained variation in effectiveness across sites.
Stephen B Soumerai - One of the best experts on this subject based on the ideXlab platform.
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economic analysis of a randomized trial of Academic Detailing interventions to improve use of antihypertensive medications
Journal of Clinical Hypertension, 2007Co-Authors: S Simon, Stephen B Soumerai, Hector P Rodriguez, Sumit R Majumdar, Ken Kleinman, Cheryl Warner, Susanne Salemschatz, Irina Miroshnik, Lisa A ProsserAbstract:The authors estimated the costs and cost savings of implementing a program of mailed practice guidelines and single-visit individual and group Academic Detailing interventions in a randomized controlled trial to improve the use of antihypertensive medications. Analyses took the perspective of the payer. The total costs of the mailed guideline, group Detailing, and individual Detailing interventions were estimated at $1000, $5500, and $7200, respectively, corresponding to changes in the average daily per person drug costs of –$0.0558 (95% confidence interval, –$0.1365 to $0.0250) in the individual Detailing intervention and –$0.0001 (95% confidence interval, –$0.0803 to $0.0801) in the group Detailing intervention, compared with the mailed intervention. For all patients with incident hypertension in the individual Detailing arm, the annual total drug cost savings were estimated at $21,711 (95% confidence interval, $53,131 savings to $9709 cost increase). Information on costs of Academic Detailing could assist with health plan decision making in developing interventions to improve prescribing.
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computerized prescribing alerts and group Academic Detailing to reduce the use of potentially inappropriate medications in older people
Journal of the American Geriatrics Society, 2006Co-Authors: S Simon, Richard Platt, David H Smith, Adrianne C Feldstein, Nancy Perrin, Xiuhai Yang, Yvonne Zhou, Stephen B SoumeraiAbstract:OBJECTIVES: To examine the effect of replacing drugspecific computerized prescribing alerts with age-specific alerts on rates of dispensing potentially inappropriate medications in older people and to determine whether group Academic Detailing enhances the effectiveness of these alerts. DESIGN: Cluster-randomized trial of group Academic Detailing and interrupted time-series analysis. SETTING: Fifteen clinics of a staff-model health maintenance organization. PARTICIPANTS: Seven practices (113 clinicians, 24,119 patients) were randomly assigned to receive age-specific prescribing alerts plus the Academic Detailing intervention; eight practices (126 clinicians, 26,805 patients) received alerts alone. Prior implementation of drug-specific alerts established a downward trend in use of target medications that served as the baseline trend for the present study. INTERVENTION: The computerized age-specific alerts occurred at the time of prescribing a targeted potentially inappropriate medication (e.g., tertiary tricyclic amine antidepressants, long-acting benzodiazepines, propoxyphene) and suggested an alternative medication. Clinicians at seven sites were randomized to group Academic Detailing, an interactive educational program delivering evidence-based information. MEASUREMENTS: Number of target medications dispensed per 10,000 patients per quarter, 2 years before and 1.5 years after the replacement of drug-specific with agespecific alerts. RESULTS: Age-specific alerts resulted in a continuation of the effects of the drug-specific alerts without measurable additional effect (P 5.75 for level change), but the agespecific alerts led to fewer false-positive alerts for clinicians. Group Academic Detailing did not enhance the effect of the alerts. CONCLUSION: Age-specific alerts sustained the effectiveness of drug-specific alerts to reduce potentially inappropriate prescribing in older people and resulted in a considerably decreased burden of the alerts. J Am Geriatr Soc 54:963–968, 2006.
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group versus individual Academic Detailing to improve the use of antihypertensive medications in primary care a cluster randomized controlled trial
The American Journal of Medicine, 2005Co-Authors: S Simon, Sumit R Majumdar, Ken Kleinman, Cheryl Warner, Susanne Salemschatz, Irina Miroshnik, Lisa A Prosser, Stephen B SoumeraiAbstract:Purpose To compare group versus individual Academic Detailing to increase diuretic or β-blocker use in hypertension. Methods We conducted a cluster-randomized controlled trial in a large health maintenance organization. Subjects (N=9820) were patients with newly treated hypertension in the year preceding the intervention (N=3692), the 9 months following the intervention (N=3556), and the second year following intervention (N=2572). We randomly allocated 3 practice sites to group Detailing (N=227 prescribers), 3 to individual Detailing (N=235 prescribers), and 3 to usual care (N=319 prescribers). Individual Detailing entailed a physician-educator meeting individually with clinicians to address barriers to prescribing guideline-recommended medications. The group Detailing intervention incorporated the same social marketing principles in small groups of clinicians. Results In the first year following the intervention, the rates of diuretic or β-blocker use increased by 13.2% in the group Detailing practices, 12.5% in the individual Detailing practices, and 6.2% in the usual care practices. As compared with usual care practices, diuretic or β-blocker use was more likely in group Detailing practices (adjusted odds ratio (OR), 1.40; 95% confidence interval (CI), 1.11 – 1.76) and individual Detailing practices (adjusted OR, 1.30; 95% CI, 0.95 – 1.79). Neither intervention affected blood pressure control. Two years following this single-visit intervention, there was still a trend suggesting a persistent effect of individual (OR, 1.22; 95% CI, 0.92 – 1.62), but not group, Detailing (OR, 1.06; 95% CI, 0.80 – 1.39), as compared with usual care. Conclusion Both group and individual Academic Detailing improved antihypertensive prescribing over and above usual care but may require reinforcement to sustain improvements.
