Technology-Enabled Academic Detailing: Computer-mediated education between pharmacists and physicians for evidence-based prescribing

BACKGROUND Academic detailing (AD) is the practice of specially trained pharmacists with detailed medication knowledge meeting with physicians to share best practices of prescribing. AD has demonstrated efficacy in positively influencing physicians' prescribing behavior. Nevertheless, a key challenge has been that physicians in rural and remote locations, or physicians who are time challenged, have limited ability to participate in face-to-face meetings with academic detailers, as these specially trained academic detailers are primarily urban-based and limited in numbers. OBJECTIVE To determine the feasibility of using information technologies to facilitate communication between academic detailers and physicians (known as Technology-Enabled Academic Detailing or TEAD) through a comparison to traditional face-to-face academic detailing (AD). Specifically, TEAD is compared to AD in terms of the ability to aid physicians in acquiring evidence-informed prescribing information on diabetes-related medications, measured in terms of time efficiency, satisfaction of both physicians and pharmacists, and quality of knowledge exchange. METHODS General Practitioner Physicians (n=105) and pharmacists (n=12) were recruited from across British Columbia. Pharmacists were trained to be academic detailers on diabetes medication usage. Physicians were assigned to one of four intervention groups to receive four academic detailing sessions from trained pharmacists. Intervention groups included: (1) AD only, (2) TEAD only, (3) TEAD crossed over to AD at midpoint, and (4) AD crossed over to TEAD at midpoint. Evaluation included physician-completed surveys before and after each session, pharmacist logs after each detailing session, interviews and focus groups with physicians and pharmacists at study completion, as well as a technical support log to record all phone calls and emails from physicians and pharmacists regarding any technical challenges during the TEAD sessions, or usage of the web portal. RESULTS Because recruitment was very low for the cross over groups, we analyzed the results in two groups instead: AD only and TEAD only. 354 sessions were conducted (AD=161, TEAD=193). Of these, complete data were available for 300 sessions, which were included in analysis (AD=133, TEAD=167). On average, TEAD sessions were 49min long, and AD sessions 81min long. Overall, physicians enjoyed both modalities of academic detailing (AD and TEAD) because they received information that both reinforced their existing diabetes knowledge and also provided new prescribing insights and approaches. CONCLUSION The results suggest that TEAD is an acceptable alternative to AD for providing physicians advice about prescribing. TEAD is more time efficient, facilitates effective knowledge exchange and interprofessional collaboration, and can reach those physicians virtually where face-to-face AD is not possible or practical. LIMITATIONS Due to logistics, physicians were allocated, rather than randomized, to receive AD and/or TEAD.

[1]  Maurice Mars,et al.  A systematic review of the effectiveness of videoconference-based tele-education for medical and nursing education. , 2012, Worldviews on evidence-based nursing.

[2]  Impact of e-detailing on the number of new prescriptions , 2010, Health care management science.

[3]  K. Squire,et al.  Design-Based Research: Putting a Stake in the Ground , 2004 .

[4]  S. Majumdar,et al.  Compliance with Clinical Practice Guidelines for Type 2 Diabetes in Rural Patients: Treatment Gaps and Opportunities for Improvement , 2003, Pharmacotherapy.

[5]  J. Avorn,et al.  Improving drug-therapy decisions through educational outreach. A randomized controlled trial of academically based "detailing". , 1983, The New England journal of medicine.

[6]  André Kushniruk,et al.  The use of conferencing technologies to support drug policy group knowledge exchange processes: An action case approach , 2011, Int. J. Medical Informatics.

[7]  A D Oxman,et al.  Educational outreach visits: effects on professional practice and health care outcomes. , 2007, The Cochrane database of systematic reviews.

[8]  J. Rodda,et al.  The use of videoconferencing to enhance interprofessional clinical education for allied health students , 2012, Journal of interprofessional care.

[9]  M. Stewart,et al.  Type 2 diabetes in family practice. Room for improvement. , 2003, Canadian family physician Medecin de famille canadien.

[10]  S B Soumerai,et al.  Principles of educational outreach ('academic detailing') to improve clinical decision making. , 1990, JAMA.

[11]  Sang-goo Lee,et al.  Application of Information Technology: A DBMS-based Medical Teleconferencing System , 2001, J. Am. Medical Informatics Assoc..

[12]  G. Hartvigsen,et al.  Telehealth at UC Davis--a 20-year experience. , 2013, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[13]  A. Taylor-Vaisey,et al.  Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines. , 1997, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[14]  M. Sheldon,et al.  Preparing rehabilitation healthcare providers in the 21st century: implementation of interprofessional education through an academic-clinical site partnership. , 2012, Work.

[15]  Stephen B. Soumerai,et al.  Improving Drug-Therapy Decisions through Educational Outreach , 1983 .

[16]  A. Wazana Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift? , 2000 .

[17]  Marie-Dominique Beaulieu,et al.  Room for improvement: patients' experiences of primary care in Quebec before major reforms. , 2007, Canadian family physician Medecin de famille canadien.

[18]  N. Barber What constitutes good prescribing? , 1995, BMJ.

[19]  Electronic detailing (e‐detailing) of pharmaceuticals to physicians: a review , 2008 .

[20]  Christina Beach Thielst At the crossroads: NRTRC white paper examines trends driving the convergence of telehealth, EHRs and HIE. , 2010, World hospitals and health services : the official journal of the International Hospital Federation.

[21]  Linda Little,et al.  E-health , 2008, BCS HCI.