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principles and uses of Academic Detailing to improve the management of psychiatric disorders
International Journal of Psychiatry in Medicine, 1998Co-Authors: Stephen B SoumeraiAbstract:Objective: The purpose of this article is to discuss the principles of Academic Detailing, or educational outreach, in primary care and review the evidence of its effectiveness in, and potential for improving, mental health care. Methods: The general educational researcl literature on improving physician performance was reviewed along with studies that were designed to test Academic Detailing. Four rigorous studies have tested this approach specifically on mental health care. These studies are reviewed in detail. Results: Measuring pre-intervention performance to target those with increased educational needs and identifying barriers to change are associated with substantially improved program effectiveness. To change strongly held beliefs or to overcome patient demands, person-to-person contact with credible experts who provide structured alternatives is necessary. Brief reinforcement visits increase success rates and targeting programs to physicians at greatest need improves the cost effectiveness of educational interventions. Conclusions: Academic Detailing is one of the few educational interventions that has consistently demonstrated improved physician performance. Educational outreach methods to improve mental health practices in primary care are in need of much additional research. Improving the detection of mental disorders and underuse of mental health treatment may prove to be more difficult than reducing the overuse of unnecessary medications.
Elyse R Park - One of the best experts on this subject based on the ideXlab platform.
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an Academic Detailing intervention to disseminate physician delivered smoking cessation counseling smoking cessation outcomes of the physicians counseling smokers project
Preventive Medicine, 2003Co-Authors: Michael G Goldstein, Raymond Niaura, Cynthia Willey, Alessandra Kazura, William Rakowski, Judith D Depue, Elyse R ParkAbstract:Abstract Background Little is known about the effectiveness of interventions to disseminate smoking cessation interventions among a population of primary care physicians. This study’s objective was to determine the effect of a community-based Academic Detailing intervention on the quit rates of a population-based sample of smokers. Methods This community-based, quasi-experimental study involved representative samples of 259 primary care physicians and 4295 adult smokers. An Academic Detailing intervention was delivered to physicians in intervention areas over a period of 15 months. Analyses were performed on the data from the 2346 subjects who reported at least one physician visit over 24 months. Multivariate regression analyses were conducted to determine the impact of the intervention on self-reported smoking quit rates, reported by adjusted odds ratios. Results Among smokers reporting a physician visit during the study period, there was a borderline significant effect for those residing in intervention areas versus control areas (OR = 1.35; 95% CI .99–1.83; P = 0.057). Among a subgroup of 819 smokers who reported a visit with an enrolled physician, we observed a significant effect for those residing in intervention areas (OR = 1.80; 95% CI 1.16–2.75; P = 0.008). Conclusion An Academic Detailing intervention to enhance physician delivered smoking cessation counseling is an effective strategy for disseminating smoking cessation interventions among community-based practices.
S Simon - One of the best experts on this subject based on the ideXlab platform.
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Academic Detailing to improve laboratory testing among outpatient medication users
Medical Care, 2007Co-Authors: Jennifer Elston Lafata, Margaret J Gunter, John Hsu, Scott Kaatz, Richard Krajenta, Richard Platt, Lonni Schultz, Joseph V Selby, S Simon, Jan SimpkinsAbstract:Purpose:To determine whether group Academic Detailing with performance feedback increases recommended laboratory monitoring among outpatients dispensed medications.Methods:Thirty-eight primary care practices in 3 states were randomized to group Academic Detailing with physician-level performance fee
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economic analysis of a randomized trial of Academic Detailing interventions to improve use of antihypertensive medications
Journal of Clinical Hypertension, 2007Co-Authors: S Simon, Stephen B Soumerai, Hector P Rodriguez, Sumit R Majumdar, Ken Kleinman, Cheryl Warner, Susanne Salemschatz, Irina Miroshnik, Lisa A ProsserAbstract:The authors estimated the costs and cost savings of implementing a program of mailed practice guidelines and single-visit individual and group Academic Detailing interventions in a randomized controlled trial to improve the use of antihypertensive medications. Analyses took the perspective of the payer. The total costs of the mailed guideline, group Detailing, and individual Detailing interventions were estimated at $1000, $5500, and $7200, respectively, corresponding to changes in the average daily per person drug costs of –$0.0558 (95% confidence interval, –$0.1365 to $0.0250) in the individual Detailing intervention and –$0.0001 (95% confidence interval, –$0.0803 to $0.0801) in the group Detailing intervention, compared with the mailed intervention. For all patients with incident hypertension in the individual Detailing arm, the annual total drug cost savings were estimated at $21,711 (95% confidence interval, $53,131 savings to $9709 cost increase). Information on costs of Academic Detailing could assist with health plan decision making in developing interventions to improve prescribing.
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computerized prescribing alerts and group Academic Detailing to reduce the use of potentially inappropriate medications in older people
Journal of the American Geriatrics Society, 2006Co-Authors: S Simon, Richard Platt, David H Smith, Adrianne C Feldstein, Nancy Perrin, Xiuhai Yang, Yvonne Zhou, Stephen B SoumeraiAbstract:OBJECTIVES: To examine the effect of replacing drugspecific computerized prescribing alerts with age-specific alerts on rates of dispensing potentially inappropriate medications in older people and to determine whether group Academic Detailing enhances the effectiveness of these alerts. DESIGN: Cluster-randomized trial of group Academic Detailing and interrupted time-series analysis. SETTING: Fifteen clinics of a staff-model health maintenance organization. PARTICIPANTS: Seven practices (113 clinicians, 24,119 patients) were randomly assigned to receive age-specific prescribing alerts plus the Academic Detailing intervention; eight practices (126 clinicians, 26,805 patients) received alerts alone. Prior implementation of drug-specific alerts established a downward trend in use of target medications that served as the baseline trend for the present study. INTERVENTION: The computerized age-specific alerts occurred at the time of prescribing a targeted potentially inappropriate medication (e.g., tertiary tricyclic amine antidepressants, long-acting benzodiazepines, propoxyphene) and suggested an alternative medication. Clinicians at seven sites were randomized to group Academic Detailing, an interactive educational program delivering evidence-based information. MEASUREMENTS: Number of target medications dispensed per 10,000 patients per quarter, 2 years before and 1.5 years after the replacement of drug-specific with agespecific alerts. RESULTS: Age-specific alerts resulted in a continuation of the effects of the drug-specific alerts without measurable additional effect (P 5.75 for level change), but the agespecific alerts led to fewer false-positive alerts for clinicians. Group Academic Detailing did not enhance the effect of the alerts. CONCLUSION: Age-specific alerts sustained the effectiveness of drug-specific alerts to reduce potentially inappropriate prescribing in older people and resulted in a considerably decreased burden of the alerts. J Am Geriatr Soc 54:963–968, 2006.
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group versus individual Academic Detailing to improve the use of antihypertensive medications in primary care a cluster randomized controlled trial
The American Journal of Medicine, 2005Co-Authors: S Simon, Sumit R Majumdar, Ken Kleinman, Cheryl Warner, Susanne Salemschatz, Irina Miroshnik, Lisa A Prosser, Stephen B SoumeraiAbstract:Purpose To compare group versus individual Academic Detailing to increase diuretic or β-blocker use in hypertension. Methods We conducted a cluster-randomized controlled trial in a large health maintenance organization. Subjects (N=9820) were patients with newly treated hypertension in the year preceding the intervention (N=3692), the 9 months following the intervention (N=3556), and the second year following intervention (N=2572). We randomly allocated 3 practice sites to group Detailing (N=227 prescribers), 3 to individual Detailing (N=235 prescribers), and 3 to usual care (N=319 prescribers). Individual Detailing entailed a physician-educator meeting individually with clinicians to address barriers to prescribing guideline-recommended medications. The group Detailing intervention incorporated the same social marketing principles in small groups of clinicians. Results In the first year following the intervention, the rates of diuretic or β-blocker use increased by 13.2% in the group Detailing practices, 12.5% in the individual Detailing practices, and 6.2% in the usual care practices. As compared with usual care practices, diuretic or β-blocker use was more likely in group Detailing practices (adjusted odds ratio (OR), 1.40; 95% confidence interval (CI), 1.11 – 1.76) and individual Detailing practices (adjusted OR, 1.30; 95% CI, 0.95 – 1.79). Neither intervention affected blood pressure control. Two years following this single-visit intervention, there was still a trend suggesting a persistent effect of individual (OR, 1.22; 95% CI, 0.92 – 1.62), but not group, Detailing (OR, 1.06; 95% CI, 0.80 – 1.39), as compared with usual care. Conclusion Both group and individual Academic Detailing improved antihypertensive prescribing over and above usual care but may require reinforcement to sustain improvements.
